Twenty seven years ago I encountered my first “fresh”, post-surgical total hip replacement (THR) patient. This gentleman was lying in his hospital bed sporting a pretty gruesome, eight inch surgical wound along the side of his hip/pelvis which was held closed by a series of metal staples.
As a physical therapist, I was well versed in a list of post-surgical precautions such as “Do not allow the hip/leg to abduct” (sweep out to the side), “Do not allow the hip/leg to turn in”, and “Sleep with a pillow in between your legs.” These rehab rules were in place to prevent potential hip dislocations which could readily occur if “given the right circumstances”.
My job during the remainder of his hospital stay was to get this patient up walking with a walker and to teach him how to navigate stairs. Once that patient left the hospital, PT would continue, either in a rehab center or at home for about 3 weeks. This would be followed by PT at an outpatient facility where the patient would be weaned to a cane and then taught to walk again without an assistive device. Strengthening of the leg would also be addressed. The whole process would take many long months.
Recently, a new surgical technique has been introduced in the US (t’s been employed in Europe for 60+ years) which is far less traumatic to the body, has far fewer precautions associated with post-surgical care, and significantly speeds up the patient’s healing time: the anterior approach.
More specifically, a THR via anterior approach sports a smaller, 4” incision which is glued shut—no stitches or staples required, a much reduced hip dislocation rate, shorter early rehabilitation, and improved accuracy of limb length and implant position. With this procedure, in contrast with the traditional lateral approach where the patient’s gluteus medius muscles are cut through, there is no muscle cutting necessary!
The only downside to having a THR with an anterior approach is that there aren’t many Orthopedists who have been trained in this newer approach, and those who have, need hospitals willing to invest in a surgical table which runs about $100,000! But be encouraged, these surgeons (and hospital suites) are out there. You just need to find them.