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By Leslie A. Whitlinger
For the more than 300,000 people who will need a new hip this year, there’s good news: A recent study found that a less invasive—but less common—approach to total hip replacement performs just as well as traditional surgery, regardless of age or weight.
The procedure is the anterior hip replacement, so called because it approaches its target from the front of the hip rather than the back (posterior). That difference means that the gluteus muscles—the most important for hip function—are not cut to reach the hip and thigh bones during replacement. Instead, the orthopaedic surgeon manipulates the muscles and moves them out of the way.
The study, conducted by Mark Zawadsky, MD, and his colleagues at MedStar Georgetown University Hospital and Georgetown University School of Medicine, evaluated the rates of complications and short-term outcomes after anterior hip replacement among 210 patients ranging in weight from normal to obese. Published in the March 2015 Journal of Arthroplasty, the findings confirmed what Dr. Zawadsky, who performs the specialized procedure almost exclusively, has experienced: Patients undergoing the frontal approach have shorter hospital stays, less pain and a faster recovery.
That was reason enough for 71-year-old William “Bill” Droms, finance professor emeritus at Georgetown University’s School of Business, who first heard about the anterior approach and its benefits from a golf partner.
“I’m all too familiar with joint surgeries,” says Bill, who underwent knee surgery for a torn quadriceps tendon in 2007 and a total knee replacement this past April with John Klimkiewicz, MD, a colleague of Dr. Zawadsky’s at MedStar Georgetown. “So when Dr. Klimkiewicz recommended the anterior approach as well, that was all I needed to know.”
Most traditional hip replacement surgeries require a recovery period of six to eight weeks to allow the severed tissues to heal and strengthen so they can support the repaired joint. In the interim, patients have strict limitations on bending and performing certain other movements that put too much stress or weight on the hip. The big fear is dislocation, in which the top of the thigh bone pops out of the hip socket, putting the patient back in the hospital. Patients must use a walker for about four weeks, then a cane until the new joint can safely bear weight.
In comparison, most anterior hip replacement patients graduate to a cane within a few days of their operation. Beyond that, restrictions are few: Avoid crossing the legs into a figure four position for a few weeks, and if a movement hurts, don’t do it. The risk of dislocation is also diminished. Complication rates are low with both procedures, but the complication is 10 times less likely to occur following the frontal approach.
Bill’s experience went exactly as expected.
“It was a very easy recuperation,” he says. “My incision and muscles were a little sore but that was it. Only four days after my surgery, I actually attended a friend’s 70th birthday!”
Currently, only about 30 percent of hip surgeons nationwide offer the anterior approach, says Dr. Zawadsky, who has performed the newer technique on about 500 patients to date. That is a significant jump from the 5 percent performing the procedure only four years ago when he first adopted the anterior approach.
“While it’s easier on the patient, it’s more demanding for the surgeon, requiring a lot of training,” Dr. Zawadsky explains. “About the only time I don’t do the anterior approach anymore is when a patient needs a revision—a repair on a previous hip replacement,” he adds.
The procedure accounts for slightly more than 50 percent of MedStar Georgetown’s total hip replacements today.
“With the anterior approach, it’s just not that traumatic,” Bill concludes. “I see no reason why anyone would choose traditional surgery if they have the choice.”
