The Anterior Approach for Hip Replacement — Is it right for you?

When Do You Need a Total Hip Replacement?

A total hip replacement is required after exhausting all non-operative measures. These include the use of walking aids such as walking sticks, activity modification, and medications. Your general practitioner will go through modalities to help manage pain due to arthritis. Hip pain can also be caused by the lower back, knees, or intra-abdominal problems — so a screening X-ray is usually required prior to seeing a specialist.

Non-Operative Management Options

Modalities to help manage pain include:

• Non-steroidal anti-inflammatories: Voltaren, Nurofen, Mobic, Celebrex
• Panadol Osteo
• Glucosamine and Fish Oil
• Walking stick (held on the opposite side)

Once pain goes beyond these modalities and stronger medications such as Tramadol or Oxycodone are required, further advice from an Orthopaedic Surgeon should be sought.

Known Causes of Hip Osteoarthritis

Arthritis is a multifactorial disease — in most cases it is not known why some people develop it. Known potential causes include:

• Post-traumatic osteoarthritis after a fracture or dislocation of the hip joint
• Femoroacetabular impingement that has been undiagnosed
• Avascular necrosis (death of the femoral head due to compromised blood supply)
• Familial factors (osteoarthritis often runs in families)

Questions That Indicate Functional Loss

The common questions asked to determine functional loss from hip arthritis include:

• How far can you walk?
• Can you put your own shoes and socks on?
• Can you get in and out of a car?
• Do you have night pain?
• Does the pain radiate anywhere (groin, buttock, knee)?

In some cases, an injection into the hip joint may help indicate where the pain is originating from.

Hip Replacement via the Direct Anterior Approach

The direct anterior approach is a refined procedure used to decrease some potential complications from other methods. Proposed benefits include:

• Accurate positioning of components (using intra-operative X-ray to check)
• Lower dislocation risk as muscles are not detached from bone
• Lower blood loss due to less muscle damage
• Less post-operative pain

Research shows that pain relief after hip replacement surgery at 2 years is no different between any approach. Deciding on the approach should be left to your surgeon — the best approach is the one they are most familiar with.

When the DAA is Not the Preferred Option

In all cases, it is best to discuss with your surgeon whether the approach is suitable. In some cases, the direct anterior approach is not preferred. These include:

• Hips that are chronically dislocated
• Congenital malformations requiring extensive work on the femoral shaft
• Joints with previous metalwork placed via alternative posterior acetabular approaches

Frequently Asked Questions