Recently, a lot of attention has been given to the Anterior Mini-Incision Total Hip Arthroplasty…unfortunately the actual head to head comparison among the several accepted surgical approaches shows this to be the least optimal choice for most patients.
The approach is being pushed as the next best thing in total hip replacement. Unfortunately, it is not a "new" thing at all. The approach has been around for better than 25 years and was tried and abandoned by most surgeons a generation ago. Why all the fuss. Several issues are at the core. Reimbursement is down and niche markets have subsequently become necessary in several parts of the country (including Savannah oddly enough). Implant companies have invested millions in research and development to come up with a new "angle" to "selling" joints to older Americans. In order to create a "market" for your product, you must create "hype". Unfortunately that is all this is at the moment. True, instrumentation has improved in order to reduce incision size, but this is across the board, not just in the anterior approach.
There has been a lot made about the improved outcomes with this approach over traditional posterior incisions. Unfortunately, those skilled in the art of reading medical literature and not company/wall street websites will see propaganda for what it is. The truth is the only reports that show a reduction in pain, hospital stay and function were done by the surgeons/companies putting them in. The peer reviewed literature (the only studies worth knowing about) show no difference whatsoever. What they do not tell you is that your visibility is drastically reduced, you are relying on fluoroscopy (x-ray) to check your cup position, you cannot adequately test stability even if you wanted to because your leg is strapped into a boot connected to the OR Table and there are several reports of patients developing a permanent limp after surgery. In addition, several studies done with plastic surgeons have shown that while the incisions on average are a few centimeters smaller (for size matched patients), they are less attractive and much more prone to infections because you are stretching the skin more during surgery.
Savannah Bone and Joint has the lowest complication rate and the highest satisfaction rate in the region for hip replacement. Part of this is due to the combination of appropriate surgical management of patients in addition to using the best implants available in the industry. The recent Australian Registry Data has shown conclusively that the Oxinium on Highly cross-linked polyethylene (Verilast) technology has the lowest wear rate in hip replacement when compared to metal on metal and ceramic on ceramic options. Additionally, the survivorship of implants has surpassed that of the competition showing there is no better solution for hip replacement. Thankfully, for Savannah Bone and Joint patients, we have been putting in nothing else since we began setting the standard for hip replacement in the region years ago.
The reason most often given for not doing a posterior approach (the one used by most reputable surgeons worldwide) is the risk of dislocation. The truth is, the data being used is not only outdated, it has been recently explained and refuted. Back in the early days of Total Hip Replacement, the posterior structures were often times not repaired back to their original position thinking that the scar would take care of the stability. This, in combination with mal-aligned implants, increased the risk of posterior dislocation and the search was on for another approach. However, now that we know the problem was improper closure, the dislocation rates when implants are put in right is almost zero and equivalent to the anterior dislocation rate for the anterior approach (especially with their higher implant malposition rate.)
Alternatively, the majority of respected surgeons use the standard posterior approach where you can adequately align the implants under direct visualization and avoid many of the complications seen with the anterior approach. Furthermore, if a complication does occur, it can be easily recognized and repaired unlike the Anterior approach. I have unfortunately been involved in the care of several Anterior Approach patients where complications were not identified and managed and the patient ended up with unnecessary suffering and complicated surgical revision (ironically, through a posterior approach). My patients are typically discharged by post operative day two and several have gone home the day after surgery.
In summary, the anterior approach in nothing new. There is no respectable literature to support claims it is superior to the standard posterior approach in any way, and in fact, there is some recent literature that shows an increase risk of complication and revision. There is nothing wrong with having your hip done this way by a competent surgeon but there is nothing revolutionary about it either. Recovery rates, pain scores, incision sizes, surgical time, infections and blood loss are not improved with this approach based on current literature. The vast majority of surgeons use the conventional (posterior) approach because of its superiority. Basically, there is just no compelling scientific data to switch.