ANTERIOR

place,” King said, adding that the “muscle- sparring procedure” avoids having to detach muscles by going in through the front of the hip. “The main thing for a surgeon to get used to is seeing things from a different perspective. Putting the components in is pretty much the same. It’s just really getting used to the muscle interval that you’re going in between and getting used to the approach.”

King believes that with time, as older orthopedic surgeons, who have utilized the traditional approaches in their practices, head toward retirement, the anterior approach will become even more popular with incoming surgeons.

But Land is quick to say, repeating what he tells patients, that “a well done hip is a well done hip.”

“It doesn’t matter if you have an anterior approach, a posterior ap-proach, a lateral approach. If you have a good surgeon you’re going to do well,” Land said. “To me the difference is how quickly can you begin to see the benefits of your surgery. With the anterior approach you see it the most quickly.”

An additional advantage to the anterior approach is that there is lower likelihood of a patient suffering a dislocated hip after surgery, by avoiding going in through the back of the hip for the procedure, Land said.

Also, with the anterior approach, patients can lie down on their back for the surgery. This means patients can be put off in a “twilight sleep” by anesthesia through the spine, making the surgery safer for those with lung or cardiac issues, Land explained.

“If you can avoid having to be put all the way to sleep then it’s a little bit safer,” he said.

Even with the benefits of the anterior approach, Land still sees it as something that will be offered “fairly selectively” in the future.

“The anterior approach takes a long time to learn well and it’s a very specific skill,” he said.

For residents in orthopedics to learn all they need to know in five years, they may not have as much time as required to focus in on this one approach and practice it at length, Land said. And learning the traditional approaches offers residents the ability to apply what’s learned to many aspects of the field, he said.

As for the future of hip replacements, “Unless you can figure out some way for a patient to swallow a hip replacement and all of a sudden it ends up in their hip, there is going to have to be an incision,” Land said. “This is the best we’ve got right now as far as getting to the hip.”

King added that the elements of the surgery are not likely to change anytime soon, but what the future will bring are developments in the components used in hip replacements. He said that over the next decade, the plastic or metal used in hip replacements will be so hard and so durable that if a surgery is performed on someone in their 40s, their hip will last the rest of their life.