Total Hip Replacement in Singapore - Direct Anterior Approach
WHAT IS DIRECT ANTERIOR APPROACH IN TOTAL
In total hip arthroplasty, the direct anterior approach is minimally invasive, often performed using a smaller incision than traditional hip replacement techniques. The procedure is performed with the patient lying flat on their back to enable the use of real-time x-ray imaging during surgery — ensuring accurate placement of the hip implant.
Moreover, this approach is associated with a lower risk of hip dislocation after surgery, as it avoids cutting key posterior hip muscles that contribute to joint stability. While the direct anterior approach offers many benefits, it’s not the best fit for every patient. The choice hinges on a combination of factors such as the surgeon’s skill level and familiarity with the procedure, the unique physical characteristics and health status of the patient, and the specific aims of the surgery.
With DAA, patients can often leave the hospital sooner, feel less pain, and hit recovery goals faster — owing to the “muscle-sparing” nature of the procedure. It doesn’t need to cut through muscles and tendons to get to the damaged area. Instead, the surgeon carefully moves them aside, puts in the implants, and then puts them back. This way, healing can happen faster and with less pain.
It’s important to note that while the DAA has certain potential benefits, it is a technically challenging procedure and may not be suitable for all patients. The surgeon’s experience with the DAA can significantly affect the outcome of the surgery. As with all surgical procedures, the DAA for hip replacement also carries potential risks, including infection, blood clots, and complications related to anaesthesia.
General potential complications and risks of hip replacement surgery
- Infection from Deep Vein Thrombosis (DVT)
- Stiffness due to uneven length of legs – the leg that was operated on may be shorter or longer than the other
- Nerve and blood vessels injury due to dislocation
- Loosening and wear of prosthesis leading to Periprosthetic Fracture
Like all surgical procedures, the direct anterior approach for total hip arthroplasty also has potential risks and complications, including nerve damage, infection, and fracture. Always consult with your orthopaedic surgeon to understand the best approach for your situation.
BENEFITS OF DIRECT ANTERIOR APPROACH
- Minimally Invasive. DAA minimises trauma to the body by steering clear of muscles and tendons during the surgery, for less tissue damage
- Reduced Postoperative Pain. Patients generally experience a relatively easier recovery, and can resume daily activities in lesser amount of time
- Surgical Specialty. DAA requires the high-level surgical skills of professionally trained and technically proficient surgeons — owing to DAA’s sustained success
- Comprehensive Treatment: DAA is not just about replacing the hip. It is a holistic treatment plan that also focuses on trauma and fracture care
Please note that while the DAA offers these potential benefits, it may not be suitable for all patients, and the outcomes can depend significantly on the surgeon’s skill and experience. Moreover, factors such as age, weight, medication usage, general health status, and whether you smoke can all affect the potential risks involved with any surgery. Always discuss with your surgeon the best surgical approach for your specific condition and needs.
DIRECT ANTERIOR APPROACH VS POSTERIOR APPROACH
The posterior and anterior approaches are surgical methods used in total hip replacement surgery, referring to the direction from which the surgeon accesses the hip joint.
Accesses the hip joint from the back
Accesses the hip joint from the front
Good view of the hip joint, making it easier to place the artificial component
Less muscle disruption, potentially leading to less post-operative pain, shorter hospital stays, and quicker recovery times
Greater muscle disruption, possibly leading to longer recovery times
More technically demanding, requiring special training and equipment
Patients with complex hip conditions where a more direct view of the joint is necessary
Patients looking for potentially faster recovery and less postoperative pain
Both approaches have been found to be effective for hip replacement surgery. At the end of the day, the best approach depends on the patient’s specific condition and the surgeon’s expertise and comfort with the procedure.
For compromised hip function due to injuries or degenerative bone disease, seek professional help from A/Professor Andrew Quoc Dutton. He is a Harvard fellowship-trained orthopaedic surgeon practising at Mount Elizabeth Hospital, Singapore with subspecialty interests in arthroscopic/keyhole surgery, sports injuries, and hip replacements.
Frequently Asked Questions on Hip Arthroscopy
- Patients who are otherwise healthy or have well-controlled medical conditions.
- Individuals who are within a healthy weight range, as excess weight can sometimes make the procedure more challenging.
- Patients with specific anatomical considerations that make this approach feasible and likely to succeed.
- Individuals who are motivated and able to actively participate in the post-operative rehabilitation process, which is crucial for recovery.
Total Hip Replacement (THR) surgery is a procedure where a damaged or worn-out hip joint is replaced with an artificial one (prosthesis). This procedure is usually recommended for individuals who experience chronic hip pain and loss of function due to conditions such as osteoarthritis, rheumatoid arthritis, hip fractures, or other degenerative diseases that affect the hip joint.
The primary goal of this procedure is to relieve pain, improve hip function, and enhance the patient’s overall quality of life. The new, artificial joint typically reduces pain and offers a wider range of motion than the damaged joint. However, it’s important to understand that there are potential risks, as with any surgery, such as infection, blood clots, and complications with anaesthesia.
Before the procedure, the patient is given either general anaesthesia or a spinal block, which numbs the lower half of the body. The surgeon then makes an incision over the hip to expose the hip joint. Afterwards, the damaged ball, which is the top part of the thigh bone (femur), is cut and removed. The damaged surface of the socket (part of the hip bone, or pelvis) is also cleaned out.
The replacement socket is usually secured into the pelvis, and the replacement ball attached to a stem is secured into the femur. The materials used for the artificial joint could be metal, ceramic, or plastic, and they’re designed to allow the joint to move smoothly. After the joint replacement, the surgeon closes the incision. The area is often drained to remove fluid build-up, and the drain is usually removed a few days after surgery.
- Attend all preoperative appointments and evaluations.
- Follow your doctor’s guidelines on medication use, including when to stop certain medications before surgery.
- Maintain a healthy diet and stay hydrated.
- Quit smoking as it can impede the healing process.
- Arrange for transportation and help at home post-surgery.
- Follow instructions regarding when to stop eating and drinking before the procedure.
- Do pre-surgery exercises if recommended by your doctor or physical therapist.
- Ensure all necessary pre-op tests (blood tests, EKG, etc.) are completed.
- Shower with antibacterial soap the night before and morning of surgery as per your doctor’s instruction.
- Avoid applying any cosmetic products (makeup, lotion, nail polish) on the day of surgery.