Wednesday, April 15, 2015

Anterior Total Hip Arthroplasty

By: James A. Flanagan, Jr., M.D. Andrews Sports Medicine and Orthopaedic Center

Making the decision to have a total joint replacement is a life-changing decision for all involved. In the past 40 years, millions of people have suffered from arthritic hip pain and experienced relief through total hip replacement and restored mobility. Most patients report that pain experienced after surgery pales in comparison to the pain they were living with on a daily basis.

What is Anterior Total Hip Arthroplasty?

The anterior arthroplasty approach to a total hip replacement is a muscle-sparing procedure that allows the surgeon to access the hip joint without disrupting the stability ligaments, thus making the hip significantly less likely to dislocate in the future. To the patient, this means there are no positional restrictions after the initial 6-week, post-op healing period.

Our surgical team’s approach is through a minimally invasive incision which allows for accelerated recovery time, reduced pain & scarring, shorter hospital stay, smaller chance of infection, and more rapid stability of the hip - compared to the traditional posterior approach.

What type of implant is used?

Our surgical team uses a prosthesis manufactured by Zimmer. There is no cement involved or metal-on-metal. The implant is a porous-coated metal implant that is press-fitted into the bone that allows the bone to grow into the implant itself. The metal is composed of a combination of cobalt chrome and titanium. A polyethylene liner is used to “cushion” the hip and allow for an easy-gliding motion of the joint. How long an implant will last varies from patient to patient depending on physical condition, activity level and body weight.

What is the hospital stay and typical recovery time?

Having a total joint replacement requires general anesthesia and typically a 2-3 day stay in the hospital. Once a surgery date is chosen, the patient is scheduled for pre-op registration at the hospital and lab work, which includes basic blood work, EKG and a possible chest x-ray.

The surgery itself takes approximately 1 hour to perform. During surgery, we utilize a multimodal pain management regimen – that includes EXPAREL. This new approach reduces pain and lessens patient recovery time. In addition, the utilization of tranexamic acid is used to better control surgery blood loss, keep the blood pressure low and lessen the likelihood of a blood transfusion.

A few hours following surgery, physical therapy - with assistance - gets the patient up and moving. PT visits twice a day during their hospital stay is crucial. Once the patient is fairly independent with a walker and able to meet discharge requirements, they are discharged either home with home physical therapy or to a skilled nursing facility. The patient can expect to walk approximately 1-2 weeks on a walker, 1-2 weeks with a cane, then eventually without assistance at all. Usually, outpatient physical therapy will be arranged upon their 1st post-op visit through our office at a facility of the patient’s choice. The patient can expect a total of 6-8 weeks of formal PT following a total hip replacement.

What are patients’ restrictions?

There are very little restrictions with the anterior approach compared to the traditional posterior approach of replacing a hip. For the first 6 weeks following surgery, each patient is limited to crossing one leg over the other and extending the operative leg behind them. Once the soft tissue is healed, the hip is considered stable and the restrictions are lifted. I do require antibiotics to be taken by mouth prior to any minor surgical procedure or dental work, including dental cleaning, to prevent bacteria from entering the blood stream and traveling to the prosthetic joint. This is required for the life of the prosthesis.

James A. Flanagan, Jr. M.D. is an orthopaedic surgeon at Andrews Sports Medicine and Orthopaedic Center in Birmingham, AL. Dr. Flanagan specializes in joint replacement and has been performing direct anterior total hip arthroplasty for the past 9 years, giving patients a more rapid recovery and less post-operative restrictions. He is also skilled in total knee, shoulder and wrist replacement.

For more information, contact Andrews Sports Medicine and Orthopaedic Center at 205.939.3699 or visit  

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