Anterior Hip Replacement Approach

The following is an overview of an article that you may find helpful if your considering having a hip replacement and you've heard of the new Anterior Approach.

Anterior Approach
Article Summary
Spondylitis Plus Winter 2006/07
(A magazine of the Spondylitis Association of America (SAA))

New Surgical Procedure Offers Hope
for A.S. (ankylosing spondylitis)
Patients Facing Hip Replacement

An Interview with Dr. Joel Matta

What is the article about?
This article contains numerous quotes from Dr. Matta as well as an anterior approach patient, Tom West (former president of SAA), that highlight the benefits of the anterior approach, in general, and specifically for patients suffering from AS.

Anterior approach from the patient's perspective
Tom West had his left hip replaced in 1992 through a traditional posterior approach. He was told at that time that he would have to have his right hip replaced within 10 years.
By 2006, the pain became too much to bear, and Tom was once again facing hip replacement surgery. That’s when he found out about Dr. Matta.

• “I found the anterior approach when I was checking into surgeons, and Dr. Matta’s name came up several times, and then my wife’s cousin from Texas knew of someone that had flown to California from Texas for this special surgery.”
• “The difference is phenomenal.
• “First of all, it was the pain differences between the two procedures that convinced me—and the recovery time was amazing. Plus there were no restrictions on my weight bearing or crossing my legs or sitting or standing. With me I’m a branch manager for a stock brokerage firm, and to be laid up for two months would have been a disaster.”
• He adds that he did have the usual swelling and bruising after that surgery...It’s still major surgery.
  

Anterior approach from Dr. Matta’s perspective

• Dr. Matta tells Spondylitis Plus that he saw an anterior hip replacement surgery performed in Paris in 1981 by French orthopaedic surgeon Emile Letournel.
  
• According to Matta, “With the help of a special operating table, Dr. Letournel accessed the hip through a frontal incision without cutting through the large muscles.”
• What are the advantages for AS patients? “First of all with AS patients seeking hip replacement surgery, I think there is a higher possibility of dislocation” Matta says, “...but with the anterior approach, there is a higher resistance to dislocation because of posterior soft-tissue preservation and more precise placement of the acetabular prosthesis.”
• Furthermore, Matta adds, “The fused spine of an AS patient is an extra problem relating to hip replacement that requires special consideration. The normal adaptive changes in positioning that the pelvis makes during standing, sitting, and walking [which would normally assist the patient in preventing dislocation] does not occur in the fused AS population.”
• “Another problem with AS patients...is an increased sensitivity to any leg length discrepancy...But the anterior hip replacement addresses both of these potential problems and yields a good outcome.”
• Dr. Matta further shares that he believes the maintenance of the posterior muscles and hip capsule as well as more accurate cup positioning help with dislocation prevention. While the features of the orthopaedic table and on-going X-ray checks help with accurate leg length.
  

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