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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 (UMMC) seeking a less invasive option known as direct anterior hip replacement. Most often, these patients have chronic hip pain (including osteoarthritis, dysplasia or misalignment of the hip joint), slipped capital femoral epiphysis (a disorder causing the femur [thighbone] to slip out of place) or a loss of blood supply to the hip (from disease or medication).

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 in 2016.

Direct anterior hip replacement removes the ball and the part of the socket of the natural hip that 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 in only a minority of hip replacement cases at UMMC, accesses the hip from the back or side. Some conventional approaches involve removing some muscle from either the back or the front of the top of the femur (thighbone) to gain access to the bones.

Physicians who perform hip replacement:

Advantages of Direct Anterior Hip Replacement

During the past several years, the direct anterior approach to hip replacement has gained popularity worldwide. With this approach, no muscles are cut during the procedure because the surgeons work between the muscles in front of the hip to access the hip joint. This leads to less blood loss, pain and scarring and theoretically results in less muscle damage, quicker recovery and less risk of dislocation (the hip popping out of the joint).

In addition, because of the way patients are positioned during surgery, it makes it easier for the surgeon to judge whether the lengths of the two legs are equal. These advantages have recently been scientifically validated by randomized clinical trials.

At UMMC, the direct anterior hip replacement approach is preferred primarily because patients recover slightly faster than with other surgical approaches. In addition, 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 hip impingement (binding of the ball on the edge of the socket).

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 body mass index (BMI), which is a ratio of body weight to height, might be better suited for 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, be sure to discuss them with your surgeon during your visit. Our primary goal is to provide you with a stable hip that relieves your pain.