Anterior Total Hip Replacement

Anterior Hip Replacement is a method for performing hip replacement through a very favourable surgical approach located at the anterior aspect of the hip joint. Dr Doneley performs high volumes of total hip replacement surgery using the anterior approach to the hip.

Technical innovations have allowed the anterior approach to the hip to be safely utilised for total hip replacement surgery. No muscles or tendons are cut (and consequently do not require repair) during anterior hip replacement. This, plus numerous other benefits, act in concert to enhance patient recovery and overall outcome.

Hip replacement performed using this approach offers numerous documented advantages compared to traditional THR:

  • Faster recovery and return of function.
  • Less post-operative pain.
  • Decreased pain relief requirement.
  • Shorter length of hospital admission.
  • Shorter length of incision.
  • Less reliance on walking aids post-operatively.
  • Improved hip stability.
  • No requirement for post-operative “hip precautions”.
  • Accurate restoration of leg length.

The Anterior Hip Replacement surgical approach is both inter-muscular and inter-nervous:

  • Inter-muscular - utilises the interval between two muscles, Tensor Fascia Lata (TFL) and Sartorius.
  • Inter-nervous - the nerve supply for TFL is the superior gluteal nerve. Sartorius is supplied by the femoral nerve. There is no risk of muscular denervation using this approach.

A short (10cm) bikini-line incision is made at the anterolateral groin. Following this, the TFL and Sartorius muscles are retracted to visualise the anterior hip capsule and underlying joint. The capsule is then opened to access the joint itself and allow surgery to proceed.

Throughout the surgery, no muscles or tendons are cut or divided. As such, postoperative comfort is usually excellent and intra-operative blood loss diminished. These factors greatly influence the speed of post-operative recovery, return of function and length of hospital admission.

Supine positioning of the patient during the surgery allows for precise leg length restoration as well as stability checks. Given the lack of muscular/tendon cuts, stability of the hip replacement is excellent and no post-operative hip precautions are routinely required.

Standard hip replacement components are employed. When performed well, anterior hip replacement is indistinguishable from classic “posterior” hip replacement on post-operative X-rays.

There is growing acknowledgement that Anterior Hip Replacement offers excellent (often superior) outcomes for patients and is rapidly gaining popularity as the approach of choice for total hip replacement.

Anterior Hip Replacement surgery is only performed by a select few specialist hip surgeons. It is technically demanding and requires a significant investment of time and dedicated training to master.

Dr Doneley has used this surgical approach in approximately 95% of hip replacements that he has performed since 2015. He is a faculty member for teaching/training of this surgery to other orthopaedic surgeons and travels both nationally and internationally in this role. He regularly hosts visiting Australian and overseas based surgeons to his operating theatre to teach advanced techniques in this surgery.

Dr Doneley is usually able to offer this surgery to people who have been advised that they are not suitable candidates – many people are advised that they are not suitable candidates for anterior THR by other surgeons who have no experience or training in performing this surgery. There are occasions (approximately 5% of patients undergoing hip replacement) where Dr Doneley will not offer anterior hip replacement surgery (usually related to groin crease hygiene issues or specific skeletal/muscular issues) – he will happily discuss his reasonings for this with this small sub-group of patients.

Please contact Dr Doneley’s rooms if you are interested in having your hip replacement performed by the anterior approach.