Anterior Total Hip Arthroplasty

The anterior approach for total hip arthroplasty was first performed in France in 1947 by Robert Judet. Theirry Judet, Robert Judet’s son, continues to use this approach routinely for total hip arthroplasty and has performed over two thousand cases.

 

The technique was popularized in the United States by Joel Matta, who studied under one of Professor Judet’s students, the world-renowned Emile Letournel. Dr. Matta refined the surgical technique by modifying the specialized table used to facilitate the surgery. Dr. Matta has also designed instruments and implants utilized for the technique.  

 

The approach is made at the front of the hip. This is advantageous because the hip joint is positioned more towards the front of the body than the back or side of the body. As a result, the incision is naturally small. The superficial layer of muscle is parted and not split or cut as in other approaches. The interval between the muscles is an internervous plane, meaning that the muscles on either side of the interval are innervated by two different nerves. This makes nerve and muscle damage unlikely. The deep and most important muscle layer is preserved and in the majority of cases is not cut from the bone. This is in contrast to other approaches and greatly improves recovery. 

 

The patient is positioned supine, or on their back, on the specialized orthopaedic table. This allows the anesthesiologist to have maximal access to the patient throughout the surgery. The supine position facilitates use of the image intensifier, the intraoperative X-ray machine. By utilizing X-ray during the procedure the position of the pelvis in space can be determined and the position of the components of the total hip arthroplasty can be accurately positioned. The advantage of using X-ray vs virtual types of navigation is that X-ray is a real-time image like a picture. A virtual navigation system is a representation and therefore less accurate. Additionally, X-ray is the standard for preoperative planning and postoperative assessment therefore it is only logical to use X-ray during the procedure.

 

Most patients leave the hospital on post-operative day one or two.  There are no hip precautions. A walker or crutches are used for about two weeks then transition to a cane or no assistive device.  Physical therapy is prescribed on an individual basis.  

 

The dislocation rate is less with the anterior approach. Traditional post-operative hip precautions are not necessary. The return to function is more rapid because there is less surgical trauma, especially to the important hip abductor and external rotator muscles.