Ask Dr. Wickum: What is a direct anterior hip replacement, and how is it different from other hip replacement procedures?

Dr. Wickum explains the difference between a posterior and a direct anterior procedure for hip replacement, and discusses the advantages of anterior hip replacements.

Hip replacement surgery consists of replacing a diseased or damaged hip joint surfaces with metal and plastic components shaped to allow continued motion of the hip. Traditionally, hip replacement surgery has been handled via a posterior procedure: the incision is made on the backside of the hip. The direct anterior approach hip replacement handles the procedure through an incision on the front of the hip.

Advanced training required to master the approach

“I’ve been asked why every orthopedic surgeon doesn’t offer the direct anterior hip replacement,” says Dr. Wickum. ”There are several good reasons why.”

”First, direct anterior hip replacement requires special training,” he explains. ”It is not a core skill required by U.S. orthopedic residency training. By contrast, the more traditional posterior approach to the hip is a core skill that every orthopedic surgeon learns in training. This is why the great majority of orthopedic surgeons perform hip replacement surgery through a posterior approach.”

Dr. Wickum hastens to add that there is absolutely nothing wrong with the posterior approach; its long-term surgical outcomes are excellent.

“The direct anterior hip replacement procedure is very difficult to learn and master,” he continues. Some experts believe that surgeons benefit from the learning curve of performing at least 100 cases to establish proficiency with this procedure. Through 100 cases, a surgeon will probably have encountered complexities including congenital deformities, intra-operative complications, and revisions. Certain deformities can be easier to handle via the direct anterior approach, including conditions such as hip dysplasia and leg length inequality.

Advantages of anterior approach hip replacement

In addition to its advantages for handling certain hip complexities, the direct anterior approach contributes to a swifter post-surgical recovery.

“The direct anterior approach spares muscle, so patients have more initial strength and less post-operative pain,” Dr. Wickum explains. “They are able to get out of bed faster and walk without the assistance of a walker or cane sooner. They report more ease going up and down stairs, and even find it easier to put on socks and shoes.”

“My job is to review options with each patient,” Dr. Wickum concludes, “and decide together which option will deliver the best outcome.”

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