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Hip Replacement - Anterior Approach
Dr. Jaspreet Sidhu discusses hip replacement surgery from the anterior approach.
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Learn more about Jaspreet Sidhu, DO
Jaspreet Sidhu, DO
Dr. Sidhu is a specialist in orthopaedic surgery with his focus of treatment being Adult Reconstruction hip and knee surgery.Learn more about Jaspreet Sidhu, DO
Transcription:
Hip Replacement - Anterior Approach
Introduction: This is Hello Healthy, A Dignity Health Podcast. Here's Bill Klaproth.
Bill Klaproth: Having a painful hip can severely affect your independence, your lifestyle, your job, and more. The good news is you may be a candidate for a new minimally invasive hip replacement procedure called in anterior hip replacement. So let's learn more about the anterior approach to surgical hip replacement surgery with Dr. Jaspreet Sidhu an Orthopedic Surgeon at Alpine Orthopedic Medical Group. Dr. Sidhu, thank you for your time. So what is the anterior approach to surgical hip replacement and how does it differ from the posterior approach?
Dr. Sidhu: Exactly as it sounds, we replace your hip joint by making an incision in the front of your hip joint as opposed to on the backside, which is also referred to as opposed to your approach. And really the main difference in the two procedures is, you know, we like to think of a hip replacement from the front or enter approach as a minimally invasive. We're separating a group of muscles and going in between two different groups of muscles as opposed to cutting through one particular muscle, which we cut through the butt muscle to get through the hip joint and replace it. So in a nutshell, that's really the difference in the two approaches, front anterior approach or back or posterior approach as they refer to it as.
Host: Right. Well, it sounds like one of the advantages is you're not cutting muscle because you're going in between two muscles. So what are the advantages then to the anterior approach?
Dr. Sidhu: There's very good evidence and literature to support that because we are not cutting the muscle, we're sort of moving it out of the way. There's less inflammation, less injury to the muscle, less blood loss. And ultimately what that translates into is faster recovery for people. If you're not injuring the muscle to the same extent,
Host: Well that certainly is a benefit. So is everyone a candidate for the anterior approach?
Dr. Sidhu: You know, that's a tough question. You know, it does require a very careful evaluation of their x-rays and patients overall morphology they are billed. On average, I offer anterior hip replacement to about 90 to 95% of my patients. People who are morbidly obese, BMI above 40, certainly about 45. I think those do present some challenges. And again, those challenges are there, whether it's a anterior approach or a posterior approach. And we're really looking at minimizing risks of infection and how those relate to increased BMI in obesity. But again, that's a conversation I think that's a lot better when evaluating the patient face to face.
Host: So you mentioned one of the benefits, shorter recovery time. How long does it take to recover from anterior hip replacement as opposed to the posterior method?
Dr. Sidhu: Traditionally, what I've been noticing in my patients, you know, I talk to them about assisted device use. I anticipate about a week combination of Walker and cane, and most people will hang onto a cane for two to three weeks. And not uncommon for people to get back to their normal day to day activities at about somewhere between four weeks to six weeks following surgery, which in my opinion, I think that's pretty remarkable considering that we're removing a joint and replacing it with an artificial joint. So I would say on average return to normal day to day activities, somewhere between the four to six week period, depending on the health of the patient. Of course.
Host: Yeah. This is really interesting. So why is it important that you are offering this type of approach?
Dr. Sidhu: I think it's very important because we have live image feedback when we're doing hip replacements from the front. And what that means is we have a live x-ray that we take interoperatively. And what that allows me to do is really pinpoint where I want the implants to be placed as far as you know, the angles and the length of the implants. And therefore I'm able to restore somebody's leg length and make it equal to what it should be as opposed to guessing as to where it should be. So I can compare an x-ray before surgery and compare that to after surgery and really try to restore the patient's anatomy. And I think that's very crucial in being able to give them faster recovery and giving them a joint that's stable and not dislocated. So that's why I think it's important to know that this is an option, a very good option that's available.
Host: Well, the benefits to the patient are clear, but it also sounds like this helps you as well. It sounds like you're able to be much more precise in the replacement. Is that correct?
Dr. Sidhu: It does. Again, I want to make sure I have every tool available to me to do the best job I can for my patients and give them the best surgery that I can offer them in my hands, and in my opinion, this, this is it. And I have that additional feedback by getting an x-ray whenever I want in the OR. And getting a very good imaging quality as a result.
Host: So in hip replacement, I know there's something called precautions. Can you explain that to us and what the precautions are for the anterior approach and how they're different from the posterior approach.
Dr. Sidhu: When hip replacement is done from the back, you know there are certain precautions. Those include not squatting below, you know, the level of your knees, not bringing your knees into your chest and things like that. Traditionally when hips dislocate, they dislocate to the back and we frankly just don't see that when the hip replacement is done from the front because all the muscles, the surrounding structures around the joint are all left intact behind the hip. So as a result, and what a lot of the studies are showing is the risk of dislocation when the replacement is done from the front is very, very, very low. And again, you know, as a patient, what people want to know is what can I do and what can't I do? And I hope that I can offer my patients a lot more of you can as opposed to you can't.
Host: Well, it certainly sounds like there's a lot more can do than can't do with the anterior approach. So are people becoming aware of this? Are they starting to ask for it?
Dr. Sidhu: Yeah, you know, as, as it is starting to become more prevalent and more studies are starting to come out and people are seeing, you know, their grandma, their friend, their aunt who's had a hip replacement done from the front, seeing, you know, the rapid recovery that occurs following that. It's kind of a no brainer for a lot of people.
Host: Well, Dr. Sidhu, This has really been fascinating and interesting. Thank you so much for your time. We appreciate it.
Dr. Sidhu: Yeah, thank you. My pleasure. Thank you for having me. Always appreciate it.
Host: That's Dr. Jaspreet Sidhu. And for more information, please visit StJosephscares.org/ortho. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, A Dignity Health Podcast. I'm Bill Klaproth. Thanks for listening.
Hip Replacement - Anterior Approach
Introduction: This is Hello Healthy, A Dignity Health Podcast. Here's Bill Klaproth.
Bill Klaproth: Having a painful hip can severely affect your independence, your lifestyle, your job, and more. The good news is you may be a candidate for a new minimally invasive hip replacement procedure called in anterior hip replacement. So let's learn more about the anterior approach to surgical hip replacement surgery with Dr. Jaspreet Sidhu an Orthopedic Surgeon at Alpine Orthopedic Medical Group. Dr. Sidhu, thank you for your time. So what is the anterior approach to surgical hip replacement and how does it differ from the posterior approach?
Dr. Sidhu: Exactly as it sounds, we replace your hip joint by making an incision in the front of your hip joint as opposed to on the backside, which is also referred to as opposed to your approach. And really the main difference in the two procedures is, you know, we like to think of a hip replacement from the front or enter approach as a minimally invasive. We're separating a group of muscles and going in between two different groups of muscles as opposed to cutting through one particular muscle, which we cut through the butt muscle to get through the hip joint and replace it. So in a nutshell, that's really the difference in the two approaches, front anterior approach or back or posterior approach as they refer to it as.
Host: Right. Well, it sounds like one of the advantages is you're not cutting muscle because you're going in between two muscles. So what are the advantages then to the anterior approach?
Dr. Sidhu: There's very good evidence and literature to support that because we are not cutting the muscle, we're sort of moving it out of the way. There's less inflammation, less injury to the muscle, less blood loss. And ultimately what that translates into is faster recovery for people. If you're not injuring the muscle to the same extent,
Host: Well that certainly is a benefit. So is everyone a candidate for the anterior approach?
Dr. Sidhu: You know, that's a tough question. You know, it does require a very careful evaluation of their x-rays and patients overall morphology they are billed. On average, I offer anterior hip replacement to about 90 to 95% of my patients. People who are morbidly obese, BMI above 40, certainly about 45. I think those do present some challenges. And again, those challenges are there, whether it's a anterior approach or a posterior approach. And we're really looking at minimizing risks of infection and how those relate to increased BMI in obesity. But again, that's a conversation I think that's a lot better when evaluating the patient face to face.
Host: So you mentioned one of the benefits, shorter recovery time. How long does it take to recover from anterior hip replacement as opposed to the posterior method?
Dr. Sidhu: Traditionally, what I've been noticing in my patients, you know, I talk to them about assisted device use. I anticipate about a week combination of Walker and cane, and most people will hang onto a cane for two to three weeks. And not uncommon for people to get back to their normal day to day activities at about somewhere between four weeks to six weeks following surgery, which in my opinion, I think that's pretty remarkable considering that we're removing a joint and replacing it with an artificial joint. So I would say on average return to normal day to day activities, somewhere between the four to six week period, depending on the health of the patient. Of course.
Host: Yeah. This is really interesting. So why is it important that you are offering this type of approach?
Dr. Sidhu: I think it's very important because we have live image feedback when we're doing hip replacements from the front. And what that means is we have a live x-ray that we take interoperatively. And what that allows me to do is really pinpoint where I want the implants to be placed as far as you know, the angles and the length of the implants. And therefore I'm able to restore somebody's leg length and make it equal to what it should be as opposed to guessing as to where it should be. So I can compare an x-ray before surgery and compare that to after surgery and really try to restore the patient's anatomy. And I think that's very crucial in being able to give them faster recovery and giving them a joint that's stable and not dislocated. So that's why I think it's important to know that this is an option, a very good option that's available.
Host: Well, the benefits to the patient are clear, but it also sounds like this helps you as well. It sounds like you're able to be much more precise in the replacement. Is that correct?
Dr. Sidhu: It does. Again, I want to make sure I have every tool available to me to do the best job I can for my patients and give them the best surgery that I can offer them in my hands, and in my opinion, this, this is it. And I have that additional feedback by getting an x-ray whenever I want in the OR. And getting a very good imaging quality as a result.
Host: So in hip replacement, I know there's something called precautions. Can you explain that to us and what the precautions are for the anterior approach and how they're different from the posterior approach.
Dr. Sidhu: When hip replacement is done from the back, you know there are certain precautions. Those include not squatting below, you know, the level of your knees, not bringing your knees into your chest and things like that. Traditionally when hips dislocate, they dislocate to the back and we frankly just don't see that when the hip replacement is done from the front because all the muscles, the surrounding structures around the joint are all left intact behind the hip. So as a result, and what a lot of the studies are showing is the risk of dislocation when the replacement is done from the front is very, very, very low. And again, you know, as a patient, what people want to know is what can I do and what can't I do? And I hope that I can offer my patients a lot more of you can as opposed to you can't.
Host: Well, it certainly sounds like there's a lot more can do than can't do with the anterior approach. So are people becoming aware of this? Are they starting to ask for it?
Dr. Sidhu: Yeah, you know, as, as it is starting to become more prevalent and more studies are starting to come out and people are seeing, you know, their grandma, their friend, their aunt who's had a hip replacement done from the front, seeing, you know, the rapid recovery that occurs following that. It's kind of a no brainer for a lot of people.
Host: Well, Dr. Sidhu, This has really been fascinating and interesting. Thank you so much for your time. We appreciate it.
Dr. Sidhu: Yeah, thank you. My pleasure. Thank you for having me. Always appreciate it.
Host: That's Dr. Jaspreet Sidhu. And for more information, please visit StJosephscares.org/ortho. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, A Dignity Health Podcast. I'm Bill Klaproth. Thanks for listening.