Faster, Safer, Home Sooner After Hip Replacement

Hip replacement surgery is one of medicine’s most successful procedures. Today, new innovations are making it even better, yielding faster recoveries, safer outcomes and same-day discharge for most patients. At the forefront of this evolution is the anterior approach to hip replacement, a muscle-sparing technique that, when combined with advanced surgical technology, is redefining recovery and restoring mobility for patients of all ages.

On Saturday, April 18, Washington Health orthopedic surgeon Alexander Sah, MD, will present, “Faster, Safer, Home Sooner after Hip Replacement: New technologies for same-day anterior hip replacement surgery,” a seminar focused on these advances in surgical techniques and technology. Dr. Sah serves as medical director of the Washington Outpatient Surgery Center Arthroplasty Program and is co-medical director of the WH Institute for Joint Restoration and Research. A past president of the Anterior Hip Foundation, and co-author of Anterior Hip Replacement textbook with Joel Matta, MD, he has helped advance the standards of anterior hip replacement nationwide.

Muscle-Sparing Approach

All hip replacements use the same fundamental implant: a stem and a cup made from advanced materials such as titanium. The difference lies in how surgeons access the joint.

Traditional surgical approaches, including posterior and lateral approaches, require cutting through muscles and tendons to reach the hip. The anterior approach works between natural muscle planes without detaching key soft tissues. That preservation of the “soft tissue envelope” helps maintain stability around the joint.

“The hip instability seen with posterior approaches is related to cutting through muscle and tendon,” Dr. Sah explained. “By preserving those structures, the anterior approach creates a more stable hip and supports faster recovery. Dislocations often associated with posterior approaches can occur both early and late, even many years after surgery due to soft tissue disruption. With the anterior approach, instability is dramatically reduced, almost being virtually nonexistent.”

Because muscles remain intact, patients typically experience:

• Less post-operative pain
• Fewer movement restrictions
• Lower risk of dislocation
• Quicker return to normal function

Technology Elevates Precision

Dr. Sah said the anterior approach is uniquely suited to modern surgical technology. Several innovations work together to improve accuracy, efficiency and outcomes.

A major innovation is the Hana table, an operating room table developed specifically for anterior hip replacement. Unlike traditional operating tables where patients lie on their side during surgery, the Hana table allows surgery to be performed with the patient lying flat on their back.

This positioning offers several advantages:

• More stable and reproducible alignment
• Reduced risk of body shifting during surgery
• Greater surgeon control of leg positioning
• Improved patient comfort

When patients are on their side for posterior and lateral hip surgery, subtle twisting, especially in those with scoliosis or other spinal conditions, can affect implant placement. Even if a surgeon positions components identically each time when the patient is on their side, differences in body positioning can alter the final result. Lying flat eliminates that variability.

The anterior approach also uniquely allows surgeons to use live X-ray imaging during the procedure through a mobile C-arm. This permits surgeons to image both hips and use the healthy side as a real-time reference.

“In medicine, it’s rare to have a patient’s own anatomy serve as a direct control,” Dr. Sah noted. “By overlaying images, surgeons can match leg length, alignment and joint mechanics with millimeter precision. We can also confirm the correct implant size and position during surgery.”

Because of that, if adjustments are needed, they can be made on the spot. With traditional approaches, imaging only occurs after surgery is complete in the recovery room, making changes impossible without re-doing the surgery.

Dr. Sah uses integrated digital software platforms designed for real-time interoperative guidance to enhance X-ray images reducing, distortion. The platform automatically identifies anatomic landmarks, instruments and implants to improve accuracy and outcomes.

“The technology systems plug into the C-arm and instantly analyze images, providing objective measurements,” Dr. Sah explained. “Instead of relying solely on visual estimation, we receive real-time feedback on position, even down to a millimeter or half a degree of angle. This layer of objective precision helps us hit our targets more consistently and efficiently.”

Same-Day Standard

Dr. Sah noted expanded technology has reduced his anterior hip replacement surgery time to under an hour. Spinal anesthesia is the standard, allowing patients to experience fewer side effects and quicker recovery.

“Most patients are walking a few hours after surgery and go home the same day,” he said. “By two weeks, many are using a cane or no support at all. By six weeks, they’re often back to swinging a golf club.”

Modern implants built from advanced titanium alloys are designed to integrate with bone. The bone grows into the implant surface, creating long-term biological fixation. The implants are extremely durable and can last 20-30 years or longer.

Patients in their 40s through their 90s can benefit. From gardening and pickleball, to skiing, surfing, dancing, and golfing, most recreational activities are fully supported.

“You can bike, swim, ski, golf, tennis, hike, surf – do what you love,” he said. “We’re giving people the opportunity to walk again, to play with their grandchildren, to return to the activities that define them. We’re giving people back their mobility and quality of life.”

Dr. Sah’s Health & Wellness seminar, “Faster, Safer, Home Sooner after Hip Replacement: New technologies for same-day anterior hip replacement,” will be available on Saturday, April 18, at 10 a.m. Following the presentation, it will be added to the WH video library at www.YouTube.com/@Washington_Health.