Anterior hip replacement surgery is a well-established but lesser known surgical approach being used by a small number of specially trained orthopaedic surgeons in Ontario. With the anterior approach, the joint is accessed from the front rather than from the side or back of the hip. The most commonly used hip replacement approach in North America is still from the back of the hip, which is called the posterior approach.
Dr. Herman Dhotar, along with his colleagues Dr. Hossein Mehdian and Dr. Shawn Garbedian, are Orthopaedic Surgeons who perform anterior hip replacement surgery at North York General Hospital. In order to perform this more technically challenging procedure, Dr. Dhotar underwent extensive training in the United States at Duke University Hospital in North Carolina.
With the anterior hip replacement method, surgeons access the damaged hip socket without cutting muscles or tendons. The benefit is slightly quicker recovery during the first 6 to 12 weeks following surgery because patients are able to start moving sooner —there are no movement precautions unlike traditional hip surgery. Patients who receive anterior hip replacement surgery are typically discharged from hospital after one night and report having less pain. Generally, this surgery is performed on non-obese, relatively healthy patients between 50–70 years of age.
Increased requests for anterior approach
With more patients accessing medical information via the internet, Dr. Dhotar is seeing a rise in the number of requests for the anterior approach. Patients want to know how quickly they can get surgery and when they'll be able to return to their regular activities.
“It is good that patients are taking the time to inform themselves before coming to see me, but it is important to remember that sometimes there is a lot of ‘hype' that surrounds procedures that are only offered in select hospitals,” says Dr. Dhotar. “Part of my role as a surgeon is to ensure patients understand the advantages and risks of a procedure as well as learn about their expectations around the outcome.”
Dr. Herman Dhotar performs anterior hip replacement surgery on a specialized piece of equipment called a HANA table. Patients who receive anterior hip replacement surgery are typically discharged from hospital after one night and report having less pain.
Joint replacement surgery can improve pain and restore mobility to those who suffer from severe osteoarthritis or traumatic injury. Appropriate surgical candidates are patients who have tried non-operative interventions such as weight loss, exercise, physiotherapy and anti-inflammatory medication, with limited success.
Given the attributes of anterior hip replacement, it may seem like a “no-brainer” when it comes to hip surgery. But all surgical procedures come with some risk and not everyone is a suitable candidate. Femur fracture is a low-incidence risk to consider with the anterior approach; the resultis a more complicated surgery and reduced ability to put weight on the affected side. Overall, it is important to note that patients experience the same long-term outcomes regardless of the surgical approach they received.
“Getting the type of surgery that is right for you is important, but following your recovery plan and not over doing it is the best prescription for a successful hip replacement,” says Dr. Dhotar. “My advice to patients is always slow and steady ― the goal is to get people moving again with less pain, so that they can enjoy everyday activities and engage in moderate exercise.”