Following on from last week’s article regarding approaches to hip replacement, we now take a look in more detail at two different hip replacement approaches.The Posterior approach is the most commonly executed hip replacement surgery in the UK, accessing the joint from the back. The Direct Anterior approach (DAA) is less common with the surgeon accessing the joint from the front. DAA is becoming more widely recognised for it’s shorter recovery times and muscle preservation.
Hip replacement approaches
When it comes to taking the decision to proceed with a total hip replacement, you are going to want to ensure you understand all options available to you.
As with most things related to your health, hip surgery isn’t a case of “one size fits all”.
There are various methods that surgeons use to replace a hip joint. Which one may depend on a number of factors relevant to your unique situation.
Read our Part 1 article which details various approaches to hip replacement, to familiarise yourself with the main options.
Continue reading as we look in more detail at the Posterior and Direct Anterior approaches to hip replacement in Part 2 of a 3 part series this month on hip replacement.
Posterior approach
Method:
When the surgeon decides to operate with a posterior approach, you will lie on your side during the surgery.
An incision is made below the buttocks, to allow access to the hip joint. This incision is likely to be 4-6 inches, although there is a chance it may be bigger if you carry excess weight or have an unusual anatomy.
In this procedure, the gluteus maximus muscle is split and two of the external rotator tendons in the hip also need to be cut to allow access to the hip joint. The surgeon will ensure the muscle is preserved as best as possible during the process and will later reattach the tendons to the bone, which does take some time to heal.
The typical length of surgery is 60-90 minutes, but many vary.
Benefits of posterior approach:
There are several benefits associated with the posterior hip replacement approach:
- It is the most common approach because it offers excellent visibility of the acetabulum (hip joint)
- There is only a one percent risk of nerve injury
- There is no risk of damage to the lateral femoral cutaneous nerve
- And only a very small risk to the sciatic nerve
- Due to excellent exposure of the hip joint, there is a low risk of fracture
- It is suitable for the majority of patients
- The surgery is widely performed in the UK as it is the simplest approach
Recovery:
Following a posterior hip replacement, you will need to stay in hospital for 2-3 days to recover.
It is normal to be able to return to:
- sedentary work within 2-6 weeks
- physical work within 3 months
- gentle physical activity within 6 weeks
- vigorous sports within 3 months
Sum up:
The posterior approach has been used successfully as the main approach to hip replacement due to it’s patient safety and ease of surgery. Recovery time is needed because tendons do need to be cut, reattached and have time to heal.
Direct Anterior approach (DAA)
Method:
The DAA approaches the hip from the front, so during the procedure you will lie on your back.
Like the posterior approach, the incision is typically around 4-6 inches but is made in the upper thigh.
Muscles are not detached from the femur like in other hip replacement approaches, instead the surgeon creates a gap between the muscles in which to access the joint.
There is a higher risk of injuring the lateral femoral cutaneous nerve in the thigh.
The new hip implants are then inserted, their accuracy determined by laser technology to ensure they are in the perfect position.
The typical length of surgery is 2-3 hours, but many vary.
Benefits of Direct Anterior Approach:
There are several benefits associated with DAA:
- Muscle sparing procedure which means less interference during the surgery
- Less muscles interference leads to faster recovery times
- Minimally invasive surgery technique
Other Considerations of DAA:
- This procedure is recognised in the US and Europe as having clear benefits over other approaches, but the UK medical system is still catching up
- This is a technically challenging procedure, which requires an experienced hip surgeon to perform.
- A special surgical table is required to ensure you are in the exact right position during surgery
- It may not be the solution for all patients
Recovery:
Following a direct anterior hip replacement, you will need to stay in hospital for typically 1-2 days.
It is normal to be able to return to:
- sedentary work within 1-2 weeks
- physical work within 1-3 months
- gentle physical activity within 1 month
- vigorous sports within 3 months
Sum up:
The DAA is worth discussing with your orthopaedic surgeon to see if this type of hip replacement would suit your case. Not all orthopaedic consultants are able to offer DAA, as the technique is specialist. Shorter recovery times, due to the muscle sparing technique used is what makes this a viable option for some patients, particularly those that want to get back to normal activities in a shorter timeframe.
Keep an eye on our blog for Part 3 this month:
What to expect after a total hip replacement?
