Why do Orthopaedic surgeons perform the anterior approach?
Total hip replacement is one of the most effective operations performed in orthopaedics. It was first performed in the 60’s by Sir Thomas Charnley and was found to be highly effective in relieving pain from an arthritic hip joint. It restored patient’s mobility and enabled them to return comfortably to participating in activities of daily living.
The anterolateral approach as described by Charnley involved detaching the hip abductor musculature (gluteals) via a trochanteric osteotomy and although providing good vision of the acetabulum and proximal femur it left a significant proportion of patients with a limp or Trendelenburg lurch as a consequence of defunctioning the abductors. The posterior approach was then popularised in order to avoid this problem however up to 3-4% of patients developed problem of recurrent post operative hip dislocation which tended to occur if patients flexed their hip beyond 90 deg. More recently the anterior approach has been introduced to minimise this complication.
The anterior approach has been the predominant approach performed in some European countries, particularly France, for many years. More recently surgeons in Australia have adopted this technique. The anterior approach differentiates itself from other approaches in that it is the only approach to the hip that is truly muscle sparing ie the approach does not divide any muscle or tendons and is via an internervous plane. Consequently it generally results in patients making a rapid recovery particularly with respect walking distances and driving. The majority of patients also have very little to virtually no pain in the immediate postoperative period.
As there is a significant learning curve with the anterior approach it is important that it be performed by surgeons who have undertaken the appropriate training which involves observing an expert ,attending cadaver workshops and having a proctor attend their initial cases before embarking on cases on their own.
In my practice I commenced performing this approach in 2007 after embarking on the training regime as mentioned. I do not perform it on every patient as there are some relative contra indications however when performed on the appropriate patient the results can be spectacular. Patients are often astonished at how easy their recovery has been and how little pain they experienced. I now act as a proctor for other surgeons interested in learning this approach.
If your patients have reached the stage where you think they would benefit from hip replacement and are interested in having it performed by this approach then I would be happy to consult with them to discuss in more detail. You can find out more by visiting my website.