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Minimally Invasive Direct Anterior Total Hip Replacement


Your hip consists of two main parts that fit together like a ball and socket:

the femoral head at the top of the leg, and the acetabulum in your pelvis.

Cartilage between the femoral head and acetabulum provides cushioning between the bones and allows for smooth movement.

A total hip replacement is usually done when severe damage from arthritis or injury has made it difficult

to perform daily activities without severe pain or restricted range of motion.

During the procedure, the femoral head and acetabulum are replaced with artificial components called prostheses.

An artificial hip prosthesis consists of a cup, called the acetabular component, and a stem and ball, called the femoral component.

Before your procedure, you will receive intravenous fluids, antibiotics, and medications to help you relax.

Most minimally invasive anterior total hip replacements are done under spinal anesthesia, so you will be awake during your operation,

but feel no pain. A catheter may be placed in your bladder to drain your urine.

Since fluid and blood loss can be significant, banked blood will be prepared in case you require a transfusion.

You may have the opportunity to collect and store your own blood in preparation for your surgery.

During a direct anterior total hip replacement procedure, you will lie on your back on a specialized table,

enabling your surgeon to perform this minimally invasive operation. Your feet will be placed in boots attached to the table,

allowing your surgeon to position your legs as necessary to gain access to your hip joint during your operation.

A fluoroscopy machine may be used during procedure to help your surgeon position your prosthesis more accurately.

Your surgeon will begin by making a 3-6 inch incision near your groin.

This incision is significantly smaller than those made during other total hip replacement procedures.

He or she will then push aside two muscles to expose the joint capsule.

No muscles are split or detached during this procedure.

After incising the joint capsule, your surgeon will dislocate the femoral head from the acetabulum.

He or she will remove any damaged cartilage or bone in the acetabulum, reshape the acetabular socket,

and secure the acetabular prosthesis in place using special cement or screws.

Turning next to the femur, your surgeon will remove the femoral head,

shape the remaining femur to fit the prosthetic stem, and secure the femoral component using cement or other techniques.

Once both components are firmly in place, your surgeon will slide the prosthetic femoral head into its acetabular counterpart,

test the movement of your new hip joint, and may verify that it is properly positioned with an x-ray.

Your surgeon will then close the joint capsule and reposition your muscles.

He or she may place a drain in your hip to remove excess fluid,

and close the incision with stitches or staples.

After your procedure, you will be moved to the post-surgical recovery area for monitoring.

You will continue your IV fluids and antibiotics for a short time and will be given pain medications as needed.

If a catheter was placed, it will be removed.

To prevent blood clots from forming in your leg, you will be given a blood thinner,

asked to wear compression stockings, and encouraged to begin walking as soon as possible, initially with a walker or cane.

Your physician may use a sequential compression device on your legs or feet to further decrease the possibility

of developing a blood clot, called a deep vein thrombosis, or DVT, in your leg veins.

No hip precautions are necessary; you may sit, bend, and cross your legs however you want.

You will be released from the hospital after you can walk up and down stairs, usually after 2 to 4 days.

The anterior approach avoids cutting any hip muscles, which may result in:

increased joint stability, lower risk of dislocation, less pain, and faster recovery.