In the mid-90’s, Dr. Matta began performing the anterior approach in Los Angeles and teaching it to other surgeons. Today, over half of all hip replacements are performed through the anterior approach.
The typical incision is about 4 inches long on the front of the hip varying slightly in length depending on the size of the patient. The anterior approach works well because the hip joint is closer to the skin in the front and covered by a thinner layer of muscle and fat than from the back (posterior) or side (anterolateral). Almost all patients regardless of size, shape or age are candidates for this procedure.
The posterior approach to the hip was traditionally the most common approach for hip replacement, which exposes the hip joint by splitting the gluteal muscles and detaching other important muscles from the femur. The anterolateral approach, which is also commonly used, also requires detachment of important muscle groups from the femur. The anterior approach goes between muscles to expose the hip joint, leaving all muscles attachments to the femur intact.
An artificial hip depends on the muscles around the hip for stability. With the anterior approach, muscles are left intact, giving immediate stability to the hip after surgery. More traditional hip replacement techniques require periods of strict precautions after surgery to assure the artificial hip will not dislocate. These precautions commonly include limits on flexion of the hip requiring elevated toilet seats and chairs. Patients are also instructed to avoid crossing legs or tying shoelaces. Since the anterior approach preserves muscle attachments, dislocation precautions are not needed. Patients are encouraged to use and position the leg in any manner avoiding the cumbersome restrictions. This accelerates rehabilitation and decreases the hospital stay after surgery.
Along with dislocation risks, leg length inequality has long been a problem with hip replacement surgery. With the anterior approach, the patient lies on their back during the surgery. In this position, fluoroscopy (intra-operative X-ray) is used to determine leg lengths, correct position and proper sizing of the implants. This ensures that every patient leaves the operating room with the artificial hip components most suited for their body.
Benefits of an outpatient anterior approach total hip replacement include:
- Less pain and a shorter recovery time
- Shorter recovery – most are outpatient surgeries
- Decreased chance of hip dislocations
- Fewer post-surgical restrictions and precautions
- Reduced tissue trauma
- Decreased likelihood of limping
- Smaller incisions
- Ensuring components are the correct position with X-rays
- Higher accuracy in leg lengths