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London joint replacement specialistFor anyone who is considering a hip replacement, it is likely that you’ll be reading around the subject and making sure that you’re up to speed on what to expect from the procedure.

There has been a flurry of news recently about the speed and efficiency of anterior hip replacements, with stories about patients having this operation and being discharged later that same day, but this has some consultants concerned.

What is an anterior hip replacement?

This type of hip replacement is designed to cause minimal damage to the tissue and muscle that surrounds your hip joint. It is a very different approach to total hip replacements, requiring surgeons to learn a different technique.

Surgeons work by making a small incision on the front of your hip (rather than the back or side, which is more typically the case with total hip replacements).

Back to a more effective approach

Joint replacement specialist Simon Bridle recognises that hip replacement technologies have progressed significantly over time, although it is his belief and recommendation that approaching the joint from the posterior (back of the joint) is the safest and most effective means of undertaking this operation.

Although the posterior approach requires an incision through the gluteus maximus muscle, it requires the fibres to be separated, not actually cut. A small group of muscles called the short rotators are cut off the back of the hip and repaired back at the end.

There is no evidence that this approach results in any detectable muscle weakness in the long term. Mr Bridle believes that the anterior approach does not provide tangible advantages in terms of limiting the amount of pain or discomfort experienced by the patient, or to the overall effectiveness of the operation.

With modern anaesthetic techniques and pain relief many patients are leaving hospital in 2 or 3 days after a posterior approach, with rapid rehabilitation, so the short term potential benefits of an anterior approach are probably overplayed, with no evidence of any long term benefit at all.

Concerns with the anterior approach

In fact, the anterior approach raises some significant concerns for surgeons such as Mr Bridle. By making the incision at the front it is much closer to the lateral cutaneous femoral nerve (this runs along the front of the hip and supplies the skin on the side of the thigh).

In some cases patients have reported feeling numb in the top of their thighs following an anterior hip replacement, as a result of damage to this nerve and this can be very troublesome. The anterior approach is more difficult, increasing the risk of other surgical problems. It has been shown that it takes surgeons a long time to learn how to do it well.

Special implants have been developed to make it easier, but these often have no track record, so we don’t know how well they will do. All these issues are avoided with a conventional posterior approach.

Best foot forward

As with any medical professional, surgeons will select and recommend the treatments that they believe are best suited to their patients’ needs and requirements. Although a shorter stay in hospital – which an anterior hip replacement may offer – may be attractive, when the overall risks and benefits are weighed up, it does not fare as favourably.

Mr Bridle believes that the posterior approach offers a safer and more reliable technique for his patients.

Is there a risk to delaying hip replacement surgery?It is not unusual to wish to put off major surgery for as long as possible. As well as having concerns about the procedure itself and the associated risks, many patients are apprehensive about the necessary downtime after the surgery and the upheaval that will bring.

With joint replacement surgery in particular, there is often a desire to delay the procedure, as London hip and knee surgeon Mr Simon Bridle knows only too well.

When a patient has been suffering with joint pain for some time, it may seem that putting off surgery by a few months will only be extending the current suffering. But are there unseen risks involved in delaying a hip replacement procedure?

Risks of delaying total hip replacement

It is fair to say that delaying joint replacement surgery by a few months will probably not create major problems. However, it is important to be appraised of all the facts when considering having – or delaying – any form of surgery, and there are some complications associated with a prolonged postponement of total hip replacement surgery. It is always a good idea to speak to your surgeon before making any major decision around hip replacement surgery.

Problems with the joint itself

Depending on your particular hip problem, there is a possibility that the problem will worsen over time. This can mean that a deformity of the joint progresses – although this is generally a gradual process, that joint stiffness increases, or that the muscles surrounding the joint become weaker as you are using your hip less. Sometimes progressive damage to the joint makes the surgery more complex and recovery longer.

Compensatory problems

When you have pain in one hip, the natural tendency is to put more pressure on other joints. There is very little clinical data to support the theory of compensatory joint problems, but anecdotal evidence is common: many patients who visit Mr Simon Bridle’s London hip clinic experience back problems and pain in other joints, as well as the affected hip. The longer surgery is delayed, the greater the chance that this pain, as well as the pain in the affected hip, will increase.

General health problems

Increasing levels of disability with progressive hip arthritis leads to a more sedentary existence and will have an effect on patients’ general health. They tend to lose physical fitness and put on weight and this can have an effect on the heart and lungs, as well as other body systems. Prolonged use of pain killers can also have an effect on the kidneys. All this can increase the small risk of complications associated with surgery.

Can I avoid or delay hip replacement surgery?

A study published in Annals of the Rheumatic Diseases in 2013 did offer some hope, suggesting that exercise could delay or avoid the need for hip replacement surgery in patients with osteoarthritis.

The study showed that patients who took part in an exercise programme for one hour, twice a week over a twelve-week period, were 44 per cent less likely to need hip replacement surgery in later life than their peers who did not exercise.

If you have already been told that you need hip replacement surgery, it is unlikely that exercise will avoid the need for the operation. However, there is no doubt that low impact exercise will improve patient’s physical fitness, which can only be a good thing when approaching major surgery.

To find out more about your own situation and whether there is anything that can be done to delay surgery, why not book a consultation with London hip surgeon Mr Simon Bridle today.