What is anterior hip replacement?

My name is Ryan Bauman.  I'm a joint replacement surgeon here in Dayton, Ohio, and I specialize in both hip and knee replacement.  Often times when patients come to my office they want to know what this newer kind of hip replacement is, the so-called anterior hip replacement.  It's actually not a new procedure, but it's something we've rediscovered in recent years as patients want to get back to their prior level of activity faster.  The anterior hip replacement is different from the other approaches in that you don't have to cut any muscle in order to do the surgery; so there's, theoretically, less pain.  And also, one of the things that cause a lot of fear and anxiety after hip replacement is the fear of dislocation or the ball coming out of the socket. With this approach, since you aren't cutting muscle, the dislocation rate should be lower. And for patients, lowering their anxiety level is very important. What we've seen as we do this more often is that patients recovery is about half as long, they're staying in the hospital about half as long, and they're requiring less pain medicine. So for all those reasons, that's become a very attractive option for patients that need hip replacement surgery.

Most patients come to see me when they have long-standing pain in their hip, for most patients that’s pain in their groin, pain in their thigh, or pain in their backside.  And really, hip replacement is the last thing. You don't want to rush to hip replacement surgery. Often times if you have arthritis in your hip, you want to try modifying your activities, seeing if anti-inflammatory drugs, such as Aleve or ibuprofen help, or even injections into your hip. Because, although we've gotten very good with hip replacement surgery, there are still risks with any surgery you do. The typical patient that gets hip replacement has pain in their groin and thigh that is really affecting their quality of life.  They aren't able to golf, or they’re having difficulty playing 18 holes and now they do nine holes in a cart. They can't play tennis, or they can't play with their grandkids -- it's the simple things in life that you suddenly aren't able to do. And once you can't do those things anymore, hip replacement is a really good option.

When you do the minimally invasive hip surgery, the biggest benefit is less pain and faster recovery. But it's not really that we’re doing just the anterior approach, we’re also taking a management of pain differently in trying to control the pain at multiple levels,  such that we can reduce the amount of narcotic medicines that you have to take that make you tired, constipated, and just not really feeling as well. And many of my patients, instead of staying in the hospital three or four days are now just staying one night and going home the following day. I saw a patient back, just last week who had missed his six week appointment to see me and I saw his daughter and said “Oh, is your Dad doing ok?” and she said, “Oh, he forgot about your appointment, he was golfing". So he had golfed 18 holes just six weeks after surgery. There really are some benefits that we haven't been seeing previously.

There is special equipment is required to do this anterior hip replacement. We use a special table that allows us to position the thigh, the thighbone or the femur bone in order to get the implants in and this makes the surgery easier for us and makes it easier to get the components for hip replacement in the right place.

Not all hospitals have the Hana table which is the table-- it's not necessary to do the anterior hip replacement, however it makes it easier to get the components in and makes the surgery faster.

I think Miami Valley Hospital is the ideal place to get this done because we really work as a team here. There is an integrative approach where the anesthesiologists, the nurses, the physicians, the case managers all work together and talk directly on a daily basis to make sure that the patient is taken care of together as a whole. It seems that when we do that patients do better, are happier, and get home faster.