The drive for minimally-invasive surgeries has led to innovations that improve patient outcomes and decrease recovery time. The anterior approach to hip replacement is one such innovation, disrupting the tissues less than the side approach that was conventionally used.
Dr. Steve Pennington, orthopedic surgeon with Inland Orthopedics, discusses the anterior approach and its benefits for the patient.
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Benefits of Anterior Approach to Hip Replacement Surgery
Featuring:
Steve Pennington, MD
Steve Pennington, MD has been practicing at Inland Orthopaedic Surgery & Sports Medicine Clinic in Pullman and Moscow since 1997. He is board certified by the American Board of Orthopaedic Surgery and the American Board of Orthopedic Surgery Sports Medicine. He performed his residency in orthopedic surgery at Campbell Clinic at the University of Tennessee. He graduated from medical school from Oregon Health Sciences University. Additionally, he serves as the team physician for the University of Idaho Department of Intercollegiate Athletics. Transcription:
Bill Klaproth (Host): 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 an anterior hip replacement, now being offered at Pullman Regional Hospital’s Orthopedic Center of Excellence. And here to talk with us about the anterior approach to hip replacement surgery is Dr. Steve Pennington, an Orthopedic Surgeon with Inland Orthopedics at Pullman Regional Hospital. Dr. Pennington, thank you for your time. What is the anterior approach to surgical hip replacement, and how does it differ from the posterior approach?
Dr. Steve Pennington (Guest): Well, thanks for letting me visit with you about this today. The approach to the hip is simply surgery terms for how we get there. When a hip is worn out, it can be approached from either the front or the back. An anterior approach refers to going into the hip from the front.
Bill: Dr. Pennington, how does this differ then from — so, you go in then from the front, not the back. Going in from the back is traditionally how you do it?
Dr. Pennington: Correct. That’s called the posterior approach. For many years, hip replacements have been done very well from a posterior approach. More recently, as orthopedists, we’re always looking for ways to do a better surgery, with a faster recovery, and have less pain. Going in from the front has always made a lot of sense. More recently, with better instruments and techniques that have been pioneered, going in through the front seems to meet some of those requirements.
Bill: It sounds like there’s advantages then to the anterior approach?
Dr. Pennington: I think that’s true, yes. Some of the advantages of the anterior approach are first of all, less muscle damage. Traditionally, going in from the posterior approach would have to cut through the gluteus maximus muscle, and then actually cut some of the small muscles that would have to be repaired at the end of the case. With the anterior approach, it’s a muscle-sparing approach. No muscles are cut. They’re just moved to the side, and so that is a tremendous advantage. Also, there is less postoperative pain; there is a faster recovery. Importantly, there is must less risk of dislocation of the hip, which has been an ongoing problem with posterior approach. Even though it doesn’t happen often, when it does it’s a severe problem. We think there is a better range-of-motion with the anterior approach, and also, we can correct leg-length differences with an anterior approach, which is something that the posterior approach did not allow.
Bill: This is amazing. Who is a good candidate for the anterior approach?
Dr. Pennington: Well, the approach to the hip is for people who have arthritis to the hip. The hip joint is a ball-in-socket, and when the ball-in-socket wears out, it’s extremely painful. Obviously, having hip arthritis — pretty much anyone who needs a hip replacement can have the anterior approach. There is a little bit of a problem with heavier patients. If they have — frankly, their belly, if it hangs over a little too far going in from the front, that can cause some wound problems. We like to have patients with a BMI — a Body Mass Index — of less than about 35. Generally, anyone who is a candidate for a hip replacement can have an anterior hip approach.
Bill: With less muscle damage — it is minimally-invasive — I would imagine the recovery time from an anterior approach is less?
Dr. Pennington: Yes. I would state that at a year, it seems that there’s no difference whether you went in from the front or whether you went in from the back to have your hip replacement, but I think where we’re seeing the real advantage is in the immediate postoperative period. The stay can be — actually, some patients are going home the same day. Generally though, you’ll spend one night in the hospital, and that’s all barring any kind of a problem or an issue. It’s a shorter hospitalization, and then there’s no precautions that we have to take as far as worrying about dislocation as much. Patients within a few hours of surgery can be up bearing full weight and working on full range-of-motion. We’re also finding that with less postoperative pain and faster walking that patients are returning to work much sooner, as well.
Bill: You just mentioned precautions. I’m wondering, how are the precautions for the anterior procedure different from the posterior approach?
Dr. Pennington: Well, sure. Yeah, typically, with the posterior approach, which all of us have done for many years — myself for 20 years — putting in the hip — going in posteriorly we had to worry about dislocation. We would really have to limit your range-of-motion for the first 8- to 12-weeks after surgery, where you just couldn’t bring your knees too close to your chest, for example. And then, oftentimes, patients would need to sleep with a wedge between their knees for several weeks. All of those precautions are not necessary with the anterior approach because going in from the front we don’t disrupt any of the ligaments or muscles that hold the hip in place, so we have a lot less worries about dislocation.
Bill: Dr. Pennington, why is it important that you are offering this type of approach?
Dr. Pennington: Well, with our Orthopedic Center of Excellence with the Pullman Hospital, we really try to be a full-service orthopedic situation here in Pullman. Because of that, we want to do everything as good as it can be done. We want to be up-to-date on everything, and I think that the anterior approach is the wave of the future as far as orthopedics and doing hip replacements. In terms of looking for the best surgery, the fastest recovery, and the least pain, and to have that type of surgery be offered at Pullman Regional at our local hospital, it’s going to be a huge advantage to our patients who don’t have to travel elsewhere to have this type of cutting-edge surgery done elsewhere.
Bill: Good to know, Dr. Pennington, that this procedure is now being offered at Pullman Regional Hospital’s Orthopedic Center of Excellence. Thank you so much for your time. For more information, please visit PullmanRegional.org, that’s PullmanRegional.org. This is the Health Podcast from Pullman Regional. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): 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 an anterior hip replacement, now being offered at Pullman Regional Hospital’s Orthopedic Center of Excellence. And here to talk with us about the anterior approach to hip replacement surgery is Dr. Steve Pennington, an Orthopedic Surgeon with Inland Orthopedics at Pullman Regional Hospital. Dr. Pennington, thank you for your time. What is the anterior approach to surgical hip replacement, and how does it differ from the posterior approach?
Dr. Steve Pennington (Guest): Well, thanks for letting me visit with you about this today. The approach to the hip is simply surgery terms for how we get there. When a hip is worn out, it can be approached from either the front or the back. An anterior approach refers to going into the hip from the front.
Bill: Dr. Pennington, how does this differ then from — so, you go in then from the front, not the back. Going in from the back is traditionally how you do it?
Dr. Pennington: Correct. That’s called the posterior approach. For many years, hip replacements have been done very well from a posterior approach. More recently, as orthopedists, we’re always looking for ways to do a better surgery, with a faster recovery, and have less pain. Going in from the front has always made a lot of sense. More recently, with better instruments and techniques that have been pioneered, going in through the front seems to meet some of those requirements.
Bill: It sounds like there’s advantages then to the anterior approach?
Dr. Pennington: I think that’s true, yes. Some of the advantages of the anterior approach are first of all, less muscle damage. Traditionally, going in from the posterior approach would have to cut through the gluteus maximus muscle, and then actually cut some of the small muscles that would have to be repaired at the end of the case. With the anterior approach, it’s a muscle-sparing approach. No muscles are cut. They’re just moved to the side, and so that is a tremendous advantage. Also, there is less postoperative pain; there is a faster recovery. Importantly, there is must less risk of dislocation of the hip, which has been an ongoing problem with posterior approach. Even though it doesn’t happen often, when it does it’s a severe problem. We think there is a better range-of-motion with the anterior approach, and also, we can correct leg-length differences with an anterior approach, which is something that the posterior approach did not allow.
Bill: This is amazing. Who is a good candidate for the anterior approach?
Dr. Pennington: Well, the approach to the hip is for people who have arthritis to the hip. The hip joint is a ball-in-socket, and when the ball-in-socket wears out, it’s extremely painful. Obviously, having hip arthritis — pretty much anyone who needs a hip replacement can have the anterior approach. There is a little bit of a problem with heavier patients. If they have — frankly, their belly, if it hangs over a little too far going in from the front, that can cause some wound problems. We like to have patients with a BMI — a Body Mass Index — of less than about 35. Generally, anyone who is a candidate for a hip replacement can have an anterior hip approach.
Bill: With less muscle damage — it is minimally-invasive — I would imagine the recovery time from an anterior approach is less?
Dr. Pennington: Yes. I would state that at a year, it seems that there’s no difference whether you went in from the front or whether you went in from the back to have your hip replacement, but I think where we’re seeing the real advantage is in the immediate postoperative period. The stay can be — actually, some patients are going home the same day. Generally though, you’ll spend one night in the hospital, and that’s all barring any kind of a problem or an issue. It’s a shorter hospitalization, and then there’s no precautions that we have to take as far as worrying about dislocation as much. Patients within a few hours of surgery can be up bearing full weight and working on full range-of-motion. We’re also finding that with less postoperative pain and faster walking that patients are returning to work much sooner, as well.
Bill: You just mentioned precautions. I’m wondering, how are the precautions for the anterior procedure different from the posterior approach?
Dr. Pennington: Well, sure. Yeah, typically, with the posterior approach, which all of us have done for many years — myself for 20 years — putting in the hip — going in posteriorly we had to worry about dislocation. We would really have to limit your range-of-motion for the first 8- to 12-weeks after surgery, where you just couldn’t bring your knees too close to your chest, for example. And then, oftentimes, patients would need to sleep with a wedge between their knees for several weeks. All of those precautions are not necessary with the anterior approach because going in from the front we don’t disrupt any of the ligaments or muscles that hold the hip in place, so we have a lot less worries about dislocation.
Bill: Dr. Pennington, why is it important that you are offering this type of approach?
Dr. Pennington: Well, with our Orthopedic Center of Excellence with the Pullman Hospital, we really try to be a full-service orthopedic situation here in Pullman. Because of that, we want to do everything as good as it can be done. We want to be up-to-date on everything, and I think that the anterior approach is the wave of the future as far as orthopedics and doing hip replacements. In terms of looking for the best surgery, the fastest recovery, and the least pain, and to have that type of surgery be offered at Pullman Regional at our local hospital, it’s going to be a huge advantage to our patients who don’t have to travel elsewhere to have this type of cutting-edge surgery done elsewhere.
Bill: Good to know, Dr. Pennington, that this procedure is now being offered at Pullman Regional Hospital’s Orthopedic Center of Excellence. Thank you so much for your time. For more information, please visit PullmanRegional.org, that’s PullmanRegional.org. This is the Health Podcast from Pullman Regional. I’m Bill Klaproth. Thanks for listening.