HIP, HIP, HOORAY!

John Brumagin is a mid-Missouri cattle rancher who has now had both knees and hips replaced by Columbia Orthopaedic Group. Although John will tell you all four replacements went smoothly, he was particularly pleased with his most recent joint – a new hip courtesy of COG surgeon Samuel Thompson, MD.

“The knees were the hardest and had the most recovery time,” John says. “But with this hip Dr. Thompson did, I didn’t have much pain at all. I took over-the-counter pills for pain for a couple of days and the therapist had me walking up and down my drive within three or four days.”

Dr. Thompson performed an anterior hip replacement on John in October 2022.

To understand the benefits of anterior hip replacement over more traditional posterior hip replacement, it helps to know how these surgeries work.

In both procedures, the surgeon removes the worn-out parts of the joint – including the ball at the top of the thigh bone, the stem that connects it to the thigh bone, and portions of the interior of the hip bone socket – and replaces them with titanium, ceramic, and plastic equivalents.

During posterior procedures, patients are placed on their sides and the surgeon makes a curved incision on the side and back of the hip. An incision is made in the large muscle in the hip (the gluteus maximus) which is laid open to get access to the joint.

During anterior hip replacement, patients are placed on their backs on a special operating table. The surgeon makes an incision, approximately 5 or 6 inches long, in the skin on the front side of the thigh. The work of removing and replacing worn parts is done between the muscles without cutting them.

To see what he’s doing during the anterior hip procedure, Dr. Thompson uses a small X-ray machine, interfaced with a computer software program called Radlink. This equipment helps him confirm that the stem inserted into the femur, ball, and socket are precisely in the correct position.

According to Dr. Thompson, there are two key reasons why anterior hip replacement may be a better option for some patients. Because the surgeon works between the muscles instead of cutting through them, your muscles don’t have to heal after surgery.

“What’s evident in the literature is that early recovery is easier,” says Dr. Thompson. “Long term, the functional outcomes are similar between both approaches, but patients can return to their desired activity level sooner after an anterior hip replacement. This is especially attractive to the younger, more active patient.”

Dr. Thompson says the risk of dislocation after posterior or anterior hip replacement is low, but the anterior procedure results in even lower numbers. He explains, “It’s becoming increasingly clear that the risk for hip dislocation after an anterior hip replacement is lower. This is probably due to the fact that we don’t have to cut the muscles around the hip to do the surgery, so the hip is not destabilized. It’s also very easy to use computer-assisted techniques during anterior hip replacements that help us accurately place the implants, reducing the possibility of putting in the parts in a way in which they might be more likely to dislocate.”

Anterior hip replacements can be done outpatient procedures. Once the patient wakes up from the anesthesia, they can usually get up and walk right away.

John did spend the night at Boone Hospital Center just like he did after the posterior hip procedure, but he’ll tell you his recovery was easier with the anterior procedure.

“This worked better. I can’t describe it, but it was better,” John says. “It took longer for my other hip to build back up that muscle they cut.”

Dr. Thompson performed John’s surgery on Thursday and discharged him on Friday. John used a walker for a couple of days but by Monday, the physical therapist had John up and down stairs and the driveway, using only a cane. He was then back on his side-by-side, helping his son and grandson feed cattle.

Not all patients are candidates for anterior hip replacement. Patients with complex problems or existing hip hardware may require the exposure afforded during a posterior hip replacement. Patients who have fat that rests over the front of the thigh are usually not candidates because it hinders proper healing of the incision.

Dr. Thompson learned anterior hip replacement during his orthopedic surgery residency and hip and knee replacement fellowship. Among the hip specialists at Columbia Orthopaedic Group, he is the only one currently performing the anterior procedure. He anticipates that will change as the procedure continues to grow popular.

“At the American Association of Hip and Knee Surgeons annual conference this past year, the percentage of hip surgeons who do anterior hip replacement as their primary approach to the hip has risen to 56 percent,” Dr. Thompson says. “In 2010, it was only 12 percent.”

Although anterior hip replacement may not be for everyone, people like John have experienced the difference.

“Basically, I don’t see how I could have done any better,” John says. “I was very pleased.”

By Michelle Terhune