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Link
www.stefankreuzermd.com
A
NEW APPROACH POPULARIZED BY
DR. JOEL MATTA
Dr. Stefan Kreuzer
Though uncommonly used in the United States, the anterior approach for
total hip replacement provides definite advantages for patients, even
those in need of bilateral procedures. Rehabilitation is simplified and
accelerated, dislocation risk is reduced, leg length is more accurately
controlled, and the incision is small.
Why, then, is this approach not more widely used by U.S. surgeons? There
are several reasons: lack of familiarity, traditional teaching, and lack
of the necessary instrumentation and equipment. The surgery is
especially facilitated by a particular operating table with unique
capabilities to position the leg. This procedure has been perfected and
popularized by Dr. Joel Matta in LA. Thanks to his persistence to
perfect this approach, we are able to do this today.
The anterior approach is an approach to the front of the hip joint as
opposed to a lateral (side) approach to the hip or posterior (back)
approach. It is a true anterior approach to the hip and should not be
confused with the Harding approach which is often referred to as an
anterior approach.
Rehabilitation is accelerated and hospital time decreased because the
hip is replaced without detachment of muscle from the pelvis or femur.
Other surgical approaches necessitate detachment of multiple muscles
from the femur during surgery. In the anterior approach, by contrast,
the hip is approached and replaced through a natural interval between
muscles. The most important muscles for hip function, the gluteal
muscles that attach to the posterior and lateral pelvis and femur, are
left undisturbed.
Arch Table
Lack of disturbance of the lateral and posterior soft tissues also
accounts for immediate stability of the hip and a low risk of
dislocation. It is normal for patients undergoing lateral or posterior
incisions to follow strict precautions that limit hip motion for the
first two months after surgery. Most importantly, they are instructed to
limit hip flexion to no more than 60 degrees. These limitations
complicate a patient's simple daily activities such as sitting in a
chair or on the toilet or getting in a car. Following the anterior
approach, however, patients are immediately allowed to bend their hip
freely and avoid these cumbersome restrictions. Additionally, if
patients are sexually active before surgery, there are no limitations on
resumption of normal sexual activity after surgery.
The normal incision is about 5 inches but may vary (shorter or longer)
according to a patient's body size. Though small incisions are often
considered desirable by patients, it should be kept in mind that the
degree and type of tissue disturbance beneath the skin is a more
important factor. Incisions of adequate length allow the necessary
side-to-side separation of the incision without undue force. Too small
an incision can be more traumatic to the tissues, particularly to
muscles that can be damaged by stretching too hard.
With the anterior approach the patient lies supine (on their back)
during surgery. X-rays taken during surgery with a fluoroscope ensure
correct position, sizing and fit of the artificial hip components as
well as correct leg length.
The OSI PROfx® Orthopedic Table
Evaluation and treatment by a physical therapist begins the day of
surgery and leads to walking and functional activities. Patients may go
home after achieving an initial degree of independence in walking with
crutches or a walker as well as capabilities in basic day-to-day
activities. Patients are commonly discharged 2 to 5 days following
surgery depending on their degree of disability prior to surgery and
their overall capabilities.
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