Minimally Invasive Anterolateral Hip Replacement
Minimally invasive anterolateral total hip replacement surgery is a specific approach to the hip that minimizes surgical trauma to soft tissues by working between muscle groups with a single small incision. There is no detachment or splitting of muscles that takes place during this procedure. This allows for less post-operative pain, shorter recovery without need for typical hip restrictions or precautions, and a faster return to function. Dr. Adam J. Rana is one of a select few surgeons in New England that performs this procedure. Dr. Rana completed his Orthopedic Surgical Residency at the Boston Medical Center and Lahey Clinic. After residency, he completed a fellowship in Adult Reconstruction, Arthritis, and Joint Replacement Surgery at the Hospital for Special Surgery (HSS) in New York City. This institution was voted the #1 rated Orthopedic Hospital in the nation according to US News and World Report. While at HSS, Dr. Rana trained under several world renowned orthopedic surgeons including Drs. Chitranjan Ranawat, Thomas Sculco, and Eduardo Salvati.
By utilizing the minimally invasive anterolateral technique and a sophisticated anesthesia protocol, patients typically are up and walking without significant pain within hours of surgery, take minimal pain medications post-operatively (often just Tylenol), and are home comfortably the day after surgery, without typical hip restrictions or precautions. The time to which patients are back to work is also faster than with the traditional hip replacement. Patients with a desk type work can return one to two weeks after the procedure, while patients with more physically demanding jobs can return within one month. The implants used with this procedure are the same ones used with traditional hip replacements and, therefore, we believe long term results will at the very least match traditional hip replacement longevity. Dr. Rana tells patients that they can expect to have their original implants in place 95% of the time at 10 years, 90% of the time at 20 years and 80% of the time at 30 years after the initial surgery.
Total hip surgery is major surgery and requires preparation. You will meet with the anesthesiologist and have pre-op labs and EKG performed.
- You will be asked to come to our office for pre-op evaluation which includes X-rays, a history and physical and to go over pre-op and post-operative pain management
- Pain management begins with pre-op medication and continues post-op. This includes Celebrex, Acetaminophen (Tylenol), Lyrica, and a low dose narcotic pain medicine when needed. This protocol will be modified if you have allergies to these medications.
- An advantage of this procedure is that there is no need for hip precautions since the muscle is left intact; therefore, no raised toilet seat or raised seat is needed.
As with all hip replacements, we use blood thinners to help prevent blood clots. Typically, patients will receive Aspirin for a total of six weeks after surgery. In certain patients with a history of blood clots, Coumadin (Warfarin) may be used for six weeks after surgery.
Post-operative patients can resume activities as their symptoms dictate. The post-op protocol includes the use of a walker (while putting full weight on the leg) for one week and the use of a cane for one week thereafter. Use of the cane may be longer as gait patterns dictate, but most patients are off the cane within two to three weeks post-op.
Frequently Asked Questions
What equipment will I need at home and how do I get it?
A prescription for a walker and cane will be provided at the pre-operative visit.
Does anyone come to my home after being discharged?
In some cases, a visiting nurse may be arranged to come in to your home to do lab work. In addition, in some cases a home physical therapist may come in for the first 2 weeks after surgery.
When do my staples get removed?
Staples are removed 10-14 days from your surgery.
Can I apply lotions/creams to the surgical site?
Do not apply lotions or creams to the surgical site until 6 weeks post-op.
When can I shower?
You may shower right after surgery. A special water repellent surgical dressing (Aquacell) is placed at the time of surgery that is to be left on until your post-operative visit.
No bathing or submerging your hip for approximately 4 weeks after surgery when your incision is well healed.
When can I drive?
At 2 weeks you may be allowed to drive. However, you must be off pain medications and should practice off the road prior to driving. In addition, you should feel comfortable initiating driving.
When can I swim?
Swimming may resume 4 weeks after surgery when your incision is well healed.
When can I fly in an airplane?
The return to air travel is dependent on your recovery process and will be based on our assessment. As a rule, flying is not recommended for the first 4 to 6 weeks after surgery. Patients with metal implants may setoff airline security alarms. We can provide you with a card stating that you have had a joint implant.
How long will I be out of work?
Resuming work is dependent on the type of occupation you have.
Patients with sedentary jobs may be able to return 1-2 weeks after surgery.
Patients with a physically demanding occupation may be able to return 4-6 weeks after surgery.
When may I resume sexual activity?
Sexual activity may resume as soon as you feel comfortable.
Is it normal to have numbness around the surgical incision?
Yes, some patients will experience numbness or decreased sensation to the skin near the scar that will likely improve over time.
Is it normal to feel like one leg is longer than the other after hip surgery?
Yes, some patients have had years of tightened muscles and loss of joint space and perceive the new hip to be longer. The goal of surgery is to restore equal leg lengths. Your body may take time to adjust to the restored space and implant, the muscle strengthening that occurs during rehabilitation, and your return to a more normal gait pattern.
How long after surgery will I need antibiotic prophylaxis prior to dental work?
You will need to take antibiotics 1 hour prior to any dental work for the first two years after your total hip replacement.
We ask that no dental work be done for the first 12 weeks after hip surgery.
Am I a candidate for minimally invasive anterolateral total hip replacement surgery?
The procedure can benefit almost anyone needing a hip replacement, young or old, healthy or sick. Only patients with significant deformities or previous surgeries may not be candidates.
What are the long-term benefits?
These are being studied. My experience, along with my partners that perform this procedure is that the risk of dislocation is significantly reduced with no restrictions in motion.
In addition, there is a benefit with this procedure of improved accuracy regarding leg lengths, as it is hard to lengthen a leg too much with this procedure, as the intact, uncut soft tissues will not allow it.
Will I need a transfusion?
Blood loss in the minimally invasive anterolateral hip replacement is typically low, transfusion rate is less than one percent. As such, we do not require pre-op blood donation.
Will I need therapy?
A physical therapist will work with you prior to discharge, teaching you to properly walk with a walker and stair climbing. You will also be taught exercises to be done at home. A physical therapist will come to your home to help with exercise and gait training as needed for the first two weeks. Outpatient physical therapy will then be started based on your need.
Do I have to worry about blood clots?
DVT is a risk of hip replacement, but the early rapid mobility after minimally invasive anterolateral hip replacement surgery seems to minimize risk. Post-op you will be on Aspirin for a total of 6 weeks after surgery, unless you have a high risk of DVT by history.
How do I get home or to the rehabilitation hospital?
Patients going home should let their family/friends know that they can be picked up the day of their discharge in any type of automobile (e.g., sedan, SUV, van, etc.). Transportation to rehabilitation facilities will be discussed and can be arranged by a member of the case management staff.
When do I need to call my doctor?
- If you have any sudden increase in pain that is unrelieved with pain medications.
- If the pain medications are not working.
- If you have a fever greater than 101.5 degrees.
- If you notice increased redness, warmth, swelling, pain or drainage around your incision.
- If you have calf pain and swelling.
When do I need to seek immediate help and call 911 or seek out emergency room treatment?
- If you fall and sustain an injury.
- If you have bleeding that does not stop.
- If you have trouble breathing.
- If you have new chest pain.