Given the nature of an anterior hip procedure, it would seem that the precautions one would be need to take following surgery would tend to be somewhat minimal in number. This is indeed the case. The main reason behind this line of thinking is that when a hip replacement procedure is done by means of entering through the anterior or front rather than through the posterior or rear part of the hip, which is the more traditional method, fewer tissues have to be cut and repaired to gain access to bones that make up the hip joint.
It is true that anterior hip replacement, a fairly recent procedure, does less damage to tissues and the recovery time is therefore faster. Nevertheless, there are several post-operative steps a patient must take and certain things that need to be avoided to prevent a hip dislocation or some other problem from arising. Before outlining what these precautions are, it would be helpful to understand what is involved in the more common types of procedures.
It should be noted that, in some cases, a total hip replacement is not always required. Instead of replacing a bone, a bone graft may make more sense. In some instances, all that is required is a bone resurfacing. These procedures may involve either an anterior or posterior procedure. In the case of an anterior procedure, the recovery time and the precautions that need to be taken will depend on what the procedure was designed to accomplish.
The precautions are discussed in some detail at the end of this article. The list is not a long one. In fact, the precautions can be summed up in these four points:
- Avoid exceeding the normal range of motion in the hip during the initial stages of recovery.
- Avoid any activity that subjects the hip joint to a sudden impact, such as jumping or the rapid changes in direction that are common to many sports activities.
- Avoid exercises or yoga poses that place excessive stress on the anterior ligaments until they have had an opportunity to heal.
- Go about your normal daily activities; exercise is good, but strenuous exercising is usually not necessary for purposes of recovery.
Hip arthroplasty is the medical term for hip replacement. A total hip arthroplasty involves removing an injured or diseased hip joint and replacing it with a prosthetic device. This usually consists of a metal or ceramic ball component and a socket made of metal, ceramic, or plastic.
Besides anterior and posterior hip arthroplasty procedures, there is also a lateral hip replacement procedure, also known as the anterolateral approach in which the hip joint is accessed through the side. This approach is not commonly practiced, however. The posterior hip procedure is the most common, primarily because it gives the surgeon the best view of the bone and socket arrangement. The posterior replacement approach has been in use for many years and has proven to be highly successful in terms of patient recovery and overall prognosis.
The primary disadvantage of a posterior hip procedure is the necessity of cutting through various tissues to reach the joint and having to repair those same tissues once an implant has been put in place. While this repair has become quite routine, it nevertheless means a longer recovery time because of the time it takes all of the repaired tissues to completely heal to the point where a possible dislocation is no longer a primary concern.
In the case of an anterior procedure, the surgeon does not have quite a good a view of the joint as is the case with a posterior replacement procedure, although it is usually quite adequate for most purposes. The main advantage that is gained is that the bones making up the joint can be accessed by moving tissues aside rather than having to cut through them. This does not mean that no incisions at all are necessary, but those that are required are usually be much smaller than is the case with a posterior hip procedure and fewer internal tissues have to be cut. Because the incisions are smaller, the procedure is sometimes referred to as mini anterior hip replacement surgery.
Advantages and Disadvantages
Anterior hip replacement surgery has not been around nearly as long as the posterior procedure, but has been practiced to some extent as far back as the 1980’s. What has made the anterior procedure more popular as of late is that advances in surgical instrumentation have made it less and less invasive with each passing year. The initial incision is generally not more than four inches in length and muscular damage in the area can usually be held to a minimum. Perhaps the main advantage offered by this type of procedure is that, while some tissues need to be cut into, the muscles primarily involved in hip joint action are normally not subjected to any damage at all with the result being less time required for recovery.
The primary disadvantage is that special equipment is required, including either a special operating table or special retractors. The risk of a patient experiencing a femoral fracture is also somewhat higher and there is even a slight risk of ankle fracture during the course of the surgical procedure. In addition, there is also a slightly higher risk of nerve damage occurring, which could lead to the patient feeling a tingling or burning sensation in the thigh. A feeling of numbness in the thigh following surgery is a somewhat common experience, but it is usually a temporary one, or if it should become permanent, it is rarely troublesome. The anterior approach may not be the best approach to take when the patient is either heavily-muscled or significantly overweight.
The surgical procedure itself normally takes about an hour. A patent will usually spend no more than 2 hours in the operating room.
When a person undergoes surgery, there is a set of physical positions that he or she must take to avoid injury to muscles and other tissues in the hip area, premature wearing on the surfaces of the implant, or dislocating the hip. The set of positions to be followed, for up to three months following surgery, in most cases involve using an elevated toilet seat, sleeping with a pillow between the legs, and avoiding crossing the legs or rotating the toes inward. Other precautions that come as no surprise would be to proceed with caution when resuming certain physical activities and avoiding others completely until the hip has healed.
While the time duration that precautions need to be taken following hip surgery will depend upon both the procedure involved and what was accomplished, there are certain procedures that need to be followed for at least three months and sometimes longer if so directed by the surgeon.
- In general, when an anterior replacement procedure has been followed, those precautions that are usually designed to prevent the hip from dislocating can often be dispensed with. Since the muscles that control movement and assist in keeping the bones in the joint in place have not been damaged or weakened, it is much less likely that the hip will pop out of place. After undergoing a posterior procedure, a patient has to be extremely careful about changing sleeping positions since rolling on one’s side could cause the hip to dislocate. This is an unlikely occurrence in the case of an anterior hip replacement, although precautions must be taken to give the ligaments that have been cut time to heal.
- After a posterior procedure, patients are told to refrain from crossing their legs, as that action could cause a dislocation due to lax or weakened muscles. Following an anterior procedure, such a precaution is not necessary.
- Immediately following the anterior replacement procedure, the patient as well as the caregiver must ensure that no hip extension or rotation beyond the normal range is permitted. Also, the patient is not allowed to lie in a fully prone position. The upper part of the body needs to be elevated slightly. A pillow is usually placed under the knee to keep the hip flexed to approximately 30 degrees. Once up and walking, the patient may use a normal or step-through gait pattern, but needs to avoid movement beyond its normal end range of motion.
- Violating these restrictions is generally an unlikely occurrence since the patient will usually experience a certain amount of pain and swelling, a certain lack of muscle control, and a definite limitation in the range of motion the hip can be subjected too. Those symptoms, combined with a general weakness felt in the leg and possible problems with balancing while upright, usually serve to keep any movement on the part of the patient within acceptable limits.
- While yoga has many benefits, there are a few poses that should be avoided during the healing process. If you attend yoga classes, you will likely find that most of the poses you have been doing will not cause any problem and some of them will in fact tend to hasten the healing process. Any type of a bridge pose, however, needs to be avoided. Also, any stretching motion that places a great deal of stress on the hip muscles should be avoided until those muscles have had a chance to fully heal. While the muscles do need a certain amount of exercise, they should be exercised lightly at first and not allowed to be stretched.
- The reason for avoiding certain poses or exercises is that the one set of soft tissues that is cut into during an anterior hip replacement procedure is the anterior capsule. The anterior capsule consists of ligaments that help to keep the joint in place and it takes up to 4 months for these ligaments to repair themselves and for the anterior capsule to reform. Excessive stretching of these ligaments will impede the healing process.
In most instances, recovery time is fast, at least relative to the time it takes to fully recover from the other types of procedures. In some cases, a patient can be discharged from the hospital the day of the operation although a second and sometimes third day before discharge is more the norm.
It is usually necessary to move around with the aid of a walker for the better part of a week. Weight can be placed on the leg, but sharp impacts need to be avoided. Once the walker can be dispensed with, the patient may find that walking with the cane will be helpful for another week or two. After a month to six weeks, the patient will find life has returned more or less to normal, although there are still some precautions that need to be taken.
In summary, the typical anterior hip precautions to be followed can be summed up as follows: Lead a normal lifestyle, but keep hip movements in moderation. Walking is fine, but hold off on running or jogging, or any activity that can cause sharp impacts to be felt. In fact, the more you walk around in the days and weeks following surgery, the better. At first, you’ll likely become fatigue long before you have any chance of hurting yourself. Exercise is good for you as well, but go easy at first, remembering not to place too much stress on the hip joint. You should be able to go about your daily normal activities, but basketball, softball, or hiking over rough terrain should be avoided for at least 3 months.