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Total hip replacement – Anterior approach

Introduction

A total hip replacement is a surgery in which the hip joint is completely replaced by an artificial hip. The anterior approach is when the surgeon makes a cut at the upper part of the pelvis as the patient lies on their back. [1] Hip replacements are commonly performed on patients who have damaged hip joints that cause pain and reduced mobility that affects their quality of life. An artificial hip will typically last for about 15 years before it may need to be replaced again. There are various types of artificial hip (prosthesis) that can be used. Hip replacements can be indicated for many reasons, the most common conditions are osteoarthritis, rheumatoid arthritis or hip fractures. The operation usually takes 1-2 hours to complete.


Benefits

Surgery can reduce pain and increase mobility in the joint which may lead to an improved quality of life. A hip replacement may prevent the symptoms of pain and reduced mobility from worsening. The anterior approach may have earlier recovery time; a shorter incision length and reduced blood volume loss than the posterior approach. [4]


Technique

The patient is positioned so they are lying on their back so that the surgeon has access to the front of the leg. A cut is made at the top of the leg underneath one of the bony prominences on the front of the pelvis. One of the muscles (tensor fascia lata) in the leg is cut to provide access to the joint. The surrounding ligaments and fatty tissue are removed to expose the bone. The socket of the joint (acetabulum) is replaced with an artificial cup. The head of the femur (thighbone) is removed and an artificial head is inserted.





2] The wound is closed with stitches and dressed. [3]



Anaesthesia

The operation is commonly performed under general anaesthetic which you will be asleep during the operation. The operation can be performed using an epidural or spinal anaesthetic which only acts on the lower body



Post operation

The surgery team will endeavour to get the patient home as soon as possible however a short stay in hospital after the operation is usually necessary for 3-5 days. The team will assess you medically and give any fluids or pain relief that may be needed. The team will assess how the new hip is functioning and advise a personalised rehabilitation plan for the following months to help recovery. This will involve a physiotherapist and an occupational therapist. The doctor or physiotherapist will be able to advise on when it is safe to return to normal activities which can differ from patient to patient. A rough guide is 6 weeks before returning to light activities and driving. The patient will be seen 6-12 weeks after the operation as an outpatient appointment to review how they are coping with the new hip. [6]















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