While not all patients are candidates to have their hip replacements done using the anterior approach, advancements in surgical technology and patient outcomes research point to an increase in the efficacy of this approach.
Santa Rosa, CA (PRWEB) July 24, 2014
According to the Centers for Disease Control and Prevention (CDC), 332,000 total hip replacements are performed in the United States each year. Dr. Ehmer at Santa Rosa Orthopedics (SRO) is a board certified orthopedic surgeon, specializing in orthopedic trauma, complex fracture care, and pelvic & acetabular reconstruction. He specializes in performing hip replacements using the anterior approach, a minimally invasive technique that requires special training and allows for quicker recovery than traditional methods.
Successful hip replacement relieves pain, restores overall function, and allows patients to return to normal activities. There is a range of surgical approaches that orthopedic surgeons utilize to access the hip joint, named according to the direction that the surgery is performed:
- the back of the hip, Posterior Approach (most common)
- the side of the hip, Lateral or Anterolateral Approach (least common)
- the front of the leg, Anterior Approach (gaining popularity)
Trauma specialist Dr. Nathan Ehmer, fellowship trained in orthopedic trauma with emphasis on pelvis and hip reconstructive surgery, is the first surgeon to offer the anterior approach to total hip replacement at both Sutter Hospital and Santa Rosa Memorial Hospital in Santa Rosa. As a trauma surgeon for the two Santa Rosa hospital emergency departments, Dr. Ehmer is also the first in the area to offer the anterior approach for select hip fracture patients who require partial or total hip replacement, as well as for degenerative hip disease.
Anterior vs. Posterior
Total hip replacement surgery has been utilized by surgeons for decades – generally as a way to treat hip trauma and late stage arthritis of the hip. Overall, long term outcomes have been observed as excellent in the majority of patients. Pioneered in the 1960s, advances made in this surgical procedure have gradually improved outcomes and patient satisfaction. The most current data demonstrates that hip replacements have an annual failure rate between 0.5%-1%, meaning 90-99% last 10 years, and 80-90% last 20 years or longer.
Over the years, doctors have improved this procedure making it less invasive, reducing the size of the incisions and incurring less damage to muscles and tendons, while improving the safety and effectiveness of the technique. However, only the anterior approach enables surgeons to perform the entire procedure without making a single incision to any muscles or tendons.
Dr. Ehmer explains, “I am very passionate about helping my patients become whole again after a life changing traumatic accident—putting their pieces back together. With modern medical technology and my desire for anatomic joint reconstruction, I am equally passionate about restoring lost function and vitality to those who suffer from degenerative joint diseases. I firmly believe that the anterior hip approach promises the best results for many of my patients.”
“Many clinical studies show far less muscle damage and weakness in both the short and long-term with the anterior, muscle-sparing approach when compared with other approaches. For patients, this means a quicker return of function in the first few months. Furthermore, a quicker recovery typically equates to a shorter hospital stay, and a higher percent of anterior total hip patients are able to go directly home rather than to a nursing home first. Another study shows that fewer anterior total hip patients require a cane or walker after surgery, provided they didn’t use one prior to the procedure.”
“The anterior approach doesn’t cut your muscles, and it doesn’t violate the posterior hip capsule and structures, yielding a lower rate of hip dislocation—less than 2% for anterior approach compared to over 4% with posterior approaches.”
“The anterior approach is performed under direct visualization of the hip joint, and with aid from a few milliseconds of live x-ray during surgery surgeons can ‘see’ how all the parts fit into patients’ unique anatomies. This allows for near-perfect anatomic restoration of leg length and precise placement of the hip replacement components for the most stable hip replacement. In traditional hip surgery, surgeons rely on a ‘trial and error,’ where a stable hip is obtained via a trial of varying combinations of parts. The surgeon cannot see the final hip replacement construct until an x-ray is taken after surgery. Leg length is also a lesser priority in traditional approaches to hip replacement because of the difficulty of obtaining precise measurements during surgery, and the necessity of stability because the posterior muscle and joint capsule were cut.”
“Because the anterior total hip surgery is so stable, my patients enjoy freedom from the dreaded hip precautions that restrict patients after traditional hip replacements procedures (no crossing of the legs, no bending over at the waist, sleeping with a foam pillow between the legs, etc.).”
“While not all patients are candidates to have their hip replacements done using the anterior approach, advancements in surgical technology and patient outcomes research point to an increase in the efficacy of this approach.”
Every surgical approach has risks and benefits, and the overall success of a hip replacement is multi-faceted. Patient factors such as age, weight, level of activity, medical conditions, as well as the hip replacement components and their alignment are all important. Each patient is unique and should consult with their surgeon in order to determine what is best for them.
Dr. Ehmer’s fellowship training and subsequent work in orthopedic trauma provide him the experience necessary to perform this technically advanced procedure with command and expertise. At Santa Rosa Orthopaedics, Dr. Ehmer is part of a collaborative team of multi-specialist orthopedic surgeons and highly skilled physical and occupational therapists. In its efforts to bring the best outcomes to patients, SRO offers patients in-house diagnostic imaging, rehabilitation, sports injury prevention, as well as advanced surgical treatments in joint replacement, sports medicine, trauma care, hand, foot, ankle, and general orthopedic surgery. For more information about Dr. Ehmer and the other SRO surgeons, visit srortho.com.