As medicine is always advancing, there are now many different ways, or “approaches”, to perform hip replacement surgery. The approach that would best suit you depends on the nature of your condition or injury. A specialist orthopaedic surgeon will be able to discuss your options with you. However, certain approaches are becoming more popular as patients experience less pain, less muscle damage and faster recovery times.
Do you need a hip replacement?
Surgery to replace the total hip joint is common and largely low risk, with approximately 60,000 operations performed each year in the UK, according to National Joint Registry.
It may be that you have explored non-surgical options to relieve pain in your hip but they have not helped, or only partly helped and you are now considering a total hip replacement.
Read more: What to know when considering a hip replacement
Continue reading as we look in more detail at the various approaches of hip replacement surgery, in Part 1 of a 3 part series this month on hip replacement.
(1) Posterior approach
The posterior approach to hip replacement involves the surgeon accessing the hip joint from the back.
Also, known as a Moore or Southern approach, this method has historically been the most commonly used procedure as it provides the surgeon with excellent access to the acetabulum.
The gluteus maximus muscle (buttock) is split during surgery, with an incision usually between 4-6 inches, although in it can be 10-12 inches, particularly if you are overweight, or have had previous surgery.
With this method there is minimal contact with with the gluteus medius and gluteus minimus muscles, which are used when the leg makes an outward movement.
However, in performing the posterior approach, the piriformis muscles and superior gemeli muscles (2 of 4 of the short external rotator tendons in the hip), are cut away from the femur and later reattached to the bone. This typically takes 4-6 weeks to heal.
(2) Lateral approach
Also known as the Hardinge or Liverpool approach, a lateral hip replacement also accesses the hip from the back.
The gluteus medium and gluteus minimus muscles are elevated, not cut, to give the surgeon access to the joint. This is possible via the inter-muscular interval between the gluteus medius and the tensor fasciae latae (TFL).
After the access is gained, the surgeon will dislocate the hip joint to expose the femur and acetabular socket. From here, the prosthesis hip implants can be inserted.
There is no cutting of the muscle involved with the lateral approach. However, recovery times can be similar to the posterior approach, as it is still a highly invasive surgery.
(3) Anterolateral approach
Also known as the Watson Jones approach, this method of hip replacement requires about one third of the gluteus medius to be detached from the femur and later re-attached.
(4) Direct Superior approach (DSA)
This approach is similar to the posterior approach, however the cutting of the rotator muscles is not required. Also, the joint is not dislocated.
The DAA approach was developed to protect the Iliotibial (IT) band and other key muscles, and therefore speed up recovery times.
Typically, the incision will be 3-6 inches, resulting in a smaller scar.
It is a fairly new method of hip replacement. During surgery, the DAA can be extended to the posterior approach if the surgeon discovers they need greater access the pelvis or femur.
(5) Direct Anterior approach (DAA)
Unlike most other hip replacement procedures, the Direct Anterior approach, also known as the Smith-Peterson approach, accesses the hip joint from the front.
This procedure is popular in the US and Europe but the UK medical system is still in the process of recognising it’s benefits.
Carrothers Orthopaedics& Norrish offer the Direct Anterior approach to hip replacement, for suitable patients. We also use the very latest laser technology to ensure the implants are in the perfect position.
The incision is made in the front of your upper thigh, whilst you lie on your back. The incision is likely to be 4-6 inches, but it could be larger if you are overweight, or have had previous surgery.
This procedure is entirely muscle sparing, in so much that the muscles are not detached from the femur. Instead the surgeon works between the muscles to insert the implants.
This is a technically challenging procedure, which requires an experienced hip surgeon to operate. A special surgical table is required to ensure the patient is in the exact right position.
Keep an eye on our blog for Part 2 this month:
Posterior versus Direct Anterior approach
(6) Minimally invasive hip replacement
It is possible to conduct hip replacement with minimally invasive techniques, using incisions of just 2.5 inches.
Typically, technology assists the surgeons with visualisation of the joint, through computer assisted guidance systems.
It is quite remarkable what can be achieved with regards to reducing and often eliminating your hip pain.
If you are considering hip replacement surgery, book a consultation with a specialist that can help you decide the best approach for your condition or situation.
