Traditionally, hip arthroplasty, commonly known as hip replacement, has been performed by accessing the joint through the rear of the leg. Recent advances in technique, however, have made an anterior approach, during which the surgeon accesses the hip joint through the front of the leg, a more desirable option for most patients.
An anterior approach offers a number of advantages. Whereas during traditional hip replacement surgery, muscles had to be cut and subsequently reattached, using the anterior approach, these muscles need only be moved aside. Moreover, an anterior hip replacement provides the surgeon with the opportunity to clearly visualize the entire hip socket and to implant a variety of necessary devices.
The minimally invasive anterior approach also lowers the risk of dislocation common in other hip replacement procedures. By maintaining the integrity of the muscles and the hip capsule, this procedure also provides the stability to keep leg lengths equal and so avoids the need for leg lengthening.
Since less muscle damage takes place, anterior hip replacement often enables the patient to be hospitalized for a shorter period of time and to recover more quickly. In many cases, patients are walking without assistive devices 2 to 3 weeks after the operation. Low impact forms of exercise are recommended immediately after anterior hip replacement, and high-impact activities are typically only prohibited for 3 months.
The anterior hip arthroplasty is not equally well-suited to all patients. Patients who are not suitable candidates for anterior hip replacement include:
- Those with previously implanted devices
- Extremely muscular individuals
- Obese patients
Whether an anterior approach to hip replacement is a viable option is determined after careful evaluation of the individual patient.
Rehabilitation After Hip Arthroplasty
Hip arthroplasty involves replacing part of the femur bone or hip socket with prosthetic devices. After surgery, a physical therapy program is created to help the individual regain flexibility, increase range of motion and strengthen the hip and leg. The goal of physical therapy is to help patients to walk safely without assistance and eventually return to all regular activities.
Initially, the physical therapist will help the patient to use an assistive device such as a walker, cane or crutches. Specific exercises are created to strengthen the hip joint and the surrounding muscles. Initial exercises may focus on contracting and releasing the muscles in the hips, buttocks and ankles. Additional exercises may include:
- Muscle strengthening exercises
- Gradual weight-bearing activities
- Range of motion exercises
- Balance training
As physical therapy progresses, the therapist will help the patient gradually increase the weight put on the leg, until he or she is able to walk without assistance. Patients must commit to their physical therapy program, to help them regain the strength and mobility needed, to return to all regular activities. Total rehabilitation after hip replacement surgery may take up to 6 months.