What is Muscle-Sparing Anterolateral Approach Total Hip Replacement?
Total hip arthroplasty, commonly referred to as total hip replacement, is a surgical procedure in which the worn-out or damaged parts of the hip joint are removed and replaced with artificial hip components called prostheses or implants made of metal, ceramic, or plastic.
Muscle-sparing anterolateral approach total hip replacement is a minimally invasive surgical approach for total hip arthroplasty in which a single small incision is made on the hip without muscle detachment or splitting of muscles as compared to traditional hip replacement that involves a larger incision and cutting of major muscles to access the hip joint. This approach helps to reduce surgical trauma to soft tissues by working between the muscle groups and enables to achieve minimal postoperative pain, shorter recovery and rehabilitation, and faster return to function.
Anatomy of the Hip
The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables frictionless movement of the joint. The bones are held together by bands of tissue called ligaments that provide stability to the joint.
Indications for a Muscle-Sparing Anterolateral Approach Total Hip Replacement
Muscle-sparing anterolateral approach total hip replacement is commonly indicated for individuals with osteoarthritis of the hip joint that is not responsive to conservative treatment. Osteoarthritis is a degenerative joint disease that causes breakdown and eventual loss of cartilage in the joint, causing a painful rubbing of bone surfaces with movement. Other hip conditions that your surgeon may recommend muscle-sparing anterolateral approach total hip replacement for include rheumatoid arthritis, septic arthritis, severe hip joint fracture or trauma, dislocation of the hip joint, and osteonecrosis.
Preparation for a Muscle-Sparing Anterolateral Approach Total Hip Replacement
Preoperative preparation for muscle-sparing anterolateral approach total hip replacement may involve the following steps:
- A review of your medical history and a physical examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Diagnostic tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure and to determine the condition of the hip joint to plan the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to stop taking medications such as blood thinners and anti-inflammatories, or other supplements for a week or two prior to surgery.
- You should refrain from alcohol or tobacco at least a few days prior to the surgery and several days after as it can hinder the healing process.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for a Muscle-Sparing Anterolateral Approach Total Hip Replacement
Muscle-sparing anterolateral approach total hip replacement surgery is performed under general or regional anesthesia. You will be asked to lie down on a special operating table in the lateral position with the affected side up that enables your surgeon to perform the surgery from the anterior (front) of the hip. The skin around your hip joint is sterilized with an antiseptic solution, and a small incision of about 3 inches long is made on the front of the hip. The muscles are pushed aside to gain access to the joint and perform the replacement. Next, the femur is separated from the acetabular socket. The acetabular surface is prepared using a special instrument called a reamer. The acetabular component is cemented or fixed with screws into the socket. Then a liner made up of plastic, metal, or ceramic is placed inside the acetabular component. The femoral head that is worn out is cut off and the femur is prepared using special instruments so that the new metal component fits the bone properly. Then, the new femoral component is inserted into the femur either by a press fit or by using special bone cement. The femoral head component made of ceramic or metal is then placed on the femoral stem. Once the artificial components are fixed in place, the hip joint is checked through its range of motion for satisfactory repair. Instruments are then withdrawn, and the incision is closed with sutures and covered with a sterile dressing.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after muscle-sparing anterolateral approach total hip replacement may involve the following:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- Most patients may need to stay in the hospital for 2 to 3 days before discharge to home.
- You may notice pain, swelling, and discomfort in the hip area. Pain and anti-inflammatory medications are provided as needed to address these.
- You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent the risk of blood clots.
- Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol will be designed to help strengthen hip muscles and optimize hip function once you are off assistive devices.
- Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, return to sports may take at least 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Benefits of Muscle-Sparing Anterolateral Approach Total Hip Replacement
Some of the benefits of muscle-sparing anterolateral approach total hip replacement over traditional approach hip replacement include:
- Minimal surgical dissection
- Shorter recovery period
- Shorter hospital stay
- Reduced post-operative pain
- Minimal blood loss
- Smaller surgical scar
- Minimal muscle trauma
Risks and Complications
Muscle-sparing anterolateral approach total hip replacement is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Infection
- Bleeding
- Postoperative pain
- Damage to surrounding soft tissues, such as nerves and vessels
- Implant failure
- Leg length discrepancy
- The need for revision surgery
