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What Is an Anterior Hip Replacement?
Many people have heard of hip replacements. They restore mobility and relieve pain in people with degenerative hip disease or hip trauma. There is a technique called an anterior hip replacement that has been shown to be less painful than many other hip replacement options. In this podcast, Dr. William Cook, chief of orthopaedic surgery at UM Upper Chesapeake Health, discusses what makes this procedure different, who is eligible, what surgery is like and much more.
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William Cook, MD
William Pierson Cook, IV, MD, is an orthopedic surgeon who specializes in total joint replacement, including total knee replacement, minimally invasive anterior total hip replacement, traditional shoulder replacement, reverse shoulder replacement, and disorders of the rotator cuff. He has more than 30 years of experience. He treats patients of all ages and develops lasting relationships with them and their families. He is chief of orthopaedic surgery at University of Maryland Upper Chesapeake Health. Dr. Cook is a member of the University of Maryland Joint Network, a group of surgeons known for their advanced expertise and positive outcomes in total hip and knee replacement. He sees patients in Bel Air and Aberdeen and is affiliated with University of Maryland Community Medical Group and UM Upper Chesapeake Health.Learn more about Dr. Cook
Learn more about the Upper Chesapeake Orthopaedic Specialty Group
Transcription:
What Is an Anterior Hip Replacement?
Joey Wahler: You may have heard of total hip replacement, which has been discussed on this podcast, but what is an anterior hip replacement? This is Live Greater, a University of Maryland Medical System podcast. Thanks for listening. I'm Joey Wahler. Our guest, Dr. William Cook. He's Chief of Orthopedic Surgery at University of Maryland Upper Chesapeake Health. He specializes in shoulder, hip, and knee replacement and minimally invasive anterior total hip replacement, which we'll discuss today. Dr. Cook, thanks for joining us.
Dr. William Cook: It's my pleasure, Joey. Nice to speak with you again.
Joey Wahler: Yes. We've spoken before about other topics. Great to have you back. So first, we'll get into some specifics in a moment. But simply put to get us started, what is the basic difference between anterior and other types of hip replacement?
Dr. William Cook: The anterior total hip replacement refers to where the incision is made and what anatomic interval we go through in order to replace the joint. Traditionally, total hips have been done either from the side or from the back through the buttocks area. The anterior hip goes through the quadriceps muscles up near the hip bone. And because the quadriceps muscles run parallel up to the hip, it's able to spread the muscles between two intervals without detaching or cutting through the muscle, that it gives us a direct approach to the joint and it requires less healing postoperatively because the muscle recovers much faster.
Joey Wahler: Gotcha. So before we go any further, who is and who isn't typically a good candidate for this procedure?
Dr. William Cook: Well, we have found that if someone is overly obese, it's a difficult approach because often the stomach will hang down over where the incision is supposed to be. Also, if someone has very weak bone, sometimes we have an increased risk of bone fracture when we have to position the leg to accommodate this approach. So, we would prefer a different approach if they had very bad osteoporosis. And also, patients who, and believe this or not, are overly muscled. So for instance, a bodybuilder who had very large muscles that had to be spread or moved, sometimes it can make it very difficult to get to the hip joint through this approach.
Joey Wahler: Someone that's overly muscled, so I certainly wouldn't have that problem, doc.
Dr. William Cook: That's right. So, Arnold Schwarzenegger might have trouble here.
Joey Wahler: Bad news for Arnold.
Dr. William Cook: But generally, we have a wide range of folks that we can find this approach is very suitable for.
Joey Wahler: Sure. So when you first examine someone, how is the need or possible need for AHR, as it's known, diagnosed by you?
Dr. William Cook: So, a hip replacement is a very common procedure now, and what brings people in most commonly is pain. They also have loss of motion and sometimes weakness that accompanies this from loss of use of the joint over the years. We can diagnose it very easily with a physical exam, a good history, and also x-rays.
Joey Wahler: Are we talking in or outpatient? About how long does this procedure take? And is there anything else you want to tell us about the operation itself?
Dr. William Cook: I would say at least 50% of my patients are now outpatient total hip replacements. Because the incision is smaller and the muscles are minimally damaged, we're able to send them home full weightbearing with appropriate medical follow up with our home health teams. If someone has some other medical issues that we want to watch, such as heart disease, then we'll probably watch them overnight in the hospital to make sure everything's okay. And once they've had appropriate physical therapy, again, get them home with their home health team.
Joey Wahler: How long does this procedure usually take?
Dr. William Cook: Generally, the operative time is about an hour. With setup time, anesthesia and nursing involvement, it's about a two-hour block of time. And then postoperatively, once the anesthesia wears off, it's a couple of hours for people to get their energy back. If they are going to go home the same day, we like to have them do some exercises with our physical therapist, and make sure that they're safe for transfers. And other things, such as being able to go to the bathroom, not have any nausea, and have their pain well controlled are certainly addressed before they go home.
Joey Wahler: So doc, when one of these is being performed, what tells the surgeon that it's a job well done? Is there one key to this particular procedure from your standpoint when you're in there?
Dr. William Cook: Well, I'm going to back up a little bit here, Joey, and I'm just going to say that the benefits of this operation are that we take away the pain initially. That's what people brings people in. And once they get their pain removed, they have much better stamina and their range of motion is reestablished. So, their activities of daily living are reestablished and that their quality of life is greatly improved.
One of the advantages of anterior total hip is that we do this under direct x-ray imaging, so that we know exactly at each stage of the operation what the appropriate size implant is, that we have it in the correct position and also that some important factors for function later, such as leg length and the hip offset so that the muscles feel natural, are reestablished. And by checking at each step of the operation, we can ensure that the cup is in the correct place, that the leg lengths match, and that the muscle function is reestablished by incorporating the proper offset into our design.
The other factor is the stability of the joint. And if you said there's a takeaway, we certainly want to make sure that in addition to the radiographic evidence, that our physical exam shows that it's a nice, stable hip with good range of motion before we finish the case.
Joey Wahler: How about recovery time and how would that compare in this procedure to other hip replacements? You touched on it earlier. But specifically, what would be, from a time standpoint, the difference between the two?
Dr. William Cook: So in some of the other approaches when they have to repair muscle back to bone, they have to limit certain activities so that it doesn't injure the repair. With an anterior hip, because there is no reattachment of muscle or sewing of muscle back together, we can allow them a much faster return to recovery. Our studies have shown that initially the anterior hip allows people much faster return to normal activity. However, after about a year, once the other types of hips have healed up, there's very little difference after about one year.
Joey Wahler: You mentioned earlier some of the benefits that people experience after undergoing this procedure. How rewarding for someone like you to see people come in in one condition and eventually, after a certain amount of timeout, to be in a completely better place?
Dr. William Cook: Well, you said it, you took the words out of my mouth, Joey. After a while of being a surgeon, you know, we live a comfortable life generally, and people know that. But the real rewards of surgery come from seeing our patients get better. It's so gratifying to have someone come in with a stiff, painful limb and, after taking care of it, to have them leave with their life changed, knowing that they're going to have an improved quality of life for decades to come because of their joint replacement.
Joey Wahler: Great to hear that. Couple of other things, doc. First, do these last for a lifetime? Or if not, how long are we talking about?
Dr. William Cook: Well, you know, when I first went into practice, it was common to tell a patient 10 or 15 years was the lifetime of the joint. But our engineers have done such a good job of improving the strength of our materials and the longevity of our bearing surfaces, that we can honestly say 30 years to a lifetime is a normal expectation for joint replacement.
The bearing surface that used to wear out, the cartilage replacement now has been made in such a way that it rarely shows the type of wear that used to cause revision surgery. And most of the time, when I have to replace a previously placed joint, it's because it was an older design that's worn out or because of a new trauma that's caused a fracture or loosened at the joint. But under normal wear and tear, I now tell my patients 30 years to a lifetime is a reasonable expectation.
Joey Wahler: How about any potential downside in terms of complications or anything else along those lines?
Dr. William Cook: Well, generally, the complication rate is 1% or less, and it can come in the form of possible infection, which is rare. We see it more in diabetics and in overly obese patients, and we try to counsel to lose weight before we do the surgery. There's a small risk of fracture in osteoporotic patients. In other types of approaches, there is a risk of leg length discrepancy and occasional nerve pain from the incision and also rare, but occasional, dislocation. And I will tell you that since I concentrated on anterior total hip replacements, my dislocation rate has gotten even lower because of the advantage of having the x-ray guidance to make sure that the components are in perfect position.
Joey Wahler: And finally, doctor, in summary here, you've talked so much about all these great advancements in this procedure in the time you've been doing them, what's your overall message to someone listening that may be considering having this done?
Dr. William Cook: My message would be, If you have pain and stiffness of a joint due to arthritis, that there are solutions and that it's a much easier process than most people are aware of. We do thousands of these every year. The pathway is laid out for people. It is a well-oiled machine. We have people helping them preoperatively during their surgery and postoperatively. I will tell you the most common comment I get after a joint replacement, whether it be shoulder, hip, or knee, is "I wish I hadn't waited so long, doc, if I'd known it'd been this easy." I truly believe that it's a life-changing operation.
Joey Wahler: Well, it certainly sounds like it. So, the message there, don't wait. Folks, we trust you're now more familiar with anterior hip replacement. Dr. William Cook, a pleasure as always. Thanks so much again.
Dr. William Cook: My pleasure.
Joey Wahler: And you can find more shows just like this one at umms.org/podcast. Again, umms.org/podcast and on the University of Maryland Medical System YouTube channel as well. Now, if you found this podcast helpful, please do share it on your social media. And thanks again for listening to Live Greater Health and Wellness Podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again. Hoping your health is good health. I'm Joey Wahler.
What Is an Anterior Hip Replacement?
Joey Wahler: You may have heard of total hip replacement, which has been discussed on this podcast, but what is an anterior hip replacement? This is Live Greater, a University of Maryland Medical System podcast. Thanks for listening. I'm Joey Wahler. Our guest, Dr. William Cook. He's Chief of Orthopedic Surgery at University of Maryland Upper Chesapeake Health. He specializes in shoulder, hip, and knee replacement and minimally invasive anterior total hip replacement, which we'll discuss today. Dr. Cook, thanks for joining us.
Dr. William Cook: It's my pleasure, Joey. Nice to speak with you again.
Joey Wahler: Yes. We've spoken before about other topics. Great to have you back. So first, we'll get into some specifics in a moment. But simply put to get us started, what is the basic difference between anterior and other types of hip replacement?
Dr. William Cook: The anterior total hip replacement refers to where the incision is made and what anatomic interval we go through in order to replace the joint. Traditionally, total hips have been done either from the side or from the back through the buttocks area. The anterior hip goes through the quadriceps muscles up near the hip bone. And because the quadriceps muscles run parallel up to the hip, it's able to spread the muscles between two intervals without detaching or cutting through the muscle, that it gives us a direct approach to the joint and it requires less healing postoperatively because the muscle recovers much faster.
Joey Wahler: Gotcha. So before we go any further, who is and who isn't typically a good candidate for this procedure?
Dr. William Cook: Well, we have found that if someone is overly obese, it's a difficult approach because often the stomach will hang down over where the incision is supposed to be. Also, if someone has very weak bone, sometimes we have an increased risk of bone fracture when we have to position the leg to accommodate this approach. So, we would prefer a different approach if they had very bad osteoporosis. And also, patients who, and believe this or not, are overly muscled. So for instance, a bodybuilder who had very large muscles that had to be spread or moved, sometimes it can make it very difficult to get to the hip joint through this approach.
Joey Wahler: Someone that's overly muscled, so I certainly wouldn't have that problem, doc.
Dr. William Cook: That's right. So, Arnold Schwarzenegger might have trouble here.
Joey Wahler: Bad news for Arnold.
Dr. William Cook: But generally, we have a wide range of folks that we can find this approach is very suitable for.
Joey Wahler: Sure. So when you first examine someone, how is the need or possible need for AHR, as it's known, diagnosed by you?
Dr. William Cook: So, a hip replacement is a very common procedure now, and what brings people in most commonly is pain. They also have loss of motion and sometimes weakness that accompanies this from loss of use of the joint over the years. We can diagnose it very easily with a physical exam, a good history, and also x-rays.
Joey Wahler: Are we talking in or outpatient? About how long does this procedure take? And is there anything else you want to tell us about the operation itself?
Dr. William Cook: I would say at least 50% of my patients are now outpatient total hip replacements. Because the incision is smaller and the muscles are minimally damaged, we're able to send them home full weightbearing with appropriate medical follow up with our home health teams. If someone has some other medical issues that we want to watch, such as heart disease, then we'll probably watch them overnight in the hospital to make sure everything's okay. And once they've had appropriate physical therapy, again, get them home with their home health team.
Joey Wahler: How long does this procedure usually take?
Dr. William Cook: Generally, the operative time is about an hour. With setup time, anesthesia and nursing involvement, it's about a two-hour block of time. And then postoperatively, once the anesthesia wears off, it's a couple of hours for people to get their energy back. If they are going to go home the same day, we like to have them do some exercises with our physical therapist, and make sure that they're safe for transfers. And other things, such as being able to go to the bathroom, not have any nausea, and have their pain well controlled are certainly addressed before they go home.
Joey Wahler: So doc, when one of these is being performed, what tells the surgeon that it's a job well done? Is there one key to this particular procedure from your standpoint when you're in there?
Dr. William Cook: Well, I'm going to back up a little bit here, Joey, and I'm just going to say that the benefits of this operation are that we take away the pain initially. That's what people brings people in. And once they get their pain removed, they have much better stamina and their range of motion is reestablished. So, their activities of daily living are reestablished and that their quality of life is greatly improved.
One of the advantages of anterior total hip is that we do this under direct x-ray imaging, so that we know exactly at each stage of the operation what the appropriate size implant is, that we have it in the correct position and also that some important factors for function later, such as leg length and the hip offset so that the muscles feel natural, are reestablished. And by checking at each step of the operation, we can ensure that the cup is in the correct place, that the leg lengths match, and that the muscle function is reestablished by incorporating the proper offset into our design.
The other factor is the stability of the joint. And if you said there's a takeaway, we certainly want to make sure that in addition to the radiographic evidence, that our physical exam shows that it's a nice, stable hip with good range of motion before we finish the case.
Joey Wahler: How about recovery time and how would that compare in this procedure to other hip replacements? You touched on it earlier. But specifically, what would be, from a time standpoint, the difference between the two?
Dr. William Cook: So in some of the other approaches when they have to repair muscle back to bone, they have to limit certain activities so that it doesn't injure the repair. With an anterior hip, because there is no reattachment of muscle or sewing of muscle back together, we can allow them a much faster return to recovery. Our studies have shown that initially the anterior hip allows people much faster return to normal activity. However, after about a year, once the other types of hips have healed up, there's very little difference after about one year.
Joey Wahler: You mentioned earlier some of the benefits that people experience after undergoing this procedure. How rewarding for someone like you to see people come in in one condition and eventually, after a certain amount of timeout, to be in a completely better place?
Dr. William Cook: Well, you said it, you took the words out of my mouth, Joey. After a while of being a surgeon, you know, we live a comfortable life generally, and people know that. But the real rewards of surgery come from seeing our patients get better. It's so gratifying to have someone come in with a stiff, painful limb and, after taking care of it, to have them leave with their life changed, knowing that they're going to have an improved quality of life for decades to come because of their joint replacement.
Joey Wahler: Great to hear that. Couple of other things, doc. First, do these last for a lifetime? Or if not, how long are we talking about?
Dr. William Cook: Well, you know, when I first went into practice, it was common to tell a patient 10 or 15 years was the lifetime of the joint. But our engineers have done such a good job of improving the strength of our materials and the longevity of our bearing surfaces, that we can honestly say 30 years to a lifetime is a normal expectation for joint replacement.
The bearing surface that used to wear out, the cartilage replacement now has been made in such a way that it rarely shows the type of wear that used to cause revision surgery. And most of the time, when I have to replace a previously placed joint, it's because it was an older design that's worn out or because of a new trauma that's caused a fracture or loosened at the joint. But under normal wear and tear, I now tell my patients 30 years to a lifetime is a reasonable expectation.
Joey Wahler: How about any potential downside in terms of complications or anything else along those lines?
Dr. William Cook: Well, generally, the complication rate is 1% or less, and it can come in the form of possible infection, which is rare. We see it more in diabetics and in overly obese patients, and we try to counsel to lose weight before we do the surgery. There's a small risk of fracture in osteoporotic patients. In other types of approaches, there is a risk of leg length discrepancy and occasional nerve pain from the incision and also rare, but occasional, dislocation. And I will tell you that since I concentrated on anterior total hip replacements, my dislocation rate has gotten even lower because of the advantage of having the x-ray guidance to make sure that the components are in perfect position.
Joey Wahler: And finally, doctor, in summary here, you've talked so much about all these great advancements in this procedure in the time you've been doing them, what's your overall message to someone listening that may be considering having this done?
Dr. William Cook: My message would be, If you have pain and stiffness of a joint due to arthritis, that there are solutions and that it's a much easier process than most people are aware of. We do thousands of these every year. The pathway is laid out for people. It is a well-oiled machine. We have people helping them preoperatively during their surgery and postoperatively. I will tell you the most common comment I get after a joint replacement, whether it be shoulder, hip, or knee, is "I wish I hadn't waited so long, doc, if I'd known it'd been this easy." I truly believe that it's a life-changing operation.
Joey Wahler: Well, it certainly sounds like it. So, the message there, don't wait. Folks, we trust you're now more familiar with anterior hip replacement. Dr. William Cook, a pleasure as always. Thanks so much again.
Dr. William Cook: My pleasure.
Joey Wahler: And you can find more shows just like this one at umms.org/podcast. Again, umms.org/podcast and on the University of Maryland Medical System YouTube channel as well. Now, if you found this podcast helpful, please do share it on your social media. And thanks again for listening to Live Greater Health and Wellness Podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again. Hoping your health is good health. I'm Joey Wahler.