Total Hip Replacement (THR) is the standard of care for disabling arthritis of the hip. It was introduced in the 1960’s and has a proven long term success rate. In the past, physicians typically recommended hip replacement for older patients because they tend to be less active and put less stress on the artificial hip compared to younger people. But today, the procedure also may be an option for those who are younger and more active due to technologically improved implants that can withstand more stress, endure more strain and last longer.The procedure to replace hips has changed with the times too. Traditionally, the operation to remove the end of the thighbone (femur) and replace the ball-and-socket mechanism in the hip with artificial implants required a 10 to 12 inch incision on the side of the hip along the buttock; requiring cuts through muscles and tendons. Patients required 4-6 weeks of healing time followed by the use of a walker or crutches. In recent years, however, new minimally invasive techniques have been developed that allow surgeons to perform the surgery through one or two small incisions, with a much faster recovery time. One such technique is the Minimally Invasive Anterior Total Hip Replacement using the HanaTM Hip and Knee Arthroplasty Table.
The HanaTM Table serves as an actual instrument during the operation and allows the leg to be positioned in such a way that the surgeon is able to replace the hip through a single 2.5 to 3 inch incision along the front of the hip. This approach enables me to gently push the anterior hip muscles aside to allow visualization of the bones. Instruments specially designed to fit through the small incision are used to prepare the hip socket and femur in order to properly place the artificial implants, which consist of a ball, socket, stem and polyetheline liner. Different liner choices exist to accommodate varying patient age and activity level. Blood loss and local tissue trauma is minimized with the small incision technique.
Afterwards, no special precautions or abduction pillows are required as the rate of hip dislocation after the anterior hip replacement is much lower than with the standard posterior technique. Due to the muscle sparing MIS anterior technique, I have found that my patients are ambulating with a walker, aided by a therapist, within three to four hours after surgery. This is important, as early mobilization is critical in preventing life-threatening blood clots. With the anterior technique, the average hospital stay for my patients is 48 hours and patients are typically discharged home with home health and physical therapy as indicated. By about 3-6 weeks post-op, most patients are able to resume normal activities including gym and non-impact sports (tennis, golf, etc.). With the standard total hip replacement technique, typical rehabilitation times can be as much as 3-6 months.
