Hip joint surgeries are among the most common orthopedic operations. Therefore, over the years, profoundly different and, more importantly, less invasive surgery methods have been developed than in the past.
Anterior-access hip replacement (AMIS) allows a conservative approach to the hip that respects the anatomy of the joint.
Prosthesis replacement for hip osteoarthritis has revolutionized and improved the lives of thousands of patients. Most notably, the increasingly used practice of performing mini surgical approach to the hip allows for greater respect for soft tissue, with greatly reduced pain and much faster resumption of mobility.
The anterior approach hip replacement: what it is about
The anterior surgical approach, also known as Hueter’s approach, provides safe access to the hip joint (acetabulum and femoral head that make up the coxofemoral joint).
This surgical approach takes advantage of an inter-nervous and inter-muscular plane: this means that no muscle will have to be dissected in order to penetrate from the outside and reach the joint you want to operate on, as opposed to when antero-lateral or posterior approach are performed. In this way, the risk of possible nerve damage will also be greatly reduced.
But how did the anterior approach come to be used in hip arthroplasty?
Hueter’s approach has existed for several years but has become a commonly used technique only in the last decade. With this surgical approach, there is limited access to the femur of the joint.With the development of bone-sparing short stems in recent years, this route has finally become routinely usable, and is preferable for most patients.
When to use the anterior approach in hip arthroplasty
The anterior approach is mainly used to perform hip arthroplasty in cases of osteoarthritis but also in cases of:
– Surgical reduction of congenital dislocations of the hip;
– Biopsies of the synovial membrane surrounding the hip joint;
– Revision surgeries of the hip prosthesis (especially the acetabular component);
• Hip replacement surgery following a displaced fracture of the neck of the
femur.
The anterior surgical technique: the surgery
In anterior hip approach replacement surgery, the patient should be placed on the operating table in the supine position. Appropriate disinfection (with antiseptic solution) of the skin of the anterior region of the thigh is then performed, and the surgical field is demarcated with sterile disposable drapes.
As a landmark, the anterosuperior iliac spine is used, which is easily palpable below the skin and identified using a dermographic pen. An 8-10 cm vertical incision is then made from the anterosuperior iliac spine downward toward the outer margin of the patella.
The bikini engraving
A variation of this surgical technique is the bikini incision, in which a transverse cut is made at the level of the inguinal crease, near the antero-upper iliac spine, and then reaches the muscular plane.
The latter incision is performed, especially in women, so that the scar can be easily covered underneath the brief or costume.
Anterior hip arthroplasty: a preferable approach?
Currently, in orthopedic surgery, it is not possible to say that one surgical approach is better than another. There are, however, many studies in the scientific field that attempt to compare different hip access routes.
The advantages
What can currently be asserted with reasonable certainty is that, patients who are operated anteriorly recover faster than those who receive the other accesses; there are, in addition, several advantages for the patient such as:
● A significant reduction in pain, due to the lack of muscle section;
● less blood loss, for the preservation of muscles and their blood vessels;
● a reduced hospital stay, due to less pain experienced and ambulation with load from the first moments after surgery;
● The prevention of postoperative lameness, due to lack of muscle section;
● A lower risk of dislocation by maintaining full muscle function;
● faster complete recovery, for the reasons mentioned before and for the FAST-TRACK rehabilitation pathways that can be applied with such a surgical route.
● the possibility of bilateral prosthetic replacement surgery, due to less blood loss and the significant decrease in pain.
Contraindications
What patients need to be aware of when undergoing an anterior approach hip replacement is that this technique, while respectful of periarticular soft tissues, has inherent difficulties in execution and, for this reason, requires certain prerequisites:
– a surgeon experienced in anterior hip approach, that is, a surgeon who has a high volume of procedures with this surgical access;
– The absence of anatomical abnormalities that contraindicate anterior approach to the hip.
Anterior hip arthroplasty: the goals
The anterior hip pathway according to Hueter is designed to eliminate periarticular muscle damage, minimizing pain and blood loss-this will result in faster recovery without muscle deficits.
