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Anterior Approach Adelaide

The Anterior Approach for Hip Replacement – Is it right for you?

A total hip replacement is required after exhausting all non operative measures. These include the use of walking aids such as walking sticks, activity modification, and medications. In general, your general practitioner will go through modalities to help you manage pain due to arthritis. Hip pain can also be caused by other areas of the body, such as the lower back, and knees, as well as intra-abdominal problems – so getting a screening Xray is usually required prior to seeing a specialist.

Modalities to help manage the pain include:

– Non steroidal anti-inflammatories: E.g. Voltaren, Nurofen, Mobic, Celebrex.

– Panadol Osteo

– Glucosamine and Fish Oil

– Walking stick

Once the pain starts to go beyond these modalities, and you are requiring stronger pain medications, such as Tramadol, Oxycodone, Panadeine Forte or pain patches, you should seek further advice from an Orthopaedic Surgeon. The best way to decide if you need to see one, is to discuss your treatment with your GP and see if anything can be done to optimise your non-operative care. Sometimes, even the best medications and treatments cannot stop the progression of arthritic disease. Arthritis is a multifactorial disease, meaning that in most cases, we do not know why some people develop arthritis whilst others don’t. The following is a list of potential causes of osteoarthritis that are known:

– Post traumatic osteoarthritis (i.e. after a fracture in the hip joint or a hip joint dislocation)

– Femoroacetabular impingement that has been undiagnosed

– Avascular necrosis (Death of the femoral head due to compromised blood supply)

– Familial (Often osteoarthritis runs in families)

Once you have been diagnosed with arthritis of your hip joint, and you have had your management of the pain optimised, you will know when you require a total hip replacement as the pain and restriction in range of movement will worsen. The common questions asked to determine your functional loss include:

– How far can you walk?

– Can you put your own shoes and socks on?

– Can you get in and out of a car?

– Do you have night pain?

– Does the pain radiate anywhere (Groin, Buttock, Knee)

All of these questions indicate how bad your hip arthritis is. When your symptoms do not match, or if the X-rays, Physical Examination and History of your injury indicate that there is something else going on, more tests may be required to determine where the pain is originating from. In some cases, an injection may be performed into the hip joint, which will best indicate where the pain is coming from.

Hip Replacement Surgery via the Direct Anterior Approach

The direct anterior approach is an approach that has been used for total hip replacement surgery for 30+ years. It is now a refined procedure used to decrease some of the potential complications from other methods of performing surgery. The proposed benefits of the surgery include:

– Accurate positioning of components (Including the use of Xray to check)

– Lower dislocation risk: as muscles are not detached from the bone

– Lower blood loss: due to less muscle damage

– Less post operative pain

These factors are anecdotal evidence from the experience of Dr Chien-Wen Liew, who is an experienced hip surgeon who has trained in all common hip replacement approaches (Anterior, Posterior, and Lateral). In general, surgeons who perform hip replacement surgery via any method will obtain a satisfactory result in the long term, and research shows that the pain relief after hip replacement surgery at 2 years is no different between any approach.

Deciding on your approach should be left to your surgeon. The best approach is one which your surgeon is familiar with. Dr Chien-Wen Liew performs the direct anterior approach on almost all patients requiring total hip replacements. He is confident that the direct anterior approach is a suitable approach for almost all patients requiring primary hip replacement surgery. In all cases, it is best to discuss with your surgeon whether or not the approach is suitable for you. In some cases, the direct anterior approach is not the preferred option. This includes:

– Hips that are chronically dislocated.

– Congenital malformations requiring extensive work on the shaft of the femur

– Joints that have previous metalwork placed in via alternative approaches to the hip (i.e. previous posterior acetabular plating)

If you require a total hip replacement, it is best to obtain as much information from your surgeon prior to having your surgery performed, to ensure that you are getting the right operation for your joint.

Thankyou for visiting this website. Please note that the information held within this site and on this page are for educational purposes only. Please consult your doctor or health professional always prior to considering any medical therapy or intervention. If you notice an error on this site, please use our contact form to let us know so we can rectify any issues. All information and graphics on this site are the property of Sempire Designs. 

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