Anterior Hip Replacement Handbook & Pathway
Home > Condition & Treatment Map > Hip & Pelvis Conditions & Treatments > Anterior Hip Replacement Handbook & Pathway
What is an Anterior Approach to Hip Replacement?
An anterior total hip replacement is a procedure which is done to treat hip arthritis. The operation involves taking away the old hip which is worn out and painful due to arthritis, and replacing it with a new prosthetic (artificial) hip.
A worn out hip on the left with red arrows indicating bone spurs, cysts and loose bodies. The right image shows a total hip replacement which takes away the arthritis and provides a smooth joint surface.
An anterior hip replacement follows the green line between muscles rather than cutting through muscles (blue and red lines), as is done with other hip replacements.
X Ray with arthritis of the right hip, and after hip replacement
What to Expect For Your Anterior Hip Replacement
Day of Surgery
You will be advised of the time of your admission by the hospital and VBJS staff prior to your hip replacement procedure. It is important that you arrive punctually to ensure that your procedures is not delayed. You should have filled out your admission information online prior to attending the hospital.
You will be admitted to the hospital and placed into a gown, and a surgical pre-wash of your thigh is conducted with antiseptic solution.
You will be taken to an anaesthetic holding bay by an orderly, where you will meet your orthopaedic surgeon, anaesthetist, surgical assistant and anaesthetic nurse, who will check you into theatre. A drip/cannula will be placed into your arm at this stage. From there you will normally proceed into theatre after a short wait.
Typically once in theatre you will be given an anaesthetic, normally a combination of a spinal anaesthetic and general anaesthetic is used.The spinal anaesthetic makes you numb from the waist down and it avoids the use of strong pain killers which can lead to nausea and vomiting after the procedure. It is similar to an epidural that is used during childbirth, and it lasts several hours. If this is used sedation is used so that you are not aware of what is occurring during the surgery, and you will not have any memory of the procedure. This will be discussed with your anaesthetist prior to the procedure.
Immediate Post-Operative Period
You will normally remember ‘waking up’ in the recovery area, here you are monitored by an anaesthetic nurse after your procedure to ensure that your pain is well managed, that your vital signs are stable, and that you are safe to return to the ward. Often you may have no recollection of this due to medications which are given.
You will have a dressing on your hip, and you will have a drip in your arm. You will also likely have an oxygen mask on your face which assists with your breathing, you will be attached to various monitors to measure things like your heart rate, temperature and blood pressure.
Anterior Hip Replacement Post-Operative Care
After an anterior total hip replacement, there is a variable amount of pain and swelling, which can vary significantly between individuals. This usually diminishes after several weeks. It is helpful to keep the leg elevated and to apply ice regularly. It is not uncommon for the thigh and leg to swell substantially and bruising and discoloration to occur.
Pain Relief
If you had a spinal anaesthetic, your leg may be numb for 3-6 hours, and you may not have any feeling in your legs and be unable to move your feet. Although you may not be having much pain, start taking your pain medication 6 hours after surgery.
You will have a painbuster catheter inserted into the wound – this provides a trickle of local anaesthetic for 24hrs
You will routinely be prescribed Palexia and Endone (2 weeks) which is a narcotic pain medication for your post-op pain control. You should aim to cease it as soon as possible.
Take the Palexia regularly for the first one-two weeks. Then take the Endone for breakthrough pain as required every 4 hours. It is better to be pain free and be able to do the exercises rather than be in pain and not be able to do any exercise.
Use the medicine as prescribed and do not drive, drink alcohol, or perform duties that require concentration (i.e. school or work) while on the narcotic medication.
Icing
It is recommended that you ice your hip. Ice in a bag with cloth covering can be used fairly consistently for the first 24 to 48 hours to help diminish the swelling. After the 48 hour period, if it is comfortable for you, you may apply ice packs to the hip 3-4 times per day for 30 minutes until swelling is resolved.
Bowel and Bladder Function
It is important that regular medications are given to soften bowel contents and typically coloxyl and senna is given or Movicol daily for the first two weeks, as the pain medications can reduce bowel function post operatively. It is also important to eat a high fibre, high protein diet to assist with bowel function.
Blood Tests and X Rays
You will undergo x-rays after the procedure on Day 1 to check the alignment of your hip. You may also undergo blood tests depending upon your physician and surgeon.
Numbness
Most patients develop numbness down the outside of the leg/thigh – this relates to nerve stretching, and it typically goes away after several months.
Wound Care
You may remove the dressing in 12 days and apply band aids to cover stitches. Please use steri strips when dressings are removed (white tapes across wound). It is OK if they fall off.
You may shower in 3 days with the incision covered. Keep it clean and dry.
Do not get into a tub or pool until the wound is reviewed at 2 weeks post op.
You have dissolvable sutures, No suture removal is necessary
Once the dressing is removed, silicone based dressings are recommended to reduce scarring, which can be used in conjunction with Bio-Oil and massage
If your dressing becomes saturated/wet please contact your GP or our offices to have it changed
Crutches
You can fully weight bear on your new hip as you can tolerate.
After 4 weeks if you feel comfortable you can transition to one crutch and then after review at 6 weeks wean off the one crutch.
Weight bearing with crutches in a heel à toe gait until 6-8 weeks when you can wean off the crutches is important. Hydrotherapy may be useful from 4 weeks.
Blood Clot Prevention
Blood clots are rare after an anterior hip replacement surgery, but they can be serious. You will undergo the following preventative strategies:
Medication – Xarelto is typically given for 14days
Compression stockings – typically for 14days
Early mobilisation – the quicker patients get up and move, the faster blood gets moving and the lower the risk of blood clots
Remaining hydrated – if you remain well hydrated this can reduce your risk of blood clots
Other Medications and Treatments
A prescription may be provided for Valium if you are having spasms and Indocid (an anti-inflammatory). Use as prescribed unless contradicted. Do not drive, operate machinery, or drink alcohol while on valium. Valium is used for muscle spasms and Indocid or anti-inflammatories are used for prevention of heterotopic ossification (excess bone re-formation).
Driving
You may not drive at least until your post anterior hip replacement operation visit when your surgeon can make a decision regarding this, this is based upon your pain, medications, leg strength and also which leg has been operated on. Typically it takes 4-6 weeks after a right total hip replacement and 2 weeks following a left total hip replacement.
Anterior Hip Replacement Post-Operative Review
You will be reviewed at 2 weeks either by your GP or by your surgeon – please call the rooms on 57525020 to arrange an appointment.
You will normally be reviewed at 6 weeks, then 6 months by your surgeon with X rays.
Physiotherapy
You will be seen on the wards twice daily by the physiotherapy team. They will help you with:
Getting in and out of bed
Using crutches
Helping you with walking and gait retraining
You can arrange to be seen by PT within the first week of discharge from surgery. You will continue therapy, with specific therapist instructions, at the first post-operative visit. You may wish to set up an appointment with physiotherapy in advance (2-3 sessions/week).
For the first two weeks until formal physical therapy, you may do the following exercises:
Limit External rotation of the hip to 10°, No restrictions on internal rotation. Hip flexion to 90°
Ankle pumps: Move ankle up and down. 30 reps, 3 times daily.
Hip Pendulum: Stand on step supported by non operative leg, allow operative leg to hang off edge, gently move leg in circular motion clockwise and counter clockwise x 10, 3 times daily.
Precautions:
No weight lifting or water therapy during first two weeks.
If an exercise is very painful, stop doing it or do it within the limits of motion that is not painful.
Major therapy gains are not made in the first two weeks – this is mainly a recuperative period
Rehabilitation
Most patients do not need to go to an inpatient rehabilitation facility following an anterior total hip replacement. Inpatient rehabilitation is reserved for patients who live alone, or those who have complex medical co-morbidities which require monitoring. Rehabilitation physiotherapy services can be arranged at home for you, where a physiotherapist visits your home on a daily basis.
Home Modifications/Assistive Devices
Shower: a plastic shower stool/chair may be useful
Toilet: an over toilet frame may be useful, especially if you have a low toilet
Mats: consider removing rugs/loose floor coverings to prevent tripping hazards
Bed: low mattresses are best avoided as these can be difficult to get off
Kitchen: everyday items should be in easy reach to prevent stretching and reaching overhead
Room: consider moving furniture so that easy access in and out of rooms can be achieved
Grasper: this can be very useful for getting things off the floor
Nutrition for Recovery
Nutrition management is a critical part of your surgical recovery. Protein and essential amino acids are vital to healing your tissues and muscles and expediting your recovery. Protein is mainly found in meat, chicken, fish, eggs, dairy, legumes, and other vegetarian and vegan alternatives. Protein spread throughout the day is best for your surgical recovery, and you should aim to consume this 2-3 times per day during your recovery.
Calcium and vitamin D are also recommended to promote bone health and growth following your procedure. Most adults in Australia are vitamin D deficient, and therefore it is recommended to start calcium and vitamin D several weeks prior to your procedure, as this has been shown to be beneficial to your health and recovery. Vitamin D is naturally generated from sunlight exposure, and it is also present in oily fish, fortified foods, mushrooms, and egg yolks.
What to Report Immediately
Signs and symptoms to report
persistent fever
wound redness, drainage, or increased skin temperature around the incision
increasing numbness
sudden increase in pain or swelling
deep calf pain and/or swelling
shortness of breath
If you have any problems please call Victorian Bone and Joint Specialists on 57525020 or 1300 266 366.
You should have a post-op appointment scheduled in 14 days. If you do not, please call 5752 5020 to schedule an appointment.
FAQs
Which implants do Victorian Bone and Joint Surgeons use?
Our surgeons use a variety of implants depending upon the shape of your bones and the type of arthritis you have. He is skilled in using uncemented, cemented and latest generation mini stems as well as a variety of bearing components to suit your individual needs. These will be discussed with you prior to surgery.
Am I too young for hip replacement surgery?
Hip arthritis affects people of many ages, and anterior hip replacement surgery is an effective pain-relieving operation. Anterior hip replacements in Melbourne are done with excellent results, on both very young (teenagers) and older patients. If hip preservation options have failed, then total hip replacement may be a viable option to discuss with your surgeon, as he specializes in hip disorders in young patients.
When can I walk after an anterior total hip replacement?
Full weight-bearing and walking is allowed immediately after an anterior hip replacement. Initially, this will be aided by crutches. We get all patients mobilizing Day 1 after their operation on crutches. Most people will walk independently by 10-14 days postoperatively.
When can I drive after an anterior total hip replacement?
You should not drive for at least 48 hours after an anaesthetics. After 48 hours, your ability to drive will depend on the side you had your operation, left or right, the type of vehicle you drive, manual or automatic and what type of pain relief you are taking. It is generally reasonable to drive when you are confident with walking and can fully weight-bear on your affected side. The usual recommendation is 6 weeks.
When can I work after an anterior total hip replacement?
Your return to work will vary depending on the procedure performed and type of work you are engaged in. Most people can return to office work within 2 weeks. More strenuous manual work may require you to take 4-6 weeks before returning to full duties.
When can I play sports after an anterior total hip replacement?
Low impact activities, such as cycling and swimming, can be commenced from week 6. High impact activities, such as running, or excessive twisting such as during tennis or golf, are best avoided for 12 weeks after surgery.
How long will I take to heal after an anterior total hip replacement?
The wounds take 7-10 days to heal. Most patients improve dramatically in the first 6 weeks. Occasionally, there are periods where the hip may become sore and then settle again. This is part of the normal healing process. It takes three months for your hip to fully recover from a hip replacement. Continued improvements may be gained up to 1-year post-surgery.
How much pain will I experience after an anterior total hip replacement?
Most patients are surprised at how little pain they have after surgery. A local anaesthetics is injected around the wound during the procedure and a local anesthetic catheter is placed in the wound after the procedure to minimize any pain you may experience. In combination with the muscle sparing anterior approach, this allows most patients to walk within a few hours after surgery.
Will I beep going through metal detectors at airports?
Maybe. It depends upon the settings of the metal detector in use, some countries have higher sensitivities than others, so whilst you may not set them off in Australia you may do so overseas. Normally it is not an issue if you tell them you have had a hip replacement.
Daily Progress
This is intended as a guide only and it may vary depending upon your circumstances
Day 0: Day of Surgery
If you have surgery in the morning:
Sit out of bed in the afternoon
Mobilise to chair with physiotherapy/nursing assistance
Day 1:
Your pain should be controlled with oral medications
Last dose of intravenous antibiotics and your drip/cannula should be removed
Shower and get dressed in your regular clothes
Sit out of bed all morning and afternoon
X ray
Walk with assistance of physiotherapy and crutches
Day 2:
Mobilising independently with crutches
Step ups/downs
Getting dressed independently
Walking outside your room with crutches
Pain catheter removal
Eating and drinking normally
Day 3: Discharge
Physiotherapy review
Discharge paperwork
Medications
Wound/dressing review
Post Op appointment confirmed
Physiotherapy Protocol Post Anterior Hip Replacement
PHASE I— IMMEDIATE REHABILITATION – Usually 1-2 weeks
Goals
Protect integrity of repaired tissue
Restore independent mobility
Reduce pain and swelling
Precautions
Crutches for first 1-2 weeks – wean to 1 crutch in OPPOSITE HAND
No extension activities beyond neutral extension with extension
No crossed legs
Specific Exercises:
Straight line walking
Clams or Side leg raises (Abductor strengthening)
Supine abduction in bed
Mini Squats
Core stabilisation
Calf pumps
PHASE II— INTERMEDIATE REHABILITATION – 2-6 weeks
Goals
Restore range of motion
Restore hip strength
Normalise gait without aid (crutches)
Precautions
Avoid active hip extension and external rotation
No distance walking – aim 2-4000 steps/day
Specific Exercises
Supine hip abduction
Clam shells
Dynamic gait progression – side stepping, tandem, low hurdles
Forward step ups/downs
Hydrotherapy and upper body exercises with pool buoy between legs
PHASE III— ADVANCED 6 weeks+
Goals
Restoration of muscular endurance/strength
Restoration of cardiovascular endurance
Optimize neuromuscular control/balance/proprioception
Precautions
No precautions
Specific Exercises
Treadmill – inline walking 20mins 2 x per day
Advanced strength training – squats/lunges as tolerated
Side to side lateral agilities
Resume normal sports drills/training at 8-12 weeks
