Many people suffering with arthritis, hip pain, and stiffness can now choose a less invasive procedure when considering hip replacement surgery.
The Anterior surgical procedure is a technique that minimizes the pain and time from surgery to recovery.
The Anterior Approach allows the surgeon to reach the hip joint from the front of the hip as opposed to the lateral (side), or the posterior (back) approach.
Kristopher M. Williams, DO, Schneck Orthopedics & Sports Medicine, is here to discuss the Anterior surgical procedure and how it can the procedure you are looking for.
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What You Need To Know About Anterior Hip Replacement
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Learn more about Kristopher M. Williams, DO
Kristopher M. Williams, DO
Dr. Williams attended Midwestern University in Chicago and completed his residency at Midwestern University in Chicago. He joined the medical staff of Schneck Medical Center in 2009.Learn more about Kristopher M. Williams, DO
Transcription:
What You Need To Know About Anterior Hip Replacement
Bill Klaproth (Host): Having a painful hip can severely affect your independence, your lifestyle, your job and more. What are your options? There is traditional hip replacement surgery or are you a candidate for a new, same day, minimally invasive hip replacement procedure called an “anterior hip replacement”? What is that? With us is Dr. Chris Williams, an orthopedic surgeon and sports medicine specialist at Schneck Medical Center and he’s going to tell us all about it. Dr. Williams, thank you so much for your time today. Tell us about this new procedure – the anterior total hip joint replacement procedure. What is it?
Dr. Chris Williams (Guest): Anterior approach hip replacement is a newer procedure. It involves a lot less surgical dissection and is involved with a quicker recovery.
Bill: Is everybody a candidate for this? What are the things you look for for someone who would be a good candidate for this?
Dr. Williams: Pretty much anyone who is a candidate for total hip replacement would be a candidate for anterior hip replacement. There are some surgeons who perform the anterior approach that weed out certain patients but in my practice, that’s all that I do. Every hip replacement that I do is through the anterior approach.
Bill: This differs from traditional hip replacement surgery. I take it for traditional hip replacement surgery you go from the front and this is kind of front the back, right?
Dr. Williams: Actually, it’s opposite. Traditional hip replacement utilizes the posterior incision, so that’s an incision on the back, kind of over the gluteus maximus and through those muscles. The anterior approach hip replacement is through the front and the great thing about that is, we don’t have to cut through any muscle to put the replacement in. Basically, once I get through the skin I just move the muscles out of the way and there is a kind of a window where I can access the hip joint. That’s different than the posterior approach. The posterior approach you have to cut through the gluteus muscles and, obviously, that’s a lot larger dissection and associated with more post-operative pain.
Bill: This seems like such a better way to perform hip replacement surgery. Why is this new? Why hasn’t this been done for a long time?
Dr. Williams: The approach itself dates back to the beginnings of orthopedics – when orthopedics was primarily surgery on children. This anterior approach was used to treat different hip diseases in kids but it was technically difficult to put a hip replacement in through the anterior approach. There’s been some new technology, some different surgical tables and some pioneering surgeons that refined the technique to enable us to go ahead and put a hip replacement in through the front. It’s just kind of an evolution of medicine. I think eventually it will be the mainstay. Right now, there are very few people performing it simply because it’s hard. It’s technically difficult and a lot of established surgeons don’t want to take the extra time to go back and learn a new technique. I had the advantage of training with this technique in Chicago and I did a lot of practice in a lab before I started practice. That’s basically why not everybody is doing it.
Bill: Are there more risks with this then traditional hip replacement surgery or less?
Dr. Williams: I would say overall there’s less risk. There’s definitely a lower incidence of dislocation which is one thing that we worry about with a posterior hip replacement--the ball kind of popping out of the socket. That’s really a very, very low risk with the anterior approach replacement. The other risks are essentially the same. Anytime you have surgery, there’s a risk of infection and so forth. None of those risks are any higher than any other approach to a hip replacement.
Bill: The main benefit then is basically recovery time?
Dr. Williams: Yes the recovery time is substantially quicker and that’s what I’ve seen in my practice. I’ve seen less use of narcotic pain medication. So, less post-operative pain immediately, quicker recovery, and even if you march it out long-term, the anterior approach patients do just slightly better than the posterior approach even on a long-term - like a two year follow up. There are a ton of advantages to it.
Bill: We’ve heard of patients actually going in early in the morning and then going home later that day.
Dr. Williams: That is possible. I would say that’s not typical. A lot of times, I keep patients overnight for antibiotics and to get some good therapy in before they leave. But, there are some surgeons out there that are doing the same day surgery – even in a surgery center type setting.
Bill: The amount of hospital stay either way is dramatically less then.
Dr. Williams: Absolutely. Yes.
Bill: What about the recovery period then? Is it easier in physical therapy after this procedure?
Dr. Williams: That’s what I’ve seen in my practice. I’ve had patients that didn’t even require any therapy after surgery which is something that I never saw from the posterior approach. It’s a lot quicker and the therapy doesn’t last as long. People are able to get back to what they want to do a lot sooner after this anterior approach replacement.
Bill: All important and good benefits of this new procedure. Are there long term benefits? Will this last longer than a traditional hip replacement or does that not matter in this?
Dr. Williams: There’s theory behind that. Definitely, I feel that the component positioning, the way that the parts are put in, I believe, is more accurate through an anterior approach. A lot of that is due to I can use x-ray during the procedure whereas during a posterior approach usually x-ray is not done until after the procedure is over. I can use real-time x-ray and fine tune the position of my component. That’s been shown in studies to increase the longevity of your component. It lasts longer if it’s put in more accurately. Definitely, it can last longer because of that reason. I also use a different material. It’s a proprietary metal called “oxinium” and there are some studies out there that show that that is one of the longest lasting implants out on the market. We definitely are putting in replacements that hopefully outlast the patient.
Bill: That’s terrific news. The recovery time is less. How soon can someone expect to resume basic normal daily things again?
Dr. Williams: A lot of that is due to the patient. What I tell patients on average is in about six weeks you’re feeling really good with it and in about three months, you’re really not thinking about the replacement anymore. That being said, I’ve had patients that have worked in factories be back to work full duty in four weeks. Right after you leave the hospital – actually the next day after surgery – you’re up and walking around and starting therapy. It varies per patient but I would say, on average, in six weeks you’re feeling pretty good.
Bill: How does that differ from traditional hip replacement surgery, then?
Dr. Williams: It’s quicker. Definitely quicker. When I was doing posterior approach, I didn’t see that quick a return to activity. Definitely an advantage there.
Bill: You said that you do this all the time. This is your normal way of doing a hip replacement. A lot of physicians still do it the old way. Is there someone who is just not physically right for this procedure?
Dr. Williams: Sometimes with the size of the pelvis, it can make it more difficult. That can be based on a patient’s weight and obesity level or it can be just the way that their bones are formed that can make it more difficult. But, as I said before, since I started doing anterior hip replacement about six years ago, I do all of my patients that way.
Bill: For someone that is dealing with hip pain, hip problem, when is it time to see the doctor? When should someone come see you?
Dr. Williams: When people are starting to experience pain that limits the activities that they would like to do and if it gets hard to sleep or exercise, that’s definitely a good indication that you probably need to come in and be evaluated. We have a lot of nonsurgical options for hip pain, too. The earlier you get started on that, the better. But sometimes I have patients come in the very first visit and their hip is worn out and it’s time to be replaced. Definitely when you start seeing that your activities are falling by the wayside – maybe people are gaining weight and not able to sleep very well. That’s definitely a time to come and be evaluated.
Bill: That makes sense. With an aging baby boomer population, this anterior total hip joint replacement seems like a welcome new procedure to get people back to their life quicker. That’s for sure. Dr. Williams, why should someone choose Schneck Medical Center for their orthopedic and hip replacement needs?
Dr. Williams: Here at Schneck, we’re utilizing state of the art technology and we’re very innovative here. A lot of the techniques that I learned in Chicago at large joint centers, I brought down with me when I started operating here. We have, for instance, pre-operatively, we have an entire team of specialists which range from physical therapists to hospitalists to anesthesiologists with which we have a meeting every Friday. In fact, I just got out of that meeting. We have a meeting every Friday to discuss each patient individually and tailor their experience to them. We go through all of their medical problems and we try to predict any kind of problems or hiccups that might present themselves and we preemptively treat those things. I don’t think that’s something that’s done in a lot of places. We also have won several awards for our joint replacement techniques and process. Our infection rate is extremely low – below the national average. Overall, we get good results. Patients are happy with their treatment and it’s just a very good place to have surgery.
Bill: Dr. Williams, thank you for your time today. For more information visit SchneckMed.org. That’s SchneckMed.org. This is Schneck Radio. I’m Bill Klaproth. Thanks for listening.
What You Need To Know About Anterior Hip Replacement
Bill Klaproth (Host): Having a painful hip can severely affect your independence, your lifestyle, your job and more. What are your options? There is traditional hip replacement surgery or are you a candidate for a new, same day, minimally invasive hip replacement procedure called an “anterior hip replacement”? What is that? With us is Dr. Chris Williams, an orthopedic surgeon and sports medicine specialist at Schneck Medical Center and he’s going to tell us all about it. Dr. Williams, thank you so much for your time today. Tell us about this new procedure – the anterior total hip joint replacement procedure. What is it?
Dr. Chris Williams (Guest): Anterior approach hip replacement is a newer procedure. It involves a lot less surgical dissection and is involved with a quicker recovery.
Bill: Is everybody a candidate for this? What are the things you look for for someone who would be a good candidate for this?
Dr. Williams: Pretty much anyone who is a candidate for total hip replacement would be a candidate for anterior hip replacement. There are some surgeons who perform the anterior approach that weed out certain patients but in my practice, that’s all that I do. Every hip replacement that I do is through the anterior approach.
Bill: This differs from traditional hip replacement surgery. I take it for traditional hip replacement surgery you go from the front and this is kind of front the back, right?
Dr. Williams: Actually, it’s opposite. Traditional hip replacement utilizes the posterior incision, so that’s an incision on the back, kind of over the gluteus maximus and through those muscles. The anterior approach hip replacement is through the front and the great thing about that is, we don’t have to cut through any muscle to put the replacement in. Basically, once I get through the skin I just move the muscles out of the way and there is a kind of a window where I can access the hip joint. That’s different than the posterior approach. The posterior approach you have to cut through the gluteus muscles and, obviously, that’s a lot larger dissection and associated with more post-operative pain.
Bill: This seems like such a better way to perform hip replacement surgery. Why is this new? Why hasn’t this been done for a long time?
Dr. Williams: The approach itself dates back to the beginnings of orthopedics – when orthopedics was primarily surgery on children. This anterior approach was used to treat different hip diseases in kids but it was technically difficult to put a hip replacement in through the anterior approach. There’s been some new technology, some different surgical tables and some pioneering surgeons that refined the technique to enable us to go ahead and put a hip replacement in through the front. It’s just kind of an evolution of medicine. I think eventually it will be the mainstay. Right now, there are very few people performing it simply because it’s hard. It’s technically difficult and a lot of established surgeons don’t want to take the extra time to go back and learn a new technique. I had the advantage of training with this technique in Chicago and I did a lot of practice in a lab before I started practice. That’s basically why not everybody is doing it.
Bill: Are there more risks with this then traditional hip replacement surgery or less?
Dr. Williams: I would say overall there’s less risk. There’s definitely a lower incidence of dislocation which is one thing that we worry about with a posterior hip replacement--the ball kind of popping out of the socket. That’s really a very, very low risk with the anterior approach replacement. The other risks are essentially the same. Anytime you have surgery, there’s a risk of infection and so forth. None of those risks are any higher than any other approach to a hip replacement.
Bill: The main benefit then is basically recovery time?
Dr. Williams: Yes the recovery time is substantially quicker and that’s what I’ve seen in my practice. I’ve seen less use of narcotic pain medication. So, less post-operative pain immediately, quicker recovery, and even if you march it out long-term, the anterior approach patients do just slightly better than the posterior approach even on a long-term - like a two year follow up. There are a ton of advantages to it.
Bill: We’ve heard of patients actually going in early in the morning and then going home later that day.
Dr. Williams: That is possible. I would say that’s not typical. A lot of times, I keep patients overnight for antibiotics and to get some good therapy in before they leave. But, there are some surgeons out there that are doing the same day surgery – even in a surgery center type setting.
Bill: The amount of hospital stay either way is dramatically less then.
Dr. Williams: Absolutely. Yes.
Bill: What about the recovery period then? Is it easier in physical therapy after this procedure?
Dr. Williams: That’s what I’ve seen in my practice. I’ve had patients that didn’t even require any therapy after surgery which is something that I never saw from the posterior approach. It’s a lot quicker and the therapy doesn’t last as long. People are able to get back to what they want to do a lot sooner after this anterior approach replacement.
Bill: All important and good benefits of this new procedure. Are there long term benefits? Will this last longer than a traditional hip replacement or does that not matter in this?
Dr. Williams: There’s theory behind that. Definitely, I feel that the component positioning, the way that the parts are put in, I believe, is more accurate through an anterior approach. A lot of that is due to I can use x-ray during the procedure whereas during a posterior approach usually x-ray is not done until after the procedure is over. I can use real-time x-ray and fine tune the position of my component. That’s been shown in studies to increase the longevity of your component. It lasts longer if it’s put in more accurately. Definitely, it can last longer because of that reason. I also use a different material. It’s a proprietary metal called “oxinium” and there are some studies out there that show that that is one of the longest lasting implants out on the market. We definitely are putting in replacements that hopefully outlast the patient.
Bill: That’s terrific news. The recovery time is less. How soon can someone expect to resume basic normal daily things again?
Dr. Williams: A lot of that is due to the patient. What I tell patients on average is in about six weeks you’re feeling really good with it and in about three months, you’re really not thinking about the replacement anymore. That being said, I’ve had patients that have worked in factories be back to work full duty in four weeks. Right after you leave the hospital – actually the next day after surgery – you’re up and walking around and starting therapy. It varies per patient but I would say, on average, in six weeks you’re feeling pretty good.
Bill: How does that differ from traditional hip replacement surgery, then?
Dr. Williams: It’s quicker. Definitely quicker. When I was doing posterior approach, I didn’t see that quick a return to activity. Definitely an advantage there.
Bill: You said that you do this all the time. This is your normal way of doing a hip replacement. A lot of physicians still do it the old way. Is there someone who is just not physically right for this procedure?
Dr. Williams: Sometimes with the size of the pelvis, it can make it more difficult. That can be based on a patient’s weight and obesity level or it can be just the way that their bones are formed that can make it more difficult. But, as I said before, since I started doing anterior hip replacement about six years ago, I do all of my patients that way.
Bill: For someone that is dealing with hip pain, hip problem, when is it time to see the doctor? When should someone come see you?
Dr. Williams: When people are starting to experience pain that limits the activities that they would like to do and if it gets hard to sleep or exercise, that’s definitely a good indication that you probably need to come in and be evaluated. We have a lot of nonsurgical options for hip pain, too. The earlier you get started on that, the better. But sometimes I have patients come in the very first visit and their hip is worn out and it’s time to be replaced. Definitely when you start seeing that your activities are falling by the wayside – maybe people are gaining weight and not able to sleep very well. That’s definitely a time to come and be evaluated.
Bill: That makes sense. With an aging baby boomer population, this anterior total hip joint replacement seems like a welcome new procedure to get people back to their life quicker. That’s for sure. Dr. Williams, why should someone choose Schneck Medical Center for their orthopedic and hip replacement needs?
Dr. Williams: Here at Schneck, we’re utilizing state of the art technology and we’re very innovative here. A lot of the techniques that I learned in Chicago at large joint centers, I brought down with me when I started operating here. We have, for instance, pre-operatively, we have an entire team of specialists which range from physical therapists to hospitalists to anesthesiologists with which we have a meeting every Friday. In fact, I just got out of that meeting. We have a meeting every Friday to discuss each patient individually and tailor their experience to them. We go through all of their medical problems and we try to predict any kind of problems or hiccups that might present themselves and we preemptively treat those things. I don’t think that’s something that’s done in a lot of places. We also have won several awards for our joint replacement techniques and process. Our infection rate is extremely low – below the national average. Overall, we get good results. Patients are happy with their treatment and it’s just a very good place to have surgery.
Bill: Dr. Williams, thank you for your time today. For more information visit SchneckMed.org. That’s SchneckMed.org. This is Schneck Radio. I’m Bill Klaproth. Thanks for listening.