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Q. I understand there is a new hip replacement procedure using a special surgical table. Can you explain what it is and whether it is an option for total hip replacement?
A. Hip replacement surgery is a miracle for patients suffering from severe daily hip pain and now there is a new method that can make this amazing technique even better with an easier, less painful recovery than with traditional hip replacement procedures.
Many techniques and procedures can be used for total hip arthroplasty (hip replacement surgery), however, direct anterior total hip arthroplasty is the only surgical method that allows the surgery to be performed without having to cut any of the muscles or tendons of this hip that are so critical for hip function. It is the most tissue-preserving approach for total hip arthroplasty.
In order to perform anterior hip surgery, the patient is lying on their back in the supine position and the leg is extended and rotated such that just the portion of the hip to be replaced is exposed without damaging the important hip muscles.
At nonprofit Banner Del E. Webb we have a specialized orthopaedic surgical table called a Pro-FX table. The table permits a more controlled surgery with less tissue damage. Banner Del Webb is the only hospital in the northwest Valley that has this specialized table.
Some surgeons around the country and world perform this procedure without using an orthopedic table specific to this type of procedure. However, in order to do so without the special table, a more extensive release of the important rotator muscles and tendons that are posterior (in the rear) to the hip is necessary. The table facilitates the procedure and allows for a controlled, precise surgery. It also eliminates the need for an assistant to struggle, holding the leg in an awkward position while the surgery is performed.
Q. What are some of your patients’ experiences following the procedure?
My patients have had a whole variety of experiences in the post-operative period, however, uniformly these patients find a rapid early recovery where they do not need a walker within one to two weeks following surgery and many return for their first post-operative follow-up visit with a cane or without any assistive devices.
Most patients are discharged two to three days after surgery. Because the anterior approach to hip replacement surgery preserves muscles and tendons, these patients leave the hospital with no restrictions after surgery and they experience less pain and walk without limp in days rather than weeks after surgery.
My patients often tell me they are amazed by the rapid recovery and feel it is miraculous. The most amazing experience was with one gentleman who took only acetaminophen after surgery was walking within three hours of finishing the surgery. He wanted to go home within five hours of surgery. Nonetheless, we do keep patients overnight to be safe and make sure they are on a solid road to recovery.
I also have performed this surgery on four patients who had both hips replaced at the same time under the same anesthesia. This option becomes available because the patient is lying flat on their back rather than on their side. By doing so, the patients don’t need to return for a second anesthesia.
Q. What are the greatest benefits of a direct anterior total hip replacement?
A. I believe the greatest benefits of direct anterior hip replacement are:
- Faster recovery in the early post-operative period
- Tissue friendly surgery with no muscle damage
- No post-operative restrictions on hip motion
- More precise surgery because of the use of xray guidance during surgery leading to less problems with leg length differences
- Option to do both hips in the same anesthesia