Total hip replacements are the final stage in treating osteoarthritis of the hip. Dr Chien-Wen Liew exclusively performs hip replacements via the direct anterior approach — an internervous, intermuscular technique with minimal post-operative restrictions.
When is a Total Hip Replacement Required?
Total hip replacements are the final stage in treatment of osteoarthritis of the hip. Pre-operative measures used prior to surgery include basic pain management, walking aids, and activity modification. By the time patients attend an Orthopaedic Surgeon, they have often exhausted non-operative options. Initial pain management options include anti-inflammatory medications such as Voltaren, Nurofen, Mobic, or Celebrex.
Dr Liew's Surgical Approach — The Direct Anterior Approach
The direct anterior approach to the hip is an internervous and intermuscular approach, meaning muscles are not cut from bone. The interval to gain access to the hip runs between muscles supplied by different nerves, placing those nerves at much lower risk of injury compared to other approaches.
The direct anterior approach has been used for over 20 years and is standard of care in France and Switzerland. After a direct anterior approach hip replacement, there are no restrictions to sitting in a normal chair, toilet seat, or car early in the rehabilitation timeline.
The procedure uses a 5–10cm cut on the front of the leg. Muscles are moved to one side as the deeper layers are split. A saw cuts the femoral neck at a predetermined level based on pre-operative X-rays. Dr Liew uses intra-operative X-rays to confirm accurate placement of implants and verify leg length measurements.
Comparison of Approaches
Dr Liew has trained in and performs all three major hip approaches — direct anterior, posterior, and direct lateral. He uses the posterior approach for revision surgery and some primary cases, and the lateral approach at the Royal Adelaide Hospital for hip fractures as per protocol.
In general, the best approach is the one a surgeon is most familiar and trained in. For different circumstances, each approach can be the better option.
After Your Operation
After surgery, patients are kept in recovery for 1–2 hours and transferred to the high dependency unit where mobilisation begins once feeling has returned to the legs. A physiotherapist will assist with standing and first steps a few hours post-surgery.
A wound drain is typically placed under the skin for approximately 24 hours. After a direct anterior approach, no pillow is required between the legs, and there are no movement restrictions within reason — except forced extension combined with external rotation, which is uncommon.
Dr Liew allows patients to drive when they are comfortable, mobilising with minimal aids, and feel able to safely control a car — often achievable at approximately 2 weeks post-surgery.
Pain Management
For pain relief, most patients require only tablets rather than injectable agents. Once comfortable, patients are discharged home — typically 2–5 days after surgery depending on progress. There is no rush to go home; discharge occurs once safe mobilisation and pain control are achieved.
Dressings remain on for 2 weeks, after which Dr Liew removes them personally at the first post-operative appointment.
Long-Term Follow-Up Schedule
Dr Liew believes in monitoring total hip replacements long term. Patients present regularly for X-rays at 2 weeks, 3 months, 1 year, 3 years, 5 years, 10 years, and 15 years after surgery, then every 5 years thereafter. This enables early detection of any changes in bone structure or implant.
As a hip joint is a bearing surface, it will wear over time and requires monitoring. There are multiple bearing surface options available including ceramic and polyethylene combinations.
Patient Information Summary
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