New anterior approach in hip-replacement surgery results in less pain, faster recovery

The morning after undergoing a total hip replacement, Sean Toohey walked up half a flight of stairs at the hospital. That afternoon, he progressed from a walker to crutches to a cane. And 15 days after his surgery, he returned to work, no longer hobbled by a severely arthritic hip that had been bone-on-bone.

"My brother, who has had both hips replaced, was very jealous of my outcome," Toohey said.

Toohey's surgeon, Dr. Harold Rees, used a new anterior approach technique that results in less pain, faster recovery and better mobility. Rees now uses the anterior approach in all primary hip-replacement surgeries, which he performs at Loyola's main campus in Maywood and at Loyola's Gottlieb Memorial Hospital in Melrose Park.

The surgery is performed through the front (anterior) of the hip, rather than the back (posterior). And rather than cutting through muscles and tendons, the surgeon goes between them to gain access to the hip joint. The anterior approach incision is only about 2 ½ inches long.

There's less pain during recovery because the muscles and tendons have not been cut and the patient does not sit on the incisions. There's a lower risk of dislocating the new hip.

Most hip replacements still are done using other approaches, and many hospitals do not offer the anterior approach. But the anterior approach is becoming increasingly popular, and Rees predicts that within five to 10 years it will become the predominant technique.

The anterior approach is more technically demanding. But specially-designed operating tables facilitate the technique. The tables enable surgeons to precisely control the position, angle, traction and rotation of the hip and leg. Loyola has two such tables, the PROfx® and hana®. Gottlieb Memorial Hospital also has a hana® table.