ORTHO PA EDIC S Newer Technique to Hip Replacement Can Reduce Pain and Speed Recovery Most hip-replacement surgery in the United States is performed by cutting through the back, or posterior approach, to the hip. Now, a newer approach that goes through the front is gaining traction as an alternative that can result in shorter hospital stays, quicker recovery time and less discomfort. While research shows that the long-term results of the anterior (from the front) and posterior hip-replacement procedures are equivalent at the six-month postoperative period, “there are major advantages to the anterior approach,” says orthopaedic surgeon Eric Johnson, MD, who has been performing the procedure at UCLA for more than 10 years. These include less pain and faster recovery, reduced risk of dislocation or other complications, and more accurate positioning of the new hip components, he explains. Although posterior hip-replacement surgery is the dominant approach, accounting for perhaps 95 percent of cases, the anterior technique dates back several decades to France, where a pair of surgeons began doing hip replacements with patients lying on their backs on an orthopaedic fracture table. And the anterior method is picking up steam as more surgeons are trained in the technique, Dr. Johnson says. The use of a special fracture table for anterior hip replacement means that the patient can be positioned face-up as the surgeon more precisely positions the hip components of each side of the joint using X-ray images. “We place both of the patient’s hips in the same position, take an X-ray of each, use a computer program to highlight the differences, and adjust accordingly to get a very accurate replacement,” Dr. Johnson says. The computerized assistance virtually eliminates the risk of hip dislocation and leg-length inequality, potential complications after posterior hip-replacement surgery, he adds. Approaching from the front, the surgeon avoids cutting a small group of posterior muscle tendons by operating through natural muscle planes, which results in less pain and faster recovery. “The afternoon after anterior hip surgery, our patients are able to walk around and sit on a normal seat,” Dr. Johnson says. Recovery usually is about four weeks. In comparison, posterior hip replacement, which generally involves a larger incision, requires up to eight weeks for recovery. In the past, hip replacement was mostly reserved for people in their 60s or 70s, but Dr. Johnson notes that with advances in the technique and newer types of hip-component surfaces, hip-replacement surgery tends to be durable enough that the need for revision surgery is decreasing, making it a more appropriate alternative for younger patients with difficult hip-joint problems. “The hip should not hurt,” he says. “If hip pain is affecting your lifestyle, there are few reasons to wait thinking that you might get a longer-lasting hip. Hip replacement, whether anterior or posterior, is among the most successful operations in orthopaedics.” Dr. Johnson notes that following successful hip replacement, patients “are some of the happiest people I see, because their lifestyles have completely changed, and they are back to doing what they want to do.” Recovery usually is about four weeks. In comparison, posterior hip replacement, which generally involves a larger incision, requires up to eight weeks for recovery. Vital Signs Winter 2017 Vol. 73 5