A new technique equals speedier recovery(but your doc might not tell you about it)

Health Goes Strong
February 21, 2011

If you or a relative is contemplating hip replacement surgery, you are certainly not alone; more than 193,000 hip replacements are performed each year in the US. The procedure usually provides a big boost in mobility and quality of life for people who’ve suffered from osteoarthritis.

But while the end result is less pain, recovery has been long and unpleasant—until now. A relatively new technique, called “direct anterior approach” hip replacement, is leaving patients pain-free and flexible within days of surgery. In this type of surgery, the surgeon operates from the front of the hip, whereas the traditional method has involved cutting through the rear or the side of the hip to get to the socket.  “Approaching from the front doesn’t require tearing through muscle and tissue, so there’s less healing required,” says Dr. Steven Louis, and orthopedic surgeon at Hinsdale Orthopaedics in suburban Chicago. “Patients experience less pain and return to normal activities sooner.”

Anterior approach hip replacement is a relatively new procedure, and Dr. Louis started performing it a little over 18 months ago. “But now I recommend it for nearly everybody,” he says. “My patients who’ve had one hip done the old way and a second hip done this way all say that there’s a world of difference in the recovery. One woman came to see me about two weeks after I did her second hip with the anterior approach and she joked, ‘I am so mad at you!  Why weren’t you doing this two years ago when I had my first hip done?'”

But if you or a family member is considering hip replacement, your doctor might not mention the anterior approach, since it’s still rare—Dr. Louis estimates that only about 1% of hip surgeons perform it.  Why isn’t it more common? “It takes a little longer, and it really helps to have a special surgical table, and those tables are expensive for hospitals,” he says. “But it’s getting increasingly common and I’m sure that this will become the dominant technique in the future.”

Dr. Louis adds that the anterior approach isn’t right for everybody (people whose hips have suffered trauma, for example) and that there’s nothing wrong with the old-fashioned style of hip replacement, but this new technique trumps it in terms of recovery. “From what I’ve seen the recovery is very different over the first six weeks, and somewhat better over the first six months, but two years later probably the only difference is the location of the scar.”

So if your doctor hasn’t told you about the anterior approach, I’d certainly suggest consulting a doctor who does it to see if you’re a candidate. As I’ve written before (and know from a very personal experience) getting a second opinion is always, always, essential when making a decision about major surgery.

You can learn more about anterior approach hip replacement at www.hipandtrauma.com, and more about hip replacement in general from the American Academy of Orthopaedic Surgeons.

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