Anterior approach hip surgery means less pain, quicker recovery

Joan Wuest likes to keep moving. The spry 83-year-old retiree’s schedule includes exercise classes, social events, volunteer activities, and time on the golf course with her husband, Curt.

A three-mile walk is an important part of Joan’s daily routine, as well.

“That’s my high,” she says.

Or at least it was until severe pain in her left hip began limiting Joan’s ability to stay active.

Joan had been through this before. Sixteen years earlier, she underwent surgery to repair her right hip. She had always figured the left hip also would give out sooner or later. Now it was painfully obvious.

As 2014 came to a close, “my left one had been bothering me for about two or three months,” Joan says. “It just kept getting worse. I knew it wasn’t going to get any better, so I decided not to wait any longer.”

Joan, who lives in Iowa City, consulted University of Iowa orthopedic surgeon J. Lawrence Marsh, MD, who had performed her right hip replacement procedure with good results. She also called her son, Thomas Wuest, MD, a Eugene, Ore.-based orthopedic surgeon who graduated from the UI Carver College of Medicine in 1987 and completed residency training in orthopedic surgery at University of Iowa Hospitals & Clinics five years later.

“You could say I did my homework,” Joan says with a laugh. “Ultimately, I decided to try this new type of hip replacement.”

The “new type” of procedure Joan refers to is called anterior approach total hip replacement surgery. A minimally invasive technique that involves a small, approximately four-inch incision, the anterior approach means entering the front of the thigh—instead of the back side as with the traditional posterior approach—to reach the hip. This allows an orthopedic surgeon to work between, rather than spreading, the muscles that hold the hip joint with its “ball and socket” in place.

For both the anterior and posterior procedures, the goal is the same: to replace the hip joint with metal implants that have metal or ceramic on plastic (cross-like, ultra-high, molecular-weight polyethylene) joint surface bearings.

With the minimally invasive anterior approach, however, patients typically experience less pain after the procedure, which often results in a shorter hospital stay and a quicker recovery. Also, the anterior technique typically offers greater joint mobility and a reduced likelihood of hip dislocation—a common post-surgery risk from hip replacement surgery. Most patients with the anterior approach are able to bend over as much as they like.

Anterior approach hip replacement surgery is not really “new,” notes retired UI orthopedic surgeon Charles Clark, MD, who did Joan’s left hip procedure.

“The anterior approach has been around for decades,” Clark says, “but relatively recent advances in technology, equipment, and training have made it a much more efficient and effective option for certain patients.”

Among patients needing total hip replacement surgery, the anterior approach is a great option for those who are relatively healthy, not obese, and without severe deformity of the hip, Clark says.

Clark, who estimates he has done thousands of posterior approach hip surgeries over the course of his career, began training on the anterior approach about 10 years ago with Joel Matta, MD, a California-based orthopedic surgeon and a pioneer in today’s anterior approach technique. Clark now partners with Matta and colleagues in teaching the anterior approach to other orthopedic surgeons around the country.

Today, the majority of total hip replacement procedures that Clark performs are done using the anterior approach.

“My patients’ length of stay in the hospital has decreased with the anterior approach (compared to the posterior approach),” he says. “Anterior approach patients really like it because they’re able to get going more quickly. There are certain operations where you don’t get a lot of feedback from patients, but I get a lot of really positive feedback on these procedures.”

Count Joan’s feedback as overwhelmingly positive. She had her procedure in February 2015.

“I was uncomfortable the first couple of days after the operation, but we started therapy right away. That’s the main thing: Do your daily therapy,” Joan says. “I still do a number of exercises, moving my hip and working the muscles, and I’m now up to walking a mile and a half. At my age, one of the best things you can do is keep walking, which is why I wanted to get my hip fixed in the first place.”

As for the care she received, Joan insists she couldn’t have asked for a better experience.

“From the surgery to the PT (physical therapy) to the nursing care, it was all great,” Joan says. “And the food was excellent, too,” she adds with a laugh.