Outpatient Anterior Approach Hip Replacement

What is Outpatient Anterior Approach Hip Replacement?

With improved technology and advances in anaesthesia and pain control, hip replacement surgery has evolved and is now being offered in an outpatient setting.

Outpatient anterior approach hip replacement refers to surgery accessed from in front of the hip in an outpatient setting. It is a minimally invasive procedure that has been developed to cause less muscle damage, faster recovery, and less disruption in a patient’s life.

This outpatient (same-day) procedure aims at replacing a damaged hip joint affected by arthritis or a severe fracture with an artificial implant (prosthesis) made of metal, plastic, or ceramic.

Who is a Candidate for Outpatient Anterior Hip Replacement?

Not all patients are candidates for outpatient surgery. The criteria required to qualify for an outpatient anterior hip replacement, include:

• Being fit and in general good health 
• Motivated with a positive frame of mind
• Maintains a normal weight with less muscle mass and fat in the thigh area
• Hip condition that has failed conservative management
• A good network of family and friends who can provide care during recovery
• Commitment and preparedness to strictly adhere to doctor’s post-surgery instructions
• Mobile, active, and independent prior to surgery

Benefits of Outpatient Surgery

As it is an outpatient surgery, you will be discharged home the same day after your anaesthesia wears off. Recovering from home means leaving the hospital setting and getting to recuperate in the comfort of your own home. You will progress better in a familiar home environment where you are more likely to receive good care and a good night’s sleep.

Some of the benefits of outpatient surgery include:

• Less pain: Outpatient surgery does not involve a pain pump for self-administered medications or IV pain medicines.
• Fewer transfusions: Patients are less likely to require blood transfusions due to improved surgical techniques involved with outpatient surgery.
• Convenience: The convenience of recovering in your home generally makes recovery time easier than in an inpatient setting.
• Lower cost: Since there are no hospital room charges and related hospital charges, costs are much lower with recovery at home.
• Better recovery: You feel isolated in a hospital setting due to lack of social interaction that negatively affects your recovery. You will recover better in a home setting with care and interaction from your family and friends.
• Safer: Home recovery is much safer compared to a hospital stay as you are at risk of developing a hospital-acquired infection (HAI) in a hospital setting, no matter how sterile a hospital environment is.

Indications for Outpatient Anterior Hip Replacement

Indications for outpatient anterior approach hip replacement is linked to the failure of conservative management to treat conditions, such as:

• Hip injury or fracture
• Osteoarthritis
• Rheumatoid arthritis
• Avascular necrosis
• Bone tumour
• Congenital hip disease
• Septic arthritis
• Ankylosing spondylitis 

Signs and Symptoms Necessitating Outpatient Anterior Hip Replacement

Signs and symptoms that prompt outpatient anterior hip replacement include:

• Joint stiffness that limits the ability to lift or move leg
• Pain, swelling, or tenderness in the hip that affects your quality of life and sleep
• Hip pain that limits activities such as bending or walking
• Hip pain that continues day or night despite sufficient resting 
• A feeling of bones rubbing against each other
• Pain symptoms not responsive to non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, or steroid injections

Preparation for Surgery

Your doctor will explain the preparation in detail and obtain information from you about:

• All your health problems
• Drug allergies
• More recent illnesses, such as a sudden fever
• Pregnancy, if you are a female
• Medications or supplements you may be taking that may need to be stopped prior to surgery.

Your doctor will also discuss about:

• Avoiding food and drink after midnight the night prior to your surgery.
• Refraining from smoking, if you are a smoker, as nicotine prevents bone fusion.
• Use of antibiotics and blood thinners to reduce the risk of wound infection and blood clots respectively.
• Anaesthetic assessment to decide on the type of anaesthesia to be used during surgery.

Procedure for Outpatient Anterior Approach Hip Replacement

The operation is performed in an outpatient setting under anaesthesia with you lying on the operating table in a face upwards position. In general, your surgeon will:

• Clean the surgical site thoroughly and mark the site for incision.
• Make a surgical cut in front of the hip joint (anterior approach).
• Carefully separate the muscles and tendons to view the hip joint.
• Remove the upper part of the femur and the damaged cartilage and bone from the pelvis.
• Replace the damaged acetabulum and parts of the shaft of the femur with an artificial joint.
• Close the incisions with sutures and dressing to complete the operation.

Postoperative Care and Instructions

After surgery, you will be transferred to the recovery area where you will rest until you are discharged. You will be given pain medications to ease pain. You may have to wear stockings to prevent blood pooling in your legs. You will be able to do light activities within a couple of weeks. You will also be given postoperative instructions, such as:

• Use of assistive devices for walking, such as cane or crutches
• Limited weight-bearing activities
• Suture and dressing care
• Physical therapy and exercise regimen to improve range of motion and strengthen muscles
• Dietary changes and supplements to improve bone health
• Adherence to prescribed medications
• Adherence to follow-up appointments

Risks and Complications of Outpatient Anterior Approach Hip Replacement

Outpatient anterior approach hip replacement is a relatively safe procedure; however, as with any surgery, it does carry some risks, such as:

• Blood clots
• Infection
• Bleeding
• Injury to nerves and blood vessels
• Leg length discrepancy
• Hip joint dislocation
• Joint loosening

Benefits of Anterior Approach Hip Replacement

Benefits of Outpatient Anterior Approach Hip Replacement include:

• Smaller incisions
• Less scarring
• Quick recovery time
• Shorter hospital stay
• Minor damage to muscles
• Less pain
• Reduced chances of hip dislocation