Anterior Hip Replacement
Minimally Invasive Anterior Approach Hip Replacment Surgery
By Jonathan Cluett, M.D., About.com Guide
Updated November 19, 2012
About.com Health's Disease and Condition content is reviewed by the Medical Review Board
Anterior hip replacement is a technique used to treat severe hip joint arthritis.
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Anterior Hip Replacement
Anterior hip replacement is not a new surgery. Many surgeons have performed hip replacements through an anterior incision for decades. In fact, the most widely referenced report of this technique was published in 1980. What is new about anterior hip replacement is that the surgery is being done through smaller incisions with more specialized instrumentation to help make this surgery less traumatic to the patient. The hip joint is deep within the body at the junction of the pelvis and the top of the thigh bone. All hip replacements, regardless of incision type, require your surgeon to replace the top of the thigh bone and the socket of the pelvis. There are a number of ways for your surgeon to achieve this, as your surgeon can approach your hip from the back of the joint (posterior approach), the side of the joint (lateral or anterolateral approach), the front of the joint (anterior approach), or through a combination of approaches (two-incision approach).It is important to understand that all of these approaches accomplish the same goal of replacing the ball and socket of the hip joint.
Unique Aspects of Anterior Approach Hip Replacement
The anterior approach hip replacement is a muscle-splitting approach, meaning that the surgeon gets to the hip between two muscles, rather than by removing and then reattaching a muscle. The advantage is thought to be that rehabilitation can proceed more quickly by not having to allow the reattached muscle to heal. As with other minimally invasive approaches, the incision size is minimized in an effort to help limit post-operative discomfort.Anterior hip replacements are thought by some surgeons to have a lower rate of dislocation, although with newer implants some surgeons feel that this is no longer a distinct advantage of the anterior approach hip replacement.
Most complications associated with anterior approach hip replacement are similar to standard hip replacement complications. One specific complication is injury to a large skin nerve just adjacent to the incision of the anterior approach hip replacement. Injury to this nerve, the lateral femoral cutaneous nerve, during surgery can lead to chronic pain and abnormal sensations along the front and side of the thigh.
Is Anterior Hip Replacement Better?
As with many other changes in joint replacement surgery, it is simply not known if anterior hip replacement is an improvement over other approaches for a hip replacement surgery. There are advantages and disadvantages of the different approaches for hip replacement surgery. While some argue that rehab may be faster or pain may be less, there is conflicting data to support this argument. Some studies have found no difference in recovery when an anterior approach hip replacement is compared to other techniques. The desire to minimize pain and speed recovery is understandable. However, the most important aspect of hip replacement surgery is to give you a joint that is pain-free and will last you a long time. These goals cannot be compromised when changes are made to hip replacement techniques.While anterior approach hip replacements may provide some benefits when compared to other types of hip replacements, it is not known if this truly represents an improvement in hip replacement surgery. You can discuss these issues with your doctor when you are ready to consider hip replacement.
Hip Bone Spurs
A bone spur, also called an osteophyte, is an abnormal growth of bone occurring at the edge of a bone, usually where two bones meet. Bone spurs most commonly form in the cervical (upper) spine, lumbar (lower) spine, heel, shoulder, and knee, but they can also be found in the hip, elbow, finger, and toe joint. The ends of normal, healthy bones are covered by cartilage, protecting them from rubbing against surrounding bones. When bone spurs appear, however, they do not form with that protective layer of cartilage, so they have the ability to cause a lot of pain.The repetitive rubbing together of bones most commonly is the cause of bone spurs. After prolonged periods of overwork or overuse, cartilage becomes worn down, exposing bare bone that is vulnerable to degeneration. This happens often with people suffering from osteoarthritis and/or tendonitis, both of which are inflammatory conditions. The formation of bone spurs is the body's way of compensating for the wear and tear.
Bone spurs that grow in the hip joint can cause serious problems when they press against the nerves in the surrounding tissues or bones. There are two areas in which bone spurs can grow in the hip: on the femoral head and on the acetabulum. Nerve impingement can cause many serious neurological problems. Nerves are composed of a plethora of tiny neurons, which, joined together, conduct electrical signals that allow the brain and body to communicate sensory messages and carry out motor functions. When any irregular growth, like a bone spur,imposes upon a nearby nerve, extra pressure is exerted on the nerve, putting this "tunnel" of communication at risk of disruption. If too much pressure is put upon a nerve, electrical signals can no longer be conducted, leading to loss of feeling in the affected limbs. Bone spurs that interfere with a ball-and-socket joint can severely impede the hip's normal range of motion. Nerve impingement within the hip joint is called femoroacetabular impingement (FAI). This is dangerous because it can cause labral tears in the hip.
It is possible to have bone spurs in the hip joint without having any symptoms for a while. Some bone spurs are not particularly harmful or disruptive at first and are easily overlooked. However, when the condition becomes painful, the normal range of motion restricted, and numbness/weakness of the extremities occurs, it is time to seek medical assistance. Bone spurs can cause pain and loss of motion due to nerve impingement. At Spine & Sports Medicine, our experts here will conduct a thorough examination and X-ray (if necessary) to properly detect any bone spurs. They will assess the situation according to your symptoms, tests, and medical history. In some more severe cases, surgery is needed to remove the growth, followed by physical therapy rehabilitation. Because the hip joint has such a wide range of motion, bone spur interference can cause major movement dysfunctions. In general, a physical therapy treatment plan can help mitigate the pain caused by bone spurs. Working with a physical therapist to strengthen the structures in the hip and to increase flexibility can allow you to regain a normal range of motion and be free of pain. Electrical stimulation is sometimes used to reduce muscle spasms, pain, and inflammation. When bone spurs occur in the hip it is extremely important to seek medical help immediately. Major inflammation is a result of bone spurs in the hip and can cause chronic, excruciating pain. If left alone without treatment, surgical intervention is often required, which in this case would be a hip replacement.
Based on a meticulous examination, a diagnosis is made and a comprehensive treatment plan is devised tailored specifically to each unique situation. It is very important to seek professional advice and treatment when dealing with hip pain because this is a condition that can become very serious very quickly. Our experts here at Spine & Sports Medicine are professionals trained to diagnose each condition; they are also highly educated on the best treatments for each respective injury. It is crucial that the injury is diagnosed correctly; otherwise further damage may be done.
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