Anterior hip replacement requires special equipment in order to be performed safely and consistently. This equipment allows us to perform the operation on all patients that require a primary hip replacement.
The most important piece of equipment is the anterior approach operating table. Without this table the operation can be very difficult for the surgeon. There are two kinds on the market and I use both at my hospital:
After Identification of the operative site by the surgeon the patient is brought to the operating room, given a general anesthetic, and placed on the special table.
Padded boots are placed on one or both feet. The boots are attached to the table. This allows the surgeon to move the leg in any direction as well as pull it out or push it in.
The other advantage is the x-ray equipment can be placed under or over the patient and used at any time during the operation to check implant position and leg length.
The hip is then covered with antisceptic as well as an antimicrobial film.
A 4 to 5 inch cut is made at the skin. Muscles at the front of the hip are separated but not cut.
The blue line shows were the muscles are separated.
The ball is then dislocated out of the socket and cut off the femur with a saw. A grater smooths the inside of the socket so it can accept the permanent shell. The shell is the advanced into the hip socket.
The leg is then lowered and the femur is prepared with broaches. The final leg length is measured. Then the premanent implant is placed into the canal of the femur.
After the implants are positioned we recheck hip stability to make sure the hip will not dislocate. The muscles are not resutured as they simply fall back into position and cover they have joint. The skin is then sewed and glued. There are no sutures to remove. A small dressing is then placed over the incision. The patient is then awoken and transferred to his bed.
Complications Of Hip Replacement Surgery
Most patients getting an anterior hip do well and have no complications. Here is a partial list of complications.
- Antibiotics are given before and after surgery to prevent infection.
- The risk of orthopedic infection is between 1 and 3%.
- Most of the time if an infection occurs it is usually minor.
- If the infection is more severe additional surgery to clean the operative site or removal of the components may be required, with reimplantation of the components done at 6-12 weeks.
Blood clots can occur in the veins of the leg following hip replacement surgery. Prevention usually eliminates this problem. All patients receive blood thinners following surgery for approximately 2 weeks. Other prophylactic measures are also used. If a blood clot is diagnosed blood thinners will be given for a few months.
A Cell Saver device is used for all patients. During the procedure blood that is lost is recovered washed and then reinjected into the patient. Despite this some patients will require a blood transfusion following surgery. Most patients however do not need a transfusion.
Leg length inequality:
We do our best to equalize leg length inequality during the procedure. During the surgery x-rays are taken to measure differences in leg lengths. Adjustments can be made based on these x-rays. Sometimes however a small difference of a few millimeters may persist despite our best efforts.
Dislocations can occur with any type of hip replacement. Anterior hip replacement has a lower risk of dislocation. If a dislocation does occur most of the time all that is needed is for the ball to be repositioned back into the socket by simply pulling on the leg.
Sometimes while placing the implants cracks or fractures can appear within the bone. These will usually have minimal impact on the long-term outcome of the prosthesis. Patient usually do well with activity modification until the fracture has healed.
Injury to the sciatic or femoral nerves are possible during this procedure. These are extremely rare and unlikely.
Injury to arteries and veins:
Injury to arteries and veins are possible during the procedure. This is also extremely unlikely occurrence.