A total hip replacement can be performed through different surgical approaches to the hip joint. The approach is essentially the surgical path through the tissues surrounding the hip that the surgeon utilises to enter the joint. Each surgical path or approach has advantages and disadvantages.
The most commonly used approach is the posterior surgical approach. The advantage of this approach is that it is versatile and can be extended easily if there are complications during surgery. The disadvantage is that one of the major muscles (gluteus maximus) needs to be split and a few minor muscles at the back of the hip needs to be divided. There is also a slightly higher rate of dislocation with this approach compared to other approaches.
Another surgical approach is the direct lateral approach to the hip. In this approach a very powerful muscle is detached from the top end of the femur or trochanter to give access to the hip joint. Whilst it provides excellent visualisation of the joint during surgery the disadvantage is that the muscle even if repaired back to the bone tends to pull off with contraction. This results in weakness of the muscle, a pronounced limp and pain in some cases.
The direct anterior approach utilises an anatomical interval between two muscle groups in the front of the hip. This essentially allows the surgeon to enter the hip joint without dividing or splitting a single muscle. As a result of this patient’s experience less pain after the surgery and are able to walk within a few hours of surgery. This enables the hip replacement to be done even as a day case procedure. The disadvantage of this approach is the difficulty in accessing the femoral canal in some cases due to excessive muscle bulk, obesity or excessive stiffness of the joint. There is a steep learning curve to this approach hence not that commonly performed. I use the direct anterior approach in selective patients and have been doing this successfully for many years. I have developed a technique of doing this with the patient in a standard lateral position without a complicated table attachment or equipment. This minimises variations in practice between the more common approaches to hip replacement and this approach thereby reducing complications such as implant malposition.
The suitability for you to have this approach depends on a number of factors which will be explored at the time of your consultation.