New hip replacement surgery – faster recovery, less pain
NEW HIP replacement surgery avoids cutting into major muscles, making recovery faster and less painful.
For patients apprehensive about undergoing total hip replacement surgery, a new technique now promises a faster post- surgery recovery, a shorter hospital stay, and less pain.
Traditionally, hip replacement surgery is performed using a method known as the posterior approach. In this technique, the surgeon cuts through the skin and muscle of the buttocks to get to the hip joint.
With the new direct anterior technique, however, the surgeon cuts through skin at the front of the upper thigh but not the major muscles, nerves and blood vessels. This is possible because of the body’s natural anatomy, and the surgeon merely spreads the muscles apart to get to the hip joint.
“In the traditional approach, the surgeon always has to cut the muscles. But in the direct anterior approach, the muscles are spared,” said Dr Pang Hee Nee, Consultant, Department of Orthopaedic Surgery, Singapore General Hospital ( SGH).
This muscle- sparing technique has a number of advantages, Dr Pang said. With the patient lying on his back, x-rays can be done easily and accurately. This makes putting in the implant more accurate, and a better fitted implant lasts longer and poses less risk of dislocation. And because the muscles and tissues aren’t cut, they don’t have to be stitched back after surgery. So, recovery is faster and patients feel less pain.
Indeed, a comparison of 25 hip replacements done at SGH using the new technique with another 25 under the traditional posterior approach found that the first group experienced less pain ( 0.6 on average versus 2.1 on the pain score), a shorter hospital stay ( 2.1 days versus 4.8 days), and took less than a day after surgery to begin walking ( 0.8 days versus 1.3 days).
Patients who underwent the traditional method had to use walking aids and avoid activities like squatting and crossing their legs for up to six weeks postsurgery. But the other group could walk normally within two weeks. In studies done overseas, patients were also found to have significant improvements at six weeks, six months and one year after surgery, said Dr Pang.
Almost anyone who needs a hip replacement can opt for the anterior approach. The few cases deemed unsuitable for this procedure would be those who have had their hip joint replaced before, suffer from infected implants, or have severe deformities in the thigh bone, said Dr Pang.
In the United States, between 20 and 30 per cent of surgeons now perform hip surgery using this method, up from around 5 per cent five years ago, Dr Pang said.
Although it is gaining in popularity, the technique is technically demanding. In addition to rigorous training, surgeons have to perform around 40 cases to be able to do this operation well.
The risks facing surgeons who are not well trained in this approach include fracturing a patient’s thigh bone, blood loss from a longer procedure, and joint dislocation. Otherwise, the risks are minimal; some patients report some numbness which eventually goes away.
Dr Pang is one of the few surgeons in Singapore trained in the direct anterior approach in total hip replacement, having spent a year learning the technique in Canada, with shorter visiting fellowships in Japan and the US. Dr Pang has run workshops for his counterparts in SGH and the region who are keen to pick up the technique.
A comparison of 25 hip replacements done at SGH using the new technique with another 25 under the traditional posterior approach found that the first group experienced less pain, a shorter hospital stay, and took less than a day after surgery to begin walking.