More than 168,000 people undergo total hip replacements in the U.S. each year. Most receive a traditional posterior or anterolateral approach that requires restricted motion and a relatively long recuperation. In recent years incision sizes have decreased but the approaches have remained essentially the same. These surgeries are a step forward, but they still require cumbersome movement restrictions and considerable patient recovery time. A minimally invasive technique has been quite successful in reducing recovery time but has been limited to a minority subset of total hip patients. Now, the anterior approach—with patients lying on their backs on a special surgical table—offers excellent results and is appropriate for nearly every primary total hip patient. Patients are allowed to bend the hip freely without limitation, and are walking several hours following surgery.

How Hip Replacement Surgery Has Changed

Today, efforts have gone beyond attempts to improve the prosthesis. Materials used in the bearing surface of hip replacements are becoming more important as a growing number of younger and more active patients are requiring hip replacement. Increasingly, orthopedic surgeons are also changing their approach to the surgery itself. Their goal is to limit or avoid disruption of soft tissues and to accelerate the recovery process. Results using a minimally invasive anterior approach and a special surgical table have been excellent, and very predictable.

The Specialized Surgical Table and its Advantages

The specially designed ProFX surgical table used to perform the anterior approach total hip replacement surgery was originally designed for use in trauma. The table, onsite at John Muir Medical Center, Walnut Creek Campus since January 2004, is currently one of only a few among Bay Area hospitals regularly being used for hip replacement. The Medical Center is one of approximately seven hospitals in California that is actively performing this type of minimally invasive total hip replacement surgery on a routine basis.

The Anterior Approach At John Muir Medical Center, Walnut Creek Campus

"The anterior approach is now my primary procedure for all total hip replacement patients, including those with hip fractures," says David A. Dodgin, M.D., orthopedic surgeon on staff at John Muir Medical Center, Walnut Creek Campus. "The two-hour surgery is performed through a four-inch incision that allows us easy access to the hip joint," he explains. "Our specialized surgical table gives a large degree of freedom of movement for the lower extremities. We can replace the hip without detaching muscle from the pelvis or femur. As a result, patients experience immediate function and greatly reduced rehabilitation time. They return to full activity much more quickly."

After surgery using the anterior approach and the ProFX fracture table, patients are immediately allowed to bend their hip freely. They are up and walking the day of surgery. In addition, they can sit in a chair, ride in a car, and perform most functions of daily living within hours or days. "Patients in a weakened condition should understand that they need time to recover from the surgery and from their condition prior to surgery," Dr. Dodgin adds.

Major Advantages of the Anterior Approach to Hip Replacement

• Permits the use of cementless or cemented implants
• No motion or weight bearing restrictions
• Reduced dislocation rates (0 - 0.5%) at active centers
• Decreased hospital time (usual stay is 2-4 days)
• No lateral-sided hip pain
• No abductor muscle weakness
• Fast return to function and normal gait
• Significantly less pain from surgery
• No strengthening limits

Possible complications are rare and remain similar to other approaches performed without the specialized surgical table. These are infection, injury to nerves and blood vessels, fracture of the femur, and need for revision surgery. Some complications are less likely to occur, such as dislocation.

Rapid Return To Full Functioning

"Some of my younger patients say they do not need physical therapy," Dr. Dodgin says. "For those who do, it is generally for only three to six weeks. When surgery is on the left hip, patients may be able to drive again within one week. Most hip replacement patients who are still driving do so by three weeks post-surgery regardless."

Potential For Bilateral Surgery

It is feasible to replace both hips in the same surgery, when indicated, because of the immediate stability of the joint, according to Dr. Dodgin. Bilateral surgeries are facilitated by the anterior approach because of the patient's supine (lying on the back) position on the ProFx table and the relatively easy recovery from each procedure.

The Future Is Here

"As more surgeons are trained in the techniques and the surgical table becomes more widely available, I believe the anterior approach will become the preferred method for primary hip replacement surgery," Dr. Dodgin concludes.

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