A new technique in hip replacement surgery, the direct anterior approach, allows patients to return to their daily routine within a month after surgery, much shorter than the three months usually needed after traditional hip surgery. In this technique, the surgeon makes an incision in the front of the hip, allowing him to separate the muscles to reach the hip joint. It is unlike the traditional hip surgery where muscles in the buttocks are cut through, and have to be stitched back after surgery leading to a longer recovery period.  

Moreover, the new technique is also highly precise as real-time fluoroscopic imaging is used during surgery. A normal hip is a ball and socket type joint. During the surgery, a metal implant shaped like a cup is placed into the socket where it becomes the artificial joint. Real-time imaging allows the surgeon to insert the cup in the optimal position and to measure the length of the patient’s leg more accurately. Improper cup position can lead to higher risk of dislocation and higher wear rate of implants. Unequal limb length can lead to abnormal gait and is the most common cause of dissatisfaction postoperatively.  

According to Dr Pang Hee Nee, Consultant, Dept of Orthopaedics Surgery, Singapore General Hospital (SGH), “Patients are able to return to their normal routine within a month of surgery, much faster than the three months for those who undergo conventional hip replacement.”

Recent studies have also shown that patients who had anterior hip replacement stayed just one-two days in hospital, shorter than the five-seven days for the traditional group as less time is needed for the muscles to heal. In fact, patients could walk unaided 12 days earlier than those who underwent conventional surgery. A faster rehabilitation period means patients can get back on their feet sooner, particularly those who lead an active lifestyle.  

“The anterior approach is technically more demanding, requiring surgeons to undergo rigorous training before they can offer this type of surgery. SGH, as an academic medical centre, is constantly seeking to sharpen its practices so that patients will benefit from the best possible care, “said Dr Pang. 

Since August last year, nearly 50 patients have undergone anterior hip replacement surgery at SGH. Besides reporting less pain, they were also able to flex their hip on the same day of the surgery. In traditional hip replacement surgery, patients are told not to exercise for about six weeks to avoid dislocating their hip.

SGH sees an average of 500 new patients with hip osteoarthritis patients each year. About 40 per cent suffer from serious hip osteoarthritis – a type of arthritis that is due to wear and tear – that requires hip replacement surgery. 

Despite the benefits, anterior hip replacement surgery is not for everyone. Those who had artificial hip replacement before may not be suitable candidates for this technique.