Total Hip Replacement (Arthroplasty)

The anterior and posterior approaches to total hip replacement surgery are two widely used methods, each with its own advantages and considerations:

ANTERIOR APPROACH –The anterior approach (AMIS approach) to hip replacement involves accessing the hip joint from the front of the hip, rather than the side or back. This method allows me to work between the muscles without cutting through them, minimising muscle damage.

Anterior Approach Potential Advantages:

• Reduced Muscle Damage: Since the approach avoids cutting major muscles, patients often experience less post-operative pain and a quicker initial recovery.
• Faster Recovery: Many patients are able to walk sooner after surgery, sometimes within hours or the next day, due to less muscle trauma.
• Reduced Risk of Dislocation: The anterior approach may lower the risk of hip dislocation post-surgery, as the hip’s posterior structures are left intact.
• Improved Range of Motion: Patients might benefit from a more natural range of motion sooner after surgery, with fewer restrictions during the recovery period.

Anterior Approach Potential Considerations:

• The anterior approach requires specific surgical expertise and equipment. Not all surgeons are trained in this technique, making it less available in some regions.
• In some cases, the surgery might take slightly longer due to the technical precision required.
• Visibility of the hip joint might be more limited compared to the posterior approach, although advanced imaging techniques can mitigate this issue.

Anterior Approach Post-Op precautions:

NONE

Common post-operative guidelines after Anterior Hip Replacement include the following:

• You may bend your hip immediately after surgery and bear full weight when comfortable.
• Your surgeon will prescribe pain medications to keep you comfortable at home.
• Keep the incision clean and dry. You may shower once the dressings are removed unless otherwise directed by your surgeon.
• You will be given specific instructions regarding activity and rehabilitation. You will not have to follow standard hip precautions.
• Physiotherapy will be ordered to restore normal hip function and strength.
• If you are having any procedures such as dental work or any other surgery you should take antibiotics before and after to prevent infection in your new prosthesis.
• Your hip replacement may go off in a metal detector at the airport.
• Eating a healthy diet and not smoking will promote healing.

POSTERIOR APPROACH – The posterior approach accesses the hip joint from the back (posterior) of the hip. This traditional method has been the standard for many years and is widely practiced.

Posterior Approach Potential Advantages:

• Familiarity: Many surgeons are trained in this approach, making it widely available.
• Better Joint Visibility: The posterior approach provides excellent visibility of the hip joint, which can be beneficial in complex cases.
• Versatility: This approach can be adapted for a wide range of patients and hip conditions, offering flexibility in handling various surgical scenarios.

Posterior Approach Potential Considerations:

• Muscle Damage: The approach involves cutting through major muscles at the back of the hip, which can lead to longer initial recovery periods and greater post-operative pain.
• Risk of Dislocation: There’s a slightly higher risk of hip dislocation after surgery, necessitating more precautions during the recovery period.
• Longer Recovery: Patients may take longer to return to certain activities, with more restrictions on movement to prevent dislocation.

Posterior Approach Post-Op Precautions:

Posterior Approach Post-op precautions are very restrictive and usually include the following:

• Avoid the combined movement of bending your hip and turning in your foot.
• You should sleep with a pillow between your legs for 6 weeks.
• Avoid crossing your legs and bending your hip past a right angle.
• Avoid low chairs.
• Avoid bending over to pick things up. Grabbers are helpful as are shoehorns or slip on shoes.
• An elevated toilet seat should be used.

Most patients return to normal, low-impact activities, enjoying significant mobility improvements. Dr. Hunt will guide you through the recovery process to ensure the best outcomes.

While there may be temporary restrictions on certain movements or activities immediately after surgery, such as bending at the hip or lifting heavy objects, most patients can gradually return to their normal activities over time. Dr Hunt will provide specific guidance on activity restrictions and limitations during the recovery period.

The timing for returning to work and driving after hip replacement surgery varies widely among patients and is influenced by several factors, including the type of work you do, your overall health, and your progress during rehabilitation. Generally, most patients can expect to return to sedentary or desk-based work within 4 to 6 weeks following surgery, provided their recovery is progressing well and they have clearance from their surgeon. More physically demanding occupations may require a longer recovery period, typically ranging from 8 to 12 weeks or more.

Regarding driving, patients typically need to wait until they have regained sufficient strength, mobility, and reaction times to safely operate a vehicle. This often occurs around 4 to 6 weeks post-surgery, but it ultimately depends on individual factors and should be discussed with Dr Hunt during follow-up appointments. It’s essential to follow his guidance and any driving restrictions imposed by local regulations or insurance policies to ensure a safe return to driving.

Some patients may require assistive devices such as a walker, cane, or crutches during the initial stages of recovery to aid with mobility and balance. The Melbourne Orthopaedic healthcare team will assess your needs and provide recommendations for any necessary equipment.