Total hip arthroplasty or hip replacement surgery may be recommended to treat a variety of disorders affecting the hip joint. Since it’s introduction in 1960, total hip arthroplasty has become one of the most successful procedures in medicine and is associated with high patient satisfaction rates.

 

Total hip arthroplasty is recommended for:

 

• Osteoarthritis of the hip

 

• Rheumatoid Arthritis of the hip

 

• Post-traumatic Arthritis of the hip

 

• Avascular necrosis of the hip

 

As a patient it is important to educate yourself on the type of hip replacement surgery you are planning to undergo. There are several surgical approaches to total hip arthroplasty.

 

Anterior Supine Intramuscular Total Hip Arthroplasty 
*Performed by Dr. David Eichten D.O.

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Dr. Eichten performs advanced minimally invasive techniques for total hip surgery, which includes the muscle sparing anterior approach.  The benefits of anterior total hip approach include a faster recovery.  Although it does take 6 weeks for the bone to integrate with the titanium stem and cup, when you don’t cut or release any muscles or tendons, the pain is less and the recovery is quicker.  

 

This approach is done without the cumbersome Hana table, and is done on a regular operating room table. There is less stress on the extremities and less risk of fracture, because the patient is not locked into boots or a table.  With the extremities free, this allows for a stability check with range of motion to ensure there is no dislocation, as well as a leg length assessment in the supine position.  Radiographs with C-arm fluoroscopy are obtained during the surgery to ensure perfect placement of the total hip components and also to allow assessment of leg length.  Dr. Eichten makes his incision slightly more lateral to avoid the lateral femoral cutaneous nerve.  The hip is not surgically dislocated, which is less traumatic to the surrounding tissue and muscle. (With dislocation of the hip, some of the nerves or muscles can be stretched and cause injury).  

 

Summary of Dr. Eichten’s Anterior Supine Intramuscular approach: 

 

• Muscle sparing approach, no muscle cut

• Preserving muscles and tendons

• Standard OR table

• C-arm radiographs during surgery confirm position of components and leg length 

• Avoid lateral femoral cutaneous nerve 

• Do not need Hana table allows full ROM check and leg length assessment in supine position

• Less risk of femur or ankle fractures 

• No surgical hip dislocation 

• Dr. Eichten also performs anterolateral approach if needed for difficult or revision total hip cases.  
   

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Anterolateral Approach

*Performed by Dr. David Eichten D.O.

 

This minimally-invasive approach to hip surgery has the advantage of not disrupting any tissue in the back of the hip joint. When compared to the posterior approach to the hip there is less risk of hip dislocation.

 

After surgery via the anterolateral approach patients can partake in any actives they wish and live without any hip precautions.

 

Posterior Approach

 

While still widely performed by many surgeons, this approach has the disadvantage of high rates of hip dislocation and a longer skin incision. The posterior hip is more likely to dislocate because the tissue at the back of the hip is cut in order to gain access to the hip joint.

 

Following a posterior hip replacement, patients must follow strict hip precautions for the rest of their life. These include not crossing your legs, bending forward or sitting in low chairs and can be extremely restricting to a patient’s lifestyle.

 

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Resources:

 

www.orthoinfo.aaos.org

 

www.mayoclinic.org

 

www.orthobullets.com