Arthritis causes the cartilage covering of the ball and socket of the hip joint to wear away, resulting in bone on bone joint movement. This typically causes significant pain and stiffness. There is nothing that can be done to replace the cartilage. It is a permanent problem that will only get worse with time. Fortunately total hip replacement surgery is very successful in relieving pain and returning you to normal functioning.
With direct anterior hip replacement, the surgery is done from in front of the hip rather than on the side or back of the hip, as it is done with traditional hip replacement. This surgery may also be called mini, modified, minimally invasive, or muscle-sparing surgery.
Having your surgery done this way may have other advantages. These are:
- Less than half of the incision size of traditional hip replacement
- Improved stability
- Quicker and easier recovery in the early stages
- Less muscle trauma
- Shorter hospital stay
- Less limping
How do you decide if I need a hip replacement?
Pain that is in your groin, or the front part of the hip, often means you could be helped by hip surgery. We look at your x-ray to see if the image on the x-ray correlates with the pain you are having. You can try using soft soled shoes or anti-inflammatory medications to relieve the pain. Cortisone injections can sometimes be an option, but are not always recommended, depending on how much joint space you have remaining and your overall health. These injections can increase the chance of complications once you do have surgery so it’s important to discuss this with Dr. Siewert. Once non-surgical options have failed to relieve your symptoms, total hip replacement is likely the best option for pain relief and improving your function.
How do you decide if you will do the surgery from the front of the hip rather than the side or back?
When possible the direct anterior approach is my preferred option for a total hip replacement. The surgery is done from in front of the hip rather than on the side or back of the hip, as it is done with traditional hip replacement. Each patient is evaluated on an individual basis to determine which approach is best for them. Typically about 90% of my patients qualify for the direct anterior approach. Body habitus and muscle mass play a role in the decision as to which approach is best for each patient.
How do I know if I am a candidate for the anterior approach?
I will evaluate your hip and discuss which approach will be optimal for your hip. Typically about 90% of my patients qualify for the anterior approach.
What can I expect with surgery?
You will arrive 1-2 hours before your surgery so that the nursing staff and anesthesia team can meet with you and prepare you for surgery. Most total joint replacement patients will have a spinal anesthetic rather than a full general anesthetic. Once the spinal is placed, you will be numb from the waist down. You will have medication to make you completely relaxed throughout the entire process. Your surgery takes place on a special table that allows me to manipulate your leg and access the hip through a very minimal incision. The surgery usually takes about 60-90 minutes. Once your surgery is complete, you will go to the recovery room until you are awake from the relaxing medications and your vital signs are good. Our Care Team members will then move you to our Joint Replacement Center where you will stay until you are discharged.
How long will I stay in the hospital?
You will typically spend one to two days in the Joint Replacement Center and receive physical therapy to prepare you to return home. Normally on the first day you will be able to have full weight bearing exercise with a walker. Most patients will use a walker for 1-2 weeks. Then you will transition to a cane for a week or two before getting back to independent ambulation by 4-6 weeks. In some cases patients elect to go to a rehabilitation facility after surgery if they do not have help at home to assist in their recovery. If you are very healthy with minimal co-morbidities, you may be a candidate for outpatient total hip replacement. Please ask Dr. Siewert if you are interested in being able to go home the same day as your surgery.
What happens when I go home?
Physical therapy will begin in the hospital following your surgery. You will be set up with physical therapy in your own home for the first couple weeks after surgery. Then you will likely continue with some outpatient physical therapy for a few more weeks or as needed. You will come to our office two weeks after surgery to check your wound and then at 6 weeks to see how you are doing and for x rays. Alternatively, video telehealth visits can also be arranged to make it as convenient as possible for patients and minimize travel or time away from work if desired. Full recovery typically takes 2-3 months.