When a patient suffers from arthritis of the hip, the symptoms include pain, stiffness, and limitation of range of motion.
These symptoms combine to interfere with all activities of daily life including walking, getting up out of a chair, going up or down stairs. The pain can be chronic or progressively more severe including sharp pains into the groin region.
Dr. Tom McKenzie, a Lodi Sutter Orthopedic Surgeon who primarily admits patients to Adventist Health Lodi Memorial Hospital for total joint replacements, has spent years studying the hip and the various reconstructive surgeries to restore hip function and mobility. He began offering total hip replacement by the anterior incision approach in 2013, and is one of few to offer this technique to patients in San Joaquin County. “A very respected mentor, Dr. Joel Matta, has been advocating this procedure since the late 1990s. After several years of in depth study, multiple surgical labs, multiple site visits to learn the technique, I converted to the anterior incisional approach,” says Dr. McKenzie.
The anterior incisional approach differs from the traditional posterior surgical approach by location of the incision, fewer postoperative restrictions for patients, increased mobility after surgery, less need for narcotic medication, and speedier return to normal life. The incision starts off the side of the lower pelvis and extends at most 10 cm along the lateral thigh. This small mini-incision provides adequate exposure for the entire surgery. No muscles are incised, but rather retracted out of way during the surgery. The exposure carefully goes in between all musculature and nerve planes. The exposure to the acetabulum, or hip socket, allows better visualization to ensure the components are more reliably placed. “The result is decreased patient pain to allow immediate ambulation with physical therapy the afternoon of surgery, and 90% probability of discharge directly home the day following surgery,” explains Dr. McKenzie.
The traditional posterior surgical approach requires a typically longer curved incision along the posterior and side of the hip, through the large and small posterior muscles to gain access to the hip. Although these muscles are usually repaired at closure, functional return is not uniformly reliable. “Those surgically violated and repaired muscles are critically important to the immediate and long-term rehabilitation of patients in their return to walking activities and the prevention of dislocations,” explains Dr. McKenzie. Dislocation precautions are consequently fewer and much easier for the anterior incision patient, as they can pretty much return to all daily activities with minimal restrictions. “The ability to do more is there,” adds Dr. McKenzie.
“My outcome statistics document a significantly decreased hospital stay, accelerated improvement and return of ambulatory activity, decreased need for narcotic and nonnarcotic pain medication in comparison to the posterior incision surgery. Both my patients and I were quite satisfied with the outcomes documented with posterior incision surgery. The anterior incision outcomes are dramatically and clearly superior,” explains Dr. McKenzie.
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