Hip Replacements Take A Big Step Forward: Anterior Approach Offers Fast Recovery, No Restrictions After Surgery

Thanks to surgical techniques and technology pioneered by Joel Matta, M.D., Medical Director of the Hip and Pelvis Institute at the Saint John’s Health Center in Santa Monica, increasing numbers of patients in North America are receiving hip and pelvis surgery that protects tissue, offers faster recovery, allows for more accurate placement of medical implants and reduces post-operation restrictions compared to traditional hip surgery.

In the “anterior approach,” the hip joint is reached from the front of the body. This allows the surgeon to operate through a natural space between the muscles, and eliminates the need to detach muscles from the pelvis or femur-unlike other procedures that take a lateral (side) or posterior (back side) approach to the hip. Since the anterior approach leaves the muscles that provide hip function undisturbed, trauma is greatly reduced and the new hip is immediately stable after surgery.

Anterior approach hip replacement offers patients faster recovery, unrestricted mobility after surgery and far fewer complications such as hip dislocation. Having performed more than 1,700 procedures since he introduced the anterior approach to North America, Dr. Matta is the leading champion and innovator of the anterior approach in North America and the United States.

“The anterior approach is a revolutionary improvement in hip surgery which helps people get back on their feet faster, without restrictions,” Dr. Matta said. “It improves patient satisfaction and health, and saves money by shortening hospitalizations and reducing the risk of future complications.”

He has continued to refine the technique since he was first trained in France 25 years ago. About six years ago, Dr. Matta collaborated with a surgical equipment company to develop a robotic table that assists with operations by holding and turning the patient precisely as needed. Today, the hana® robotic table, manufactured by Mizuho OSI, brings the benefits of the anterior approach within reach.

Although the anterior approach technique has been known for many years, difficulties in reaching the femur bone have prevented surgeons from adopting it widely. The robotic table gives surgeons better access by raising and positioning the femur, making the anterior approach easier to perform.

If a patient needs both hips replaced, both procedures can be performed in one visit to the operating room. Patients receiving the anterior approach typically leave the hospital in one or two days; with other approaches, recovery takes four weeks or longer.

There have been an increasing number of high-profile anterior hip patients. Last fall, Dr. Matta performed anterior approach surgery on eight-time major golf champion Tom Watson. Watson left the hospital a day after his surgery and within three months was playing on the tournament circuit again. The success story was featured in the March 2009 issue of Golf Digest magazine.

“I studied a variety of surgeons and techniques. I wanted to know about complication rates, recovery time and how well the anatomy was put back together,” Watson said. “Then I sought the best surgeon. After a lot of due diligence, I selected Dr. Matta.”

All types of artificial hip prostheses can be used with the anterior approach. What may be even more important, though, is that prosthetic hip implants can be situated more accurately and consistently with the anterior approach, Dr. Matta said. This ensures that both the position of the components and leg length will be correct, which are critical to normal hip function.

In planning a hip replacement, one mistake both patients and doctors can make is to become overly concerned with the prosthetics rather than the surgical approach itself.

“People get too focused on what kind of parts and materials are being used,” Dr. Matta said. “That’s a good discussion to have, but what’s more important is what the surgeon will do during the operation. As surgeons, we need to ensure that the muscles around the hip aren’t disturbed, the parts are fitted and oriented properly, and that the leg length is correct. And it behooves us to perform hip replacements that don’t rely on our patients restricting their movements for the rest of their lives.”

Anterior approach patients have no restrictions on their movements. In contrast, patients undergoing traditional surgeries have an extensive list of movements they must avoid to prevent dislocating the new hip. Simple actions such as crossing legs and tying shoes normally may be permanently prohibited. Yoga is out. Even sitting on the toilet can risk dislocation.

“The lateral and posterior approaches to hip replacement traumatize the muscles that support the hip. They destabilize the hip and increase the risk of dislocation,” Dr. Matta explained. He noted that in the U.S., an average of 4% of traditional hip replacement patients suffer hip dislocation, requiring additional hospitalizations and surgeries.

In comparison, the risk of dislocation is far lower with the anterior approach: A multicenter research study showed that only 0.6% of anterior approach patients experienced hip dislocation. Dr. Matta’s own patients fared even better, at a low 0.2%.

“And these are patients with no restrictions,” Dr. Matta added. “It shows that anterior approach patients can do anything they want, and still have a 20 times reduced risk of dislocation.”

As word spreads about the anterior approach, patient interest is causing more surgeons in the United States and the rest of the continent to seek out Dr. Matta for training. He has trained hundreds of physicians and is conducting nearly a dozen courses this year.

Source: Saint Johns Health Center

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