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Total Hip Replacement performed via the Direct Anterior Approach

Deciding on whether to have a Total Hip Replacement can be a daunting task. There are many choices which allow patients to decide what method of Total Hip Replacement they would like. One of the benefits of the modern age, are that patients can now read about the various methods, however, often this can lead to more confusion. The first and best method for determining your choice of Hip Replacement, Hip Surgeon, Approach and Method is by speaking to as many people as you can. This means talking to your friends, family, general practitioner, physiotherapist and ultimately the surgeon.

A Total Hip Replacement can be inserted in a variety of ways. Since the start of modern medicine, orthopaedic surgeons have been refining the way that Total Hip Replacement surgery is performed, in an attempt to try to decrease the amount of soft tissue damage and improve the alignment and accuracy when performing surgery. Currently, the main method of hip insertion in Adelaide is using what is called the “Posterior Approach”.

Posterior Approach

The Posterior approach is the most widely used approach in Adelaide. It involves a skin incision down the side of the leg, often curving back towards the buttock. To gain exposure to the hip, the Gluteus Maximus is usually split, and then 4 of the muscles attaching to the back of the bone of the hip joint are reflected (cut away from bone) to dislocate the hip in order to see the hip joint. This is the preferred approach for more complex surgery as it gives more visibility down the femoral shaft as the muscles are not in the way.

In more recent times, there has been a large push towards minimally invasive surgery. This surgery implies that muscles and soft tissue are respected, with a focus on decreasing the amount of damage that may occur during surgery. This has been theorised to result in faster rehabilitation, quicker return to function, less pain, and improved outcomes. As in all medical fields, there are pros and cons of every method. Each surgeon will generally advocate for the method that produces the best results in their own series, or with their experience and training.

Anterior Approach

The Direct Anterior Approach for total hip replacement surgery is not widely used in Adelaide as yet, however it is becoming more popular. It involves an incision on the front of the leg, rather than the side. The main difference between the anterior and the posterior approach are that the muscles are not detached from the bone during the anterior approach. They are left in place. This is generally considered more technically demanding, but can result in excellent results due to the minimally invasive nature.

Hip surgery has evolved over the last 2 decades, and more surgery can now be performed without requiring large cuts on the skin, hip dislocations, or cutting of the bones (Osteotomy). Today, options such as Hip Arthroscopy (Key hole surgery), and muscle sparing approaches are paving the way for outcomes that match todays rigorous demands.

What does Dr Liew perform?

Dr Liew chooses to perform the Direct Anterior Approach for all of his Total Hip Replacement surgery. To date, he has performed 99% of his hip replacements via this method. He uses a custom made traction table, designed to be used only for hip replacement surgery of this method, that was purpose built and refined over the last 30 years. This table enables accurate positioning of the leg during surgery, and decreases the amount of “touching” during surgery. The theory is that this may decrease the risk of infection, and allow a more elegant procedure.

One of the differences of surgery performed using the direct anterior approach is that Xray can be used during surgery with ease. The table is made from a carbon fibre structure making X-rays quick and easy. This allows minor adjustments to be made during surgery and provides immediate visualisation of exactly where the implant is situated within the bone – something that cannot be obtained by looking at the prosthesis alone. This aids in the accurate placement of the final implant, and gives another check to leg length measurements.

There are other hip approaches being performed, however they are less common than the above methods. It is recommended that patients seek a surgeon who they know performs a particular approach that they would like, as the best approach is the one that is performed regularly, by a skilled surgeon. Current research shows that at 2 years, there is little difference separating the satisfaction of a total hip replacement from any approach.

To discuss the management of hip replacements further, please contact the office of Dr Liew on (08) 7099 0188 during business hours.

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