By Drew Yanker, PT, DPT, CSCS, Clinic Manager
ApexNetwork Physical Therapy – Frontenac, MO clinic
So, you’ve been told you need a new hip. Where to go from here? Undergoing a hip replacement surgery can seem like an overwhelming and scary experience. Luckily, hip replacements are one of the most successful procedures performed today. With a skilled surgeon followed by intensive physical therapy, you can expect a greatly improved quality of life.
It is important to note, however, that there are options on the table as far as how the surgery will be performed. Various “approaches” have been developed throughout the years to further improve prosthesis performance as well as patient recovery. Below are explained a few of the common ways hips are replaced to further aid you in your decision!
The first and still the most common approach is known as the “posterior approach”. The approach requires the surgeon to create an incision in the back of the glute that results in a blunt splitting of the gluteus maximus muscle. Cutting the short external rotators is required as well. The approach does however spare hip abductor musculature which will be essential to proper gait mechanics later in therapy. All incised musculature is repaired once the implant has been placed. To place the implant, dislocation of the hip is necessary with this approach to gain access to the femur and acetabulum (thigh and hip bones). Because of this, as well as the musculature cut to gain access to the hip, your surgeon will place you under certain “hip precautions” for a time following your surgery. These will include no flexing your hip past 90 degrees, no crossing your legs, and no rotating your leg inward. Following these will reduce your risk of dislocation post-operatively.
Our next method used to replace the hip is known as the “anterior approach”. This is considered to be more “muscle sparing” when compared to the posterior as less hip musculature is required to be cut. This generally results in a decreased risk of hip dislocation postoperatively as well as a quicker return to normal gait mechanics. In this procedure, an incision is made in the front of the hip and the musculature is able to be moved aside rather than cut through. The distraction of the hip is required to obtain access to the hip joint however full dislocation is not as it is with the posterior approach. This approach does not have the same precautions as with the posterior due to the path is taken to the hip joint. In general, all active motion of the hip is allowed following surgery however excessive hip extension (leg behind you) as well as excessive turning out of the leg will be cautioned against.
One of the newer methods of replacing the hip is the “SuperPath” procedure. This procedure may be the least invasive method of replacing the hip as no musculature is cut and muscle and tendon stretching are minimized. During this procedure, an incision will be made in the side of the hip and, as with the anterior approach, hip musculature is spread to gain access to the hip joint. A trough is made through the thigh bone to allow the lower part of the prosthesis to be implanted. The top of the femur is then removed at this stage which decreases odds of tissue damage and blood loss. After which the top of the hip prosthesis is positioned and musculature is moved back into place. Following this procedure, there are no precautions as there are with previous approaches.
The choice of a hip replacement is not an easy one and will come down to the conversation had between you and your doctor. Hip replacements, regardless of the approach, generally have very good outcomes. Physical therapy may be required to facilitate your rehabilitation to help you return to your normal activities. Your physical therapist will work with you to regain your strength, range of motion and balance to get you back to life faster!