Washington Health Offers Cutting-edge Approach to Hip Surgery

Every patient brings specific needs and goals to hip replacement surgery. Washington Health orthopedic surgeon Erik McDonald, MD, will address his individualized approach and share information about anterior total hip replacement at a Health & Wellness seminar, “Anterior Total Hip Arthroplasty: Facts and Fiction,” on July 23, at 5 p.m. The public may watch in real time online at facebook.com/WashingtonHealth1, or at their convenience on youtube.com/@Washington_Health

More than half a million hip replacement surgeries take place each year, and this number is only expected to rise. The procedure is done to relieve pain and restore mobility to people whose hips have been damaged by degenerative diseases such as arthritis or other causes such as trauma. Total hip arthroplasty, also known as total hip replacement (THR), is the most common form of hip replacement surgery. The hip is a ball and socket joint, where the socket is part of the pelvis and the ball (the femoral head) is the “knob” on top of the femur. THR involves replacing both the socket and the ball of the hip joint with prosthetic components. The damaged bone and cartilage are removed, and the new prosthetic components are securely attached to the remaining healthy bone.

The surgery can be performed using either a posterior approach (from an incision on the side of the hip) or an anterior approach (from an incision in the front of the leg). Surgeons determine the approach they use based on their expertise and experience as well as the patient’s anatomy, medical history and the complexity of the procedure. Dr. McDonald has trained extensively on the anterior approach and it is his preferred method. Having performed anterior hip replacements on patients in their teens to centenarians, he emphasizes that an individualized approach is important for each patient.

“The anterior approach allows me to treat patients presenting with challenging issues, including bariatric patients, patients requiring revisions of prior surgeries and even salvage operations like proximal femur replacements,” Dr. McDonald explained.

“I have found my patients typically have very little pain and a fast return to normal activities,” he continued. “The anterior approach generally requires a small incision, which also allows for good wound healing.”

Facts and Fiction

For Dr. McDonald, education is the first step in establishing a relationship with patients. That guides his interactions from the first appointment through the surgery, to rehab and beyond. “It’s important for my patients to understand the risks and benefits of total hip replacement,” he said. “Surgery is a big deal. Some surgeons call it ‘minimally invasive,’ but it is really ‘less invasive.’ The body isn’t intended to be operated on. We’re still retracting muscles, navigating around nerves and blood vessels, and cutting bone to insert the implants. It’s my job to educate patients about what this means for them in the short- and long-term.”

Dr. McDonald noted anterior hip replacement is surrounded by both facts and misconceptions. While the technique leads to potentially faster recovery and less pain for some patients, it's not a universally superior method, and its success is often surgeon-dependent.

“Anterior total hip arthroplasty is a true internervous dissection, meaning we operate in between nerves and in between muscles, compared to traditional approaches, potentially leading to faster recovery and less pain,” he shared. “Patients may find they can return to walking unaided with less reliance on assistive devices.”

There are also misconceptions surrounding the use of the anterior approach. These include the idea that one type of approach is the best for all patients. “Surgery is not one size fits all,” he explained. “It’s imperative to cultivate a relationship with each patient to find the best solution to their particular situation.”

While a patient’s pain from before the surgery is typically gone right away, Dr. McDonald noted all hip replacement surgeries involve some degree of post-op discomfort. Patients expecting an immediate full recovery will find they still need some physical therapy after their surgery to regain strength and mobility. And while the risk of dislocation is lower with the anterior approach, it is still a risk.

“Like any surgery, anterior hip replacement carries potential risks, including infection, bleeding, blood clots, nerve damage, and implant-related issues,” he explained. “The anterior approach to hip replacement offers potential benefits in terms of lower dislocation rate, especially in patients with stiff spines, allows me better control of the leg during surgery and provides my patients with an outcome that makes their quality of life better.”

The seminar, “Anterior Total Hip Arthroplasty: Facts and Fiction,” can first be viewed at 5 p.m. on July 23. Following the presentation, it will be added to Washington Health’s library of videos on their YouTube channel, YouTube.com/@washington_health. To learn more about Dr. McDonald and the joint replacement program at Washington Health, see WashingtonHealth.com/IJRR.