Hip replacement surgery isn’t just for “old” people anymore. People of all ages, weary of living with constant hip pain, are coming to University of Maryland Medical Center seeking a less invasive option known as direct anterior hip replacement. Most often it is patients with chronic hip pain, including osteoarthritis; dysplasia, or a misalignment of the hip joint; slipped capital femoral epiphysis, a disorder causing the thighbone to slip out of place; or a loss of blood supply to the hip from disease or medication use who seek out a replacement.

The University of Maryland is at the leading edge of advancements in complex hip surgeries, having performed anterior hip surgery for many years and switching nearly entirely to the anterior approach about two years ago.

Direct anterior hip replacement removes the ball and part of the socket of the natural hip – which is diseased or injured – and replaces them with artificial parts by accessing the hip socket from the front of the body, known as the anterior side. Conventional hip replacement surgery, now done on only a minority of hip replacement patients at UMMC, accesses the hip from the back or side, but the anterior method avoids cutting through muscle, leading to less blood loss, pain and scarring. Hospital stays are generally shorter with direct anterior hip replacement because of less trauma to the hip tissues.

Physicians who perform hip replacement:

Advantages of Direct Anterior Hip Replacement

Hip replacement involves removing the ball and part of the socket of the native hip and replacing them with artificial parts. This is one of the most successful operations ever devised, and many ways to access the bones (surgical approaches) have been used over the years. Some approaches involve removing some muscle from either the back or the front of the top of the thigh bone (femur) to gain access to the bones.

During the past several years, the direct anterior approach has gained popularity worldwide as a surgical approach for hip replacement. The main advantage of this approach is that no muscles are cut during the procedure because the surgeons work between the muscles in front (anterior) of the hip to access the hip joint. This theoretically results in less muscle damage, quicker recovery, and less risk of the hip popping out of the joint (dislocation). In addition, because of the way patients are positioned during surgery, it makes it easier for the surgeon to judge whether the length of the two legs are equal. These advantages have recently been scientifically validated by randomized clinical trials.

I like the direct anterior hip replacement approach primarily because patients recover slightly faster than with other surgical approaches. In addition, I believe that the direct anterior hip approach allows for more accurate installation of the socket component of the hip replacement. More accurate socket placement has the advantage of lower wear rates and less binding of the ball on the edge of the socket (hip impingement).

Disadvantages of Direct Anterior Hip Replacement

Not everyone is a candidate for direct anterior hip surgery. Patients who have had extensive previous hip operations, for example, and those who have a high ratio of body weight to height might be better suited to other hip approaches.

A specific side effect of the direct anterior approach is numbness of a skin nerve on the front of the thigh close to where the incision is made. In the majority of these operations performed by expert surgeons, this numbness is a common finding. The vast majority of patients who experience it are not bothered by the numbness, but it is important to understand that it can occur.

If you have any questions about the direct anterior approach or hip replacements in general, feel free to discuss them with me during your visit. My primary goal is to provide you with a stable hip that relieves your pain.

Ted Manson, M.D.

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