Edward Petrow Jr., DO, an orthopedic surgeon at Tucson Orthopaedic Institute, discusses five points on performing anterior hip replacements and what it can mean for the future.
1. Difference in surgical technique. The traditional approach to hip replacement surgery is going through the back, splitting the buttock muscles and pealing back the hip muscles to access the joint. When surgeons employ the anterior approach to hip replacement surgery, they enter the hip through the front part of the joint. "When we take the anterior approach, we don't detach or remove any muscles," Dr. Petrow says. "From a recovery standpoint, that means less pain and quicker return to function."
The anterior approach is a minimally invasive surgery because you can perform the whole procedure through a 10 centimeter or less incision. When surgeons eliminate the muscle disruption, patients don't have to go on hip precaution, as other hip replacement patients do, and they can return to regular activity quicker.
2. Imaging technology allows for greater precision. In addition to providing a quicker recovery, the anterior approach can also allow surgeons to more precisely place the implant because they can use real-time X-ray guidance perioperatively. "With this equipment, you are watching the procedure on X-ray as you go in so you can see where the implant is going and get it exactly where you want it," says Dr. Petrow. "This gives you better control of their leg length."
Experienced surgeons know how to closely reproduce the patient's leg length, but with the real time X-ray, they can measure both sides to make sure they are the same length. There have been many cases of hip replacement failures due to leg lengthening issues, but with the minimally invasive anterior approach those complications become nearly extinct.
3. Why the procedure isn't more widespread. While the anterior approach may be less invasive and associated with fewer complications, surgeons without extra training in the technique will not be able to perform in a safe and effective manner. "You have to be committed to doing some extra training to be able to perform it safely," says Dr. Petrow. "The other issue is that you have to have specialized table to allow you to get to the hip from the front. The hospital has to be committed to getting the table and the surgeon has to commit to the extra training, but it's a better treatment."
It's often hard for surgeons to stay abreast of the most recent treatments and techniques, but it can be worthwhile. The anterior approach may be different, but surgeons can still use the same instrumentation they've always used during the surgery. "Just because you've done hip replacement surgery the same way over your career doesn't mean you can't change," he says. "Some surgeons won't and that's fine, because the posterior approach can still provide a good outcome."
4. Hospitals benefit from the technique as well. From his perspective, Dr. Petrow says the extra time and financial investment in the anterior approach is worthwhile because he hasn't experienced any complications, nerve problems or dislocations from patients undergoing anterior hip replacements. It's also been his experience that these patients are up walking faster, off pain medication sooner and discharged from the hospital sooner.
"We've experienced a whole day decrease in the length of stay, from three days to two," says Dr. Petrow. "All the way around, the short-term recovery has been quicker and there haven't been any complications."
5. Anterior hip replacements are the way of the future. As patients find out more about the advantages associated with anterior hip replacements, they will demand that type of procedure and drive it forward, says Dr. Petrow. The technology developed in the past few years has made it an easier and more accessible procedure for surgeons to perform. However, in the future he doesn't see the procedure becoming much less invasive than it is now, which means further innovation will come from implant design and placement.
"You don't want to sacrifice good results, and there needs to be a balance between minimally invasive techniques and achieving durable, reproducible results with implants," he says. "I know the implants I use are durable and I can see patients have a good outcome. It's the next step forward in what we do as far as hip replacement surgery."
Learn more about Dr. Edward Petrow.
Related Articles on Hip Surgery:
Dr. Lawrence Dorr: 6 Points Making the Case for Robotics in Hip Surgery
Dr. Mark McFarland: The Future of Total Hip and Knee Replacement as an Outpatient Procedure
Study: 90.4% of Hip Surgery Patients Return to Work Post-Surgery
Anterior Hip Replacements are the Future: 5 Points from Dr. Edward PetrowWritten by Laura Dyrda | Tuesday, 26 July 2011 20:37
A growing number of joint replacement surgeons are beginning to perform hip replacement surgery using an anterior approach instead of the traditional posterior approach because of the benefits it has for the patient as well as the provider. It can be safely performed on many patients, as long as they have a low risk of fracture and normal anatomy.Last modified on Monday, 08 August 2011 13:41
© Copyright ASC COMMUNICATIONS 2016. Interested in LINKING to or REPRINTING this content? View our policies here.
Most Read - Improving Profits
- 13 facts and statistics on Baby Boomers for spine surgeons to know
- Yearlong investigation finds 2.4k+ physicians sanctioned for sexually abusing patients: 8 things to know
- EHRs may yield higher malpractice risk: 6 key points
- Will the 2017 CMS payment update mean more independent practices?
- Leading orthopedic surgeons into a value-based world — Ortech Systems' VP of sales & marketing Michael Barr on patient-reported outcomes
Top 40 Articles from the Past 6 Months
- Medtronic, Stryker, Zimmer Biomet, DePuy Synthes, Smith & Nephew: Who had the best 2015? 32 things to know
- Justice Department investigates pain compounding cream for $500M potential fraud: 5 things to know
- Physician receives second-degree murder sentence for overprescribing pain medication: 6 key points
- 22 spine surgeon leadership awards | 2016
- Has Xenco Medical Ushered in the Future of Spine Surgery?
- 10 spine, neurosurgeons on the move in January 2016
- 5 things to know about wearable technology in medicine
- Zimmer Biomet, Stryker, J&J & more: 26 key notes — AAOS edition
- Dr. James Andrews #5 among richest doctors in the world: 6 points
- Stryker, Titan Spine, ConforMIS & more: 16 key notes
- 5 ways big data will affect healthcare providers in 2016 & beyond
- Surgical tech sues Yale-New Haven Hospital surgeon after OR altercation — 5 key notes
- Bundled payments, consolidation & more: How OrthoVirginia is building a future-facing empire
- Beyond the device: How DePuy Synthes is innovating in orthopedic & spine technology
- Orthopedic surgeons generate $2.7M for affiliated hospitals; 5.5 times what they make — 5 survey findings
- CJR bundles to pay $25k per episode: 8 statistics on cost breakdown
- The best way to prepare for the future in spine: Dr. Hyun Bae
- 15 statistics on orthopedic surgeon starting salaries
- Top 10 highest-earning physician specialties — Orthopedics leads for 6th consecutive year
- Dr. Kevin Pauza unsurprised with Tiger Woods' slow back surgery recovery: 5 insights
- The entrepreneur mindset: How an MBA opened doors for one spine surgeon's practice
- 13 statistics on neurosurgeon salary in 2016
- The growth of outpatient spine — 9 Key Points
- 6 statistics on orthopedic surgeon compensation — Which practice setting pays most?
- PODs under attack again: 5 key notes from the Senate Finance Committee's report
- Novel technologies make a splash in outpatient spine setting — Dr. Nick Shamie weighs in
- Top 5 EHR vendors to partner with in 2016
- Where global spine market leaders are headed: 7 key notes on Medtronic, DePuy Synthes, Stryker & more
- Should medical device companies advertise direct to consumers?
- CMS's lowest vs. highest-paid physicians: 5 key points
- 5 trends in complex spine surgery
- Orthopedic surgeons leave Salina Regional over on-call payment dispute: 5 things to know
- Andrews Institute adds regenerative medicine, stem cell center: 5 things to know
- Dr. George Rappard performs 1st US MIS procedure with Sony heads-up display: 5 observations
- Siemens, Ziehm, GE, Hologic, OrthoScan & Medtronic: 26 O-arm & C-arm systems
- ISSCR updates stem cell research guidelines; warns against stem cell medical tourism — 5 insights
- Which 4 emerging trends will drive the global spine surgery market?
- Long Island physician faces drug charges following patient death — 5 things to know
- Annual & hourly orthopedic surgeon salary — 10 latest statistics
- Consumer Reports: 34 top-rated US hospitals for hip replacements