Medical Professionals
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Total Hip Arthroplasty Anterior Approach vs. Posterior Approach David Walinger, PTA
Total hip arthroplasty (THA) is used worldwide as one of the most effective procedures for relieving pain, restoring function, and improving quality of life in patients with painful or deformed hip joints. Improvements in hip arthroplasty procedures have led to faster recovery, shorter hospitalization, and higher patient satisfaction.
In the United States, more than 300,000 patients between 50-80 years of age undergo total hip replacement. The most common cause for requiring a THA is due to osteoarthritis or injury. Symptoms of osteoarthritis include pain, joint stiffness, and decreased range of motion. THA has the ability to relieve pain and improve quality of life. Among all the joints in the human body, the hip joint has a faster, more durable and successful recovery following replacement. The hip joint is a ball-and-socket joint. The prosthetic (artificial) portion of the hip joint consists of two parts, a cup-like component that is attached to the acetabulum (portion of the pelvic bone), and a shaft with a round top that attaches to the femur (thigh bone of the leg). The damaged parts of the hip bone are removed, contoured and replaced with the prosthetic. These material combinations can include metal-on-polyethylene ,metal-on-metal, and ceramic-on-ceramic. Total hip replacements can be performed with two techniques which include an anterior approach or posterior approach. The anterior approach is considered less invasive in comparison to the posterior approach. During a posterior approach, while lying on your side, your orthopedic surgeon will create a 4-7 inch incision behind the hip along the outer buttock
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area. The gluteus maximus muscle is split but will not require repair. Two hip external rotator muscles are detached and then reattached to bone and will heal within 4-6 weeks. The anterior approach is usually performed creating an incision along the front upper thigh separating but not detaching muscle to avoid nerve damage. Following surgery, your physician will discuss your hip precautions to ensure a successful recovery.
Hip Precautions
Posterior Approach: What to avoid: • Sitting on low chair/toilets • Bringing you knee past you hip ( >90 degrees of hip flexion) • Bending at the waist to pick up objects off the floor • Standing “pigeon toed” (inward rotation of feet) • Crossing of legs
Anterior Approach: What to avoid:
• Stepping backwards on your surgical leg • Crossing of legs • Lying on your stomach • Standing with your feet rotated outward *Please consult with your physician regarding hip precautions
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Physical Therapy
Early postoperative therapeutic exercises are necessary for preventing blood clots and increasing blood circulation to your lower extremities. Early exercises are also important to strengthen muscles and maintain joint integrity. Following surgery, you will meet your supervising physical therapist in the recovery room to begin exercises implemented in your personal treatment plan. It may feel uncomfortable at first, but these exercises will speed your recovery and reduce your postoperative pain. Outpatient physical therapy sessions will help restore range of motion and increase your proximal hip stability. Weight-bearing activities will help restore strength to optimal levels as well. This level of physical therapy focuses on activity-specific rehabilitation for your personal goals, such as a return to work or other activity. Your physical therapist will incorporate exercises that simulate those activities. These may include lifting techniques, pushing, pulling carts, climbing ladders, agility exercises, or light jogging depending on your recovery and activity level. Today, 80% of all hip replacements last for up to 20 years. Some are not always successful, leaving various factors which increase the chances of failure including an individual’s weight, compliance of hip precautions as well as level of activity and overall health status. Performing strengthening exercises is essential for stabilizing the hip during recovery. Excessively high impact exercises can cause too much force and can increase the likelihood of complications. Skilled manual therapy and rehabilitation is very important in order to regain full potential and proper recovery. For more information on the importance of physical rehabilitation following a total joint replacement surgery, please call (609) 660-1900 to schedule an appointment at our Barnegat location.
David Walinger, PTA David graduated from Union County College where he earned his Associates Degree in Applied Science with successful completion of the Physical Therapist Assistant Program. Prior to this, he attended Bloomsburg University where he studied exercise science. During his clinical rotations he has treated many patients with a variety of pathologies including musculoskeletal injuries, Parkinson’s disease, cerebrovascular accidents, traumatic brain injuries, and more. David is an active member of the American Physical Therapy Association and is delighted to be a part of the All-Care team.
January/February 2022
