Our Summary

This research paper discusses a popular method of hip replacement surgery called the direct anterior approach (DAA). While the DAA has many benefits, it can also lead to a higher rate of fractures in the femur (thigh bone) surrounding the artificial hip joint. The way the artificial hip stem is designed and inserted during DAA surgery might be contributing to this increased risk of fracture. However, specific designs of the hip stem and ways of securing it could potentially lower the risk of these fractures during DAA hip replacement surgeries.

FAQs

  1. What is the direct anterior approach in total hip arthroplasty?
  2. Why are periprosthetic femur fractures rates higher with the direct anterior approach?
  3. How can certain stem designs and fixation methods reduce the risk of periprosthetic femur fractures in total hip arthroplasty?

Doctor’s Tip

A doctor might advise a patient undergoing hip replacement surgery to discuss with their surgeon the type of femoral stem design and fixation method that will be used, as certain designs may reduce the risk of periprosthetic femur fractures. It is important to have a thorough discussion with your surgeon about the potential risks and benefits of different surgical approaches and implant options to ensure the best possible outcome for your hip replacement surgery.

Suitable For

Patients who are typically recommended for hip replacement surgery include those with severe arthritis or joint damage that causes pain, stiffness, and limited mobility in the hip joint. Other conditions that may warrant a hip replacement include hip fractures, avascular necrosis, rheumatoid arthritis, and hip dysplasia. The decision to undergo hip replacement surgery is typically made after conservative treatments such as medication, physical therapy, and lifestyle modifications have proven ineffective in managing symptoms.

Timeline

Before hip replacement:

  • Patient experiences hip pain and limited mobility, often due to arthritis or other degenerative conditions
  • Patient consults with orthopedic surgeon and undergoes various pre-operative tests and evaluations
  • Surgery is scheduled and patient prepares for the procedure, including arranging for post-operative care and rehabilitation

After hip replacement:

  • Patient undergoes hip replacement surgery, which involves removing the damaged hip joint and replacing it with an artificial prosthesis
  • Patient typically stays in the hospital for a few days for monitoring and initial recovery
  • Patient begins physical therapy and rehabilitation to regain strength and mobility in the hip joint
  • Over time, patient experiences improved function, reduced pain, and increased quality of life as the hip joint heals and the artificial prosthesis integrates with the surrounding bone.

What to Ask Your Doctor

  1. What are the potential risks and complications of hip replacement surgery, particularly in relation to periprosthetic femur fractures?

  2. How experienced are you in performing hip replacements using the direct anterior approach?

  3. What specific femoral stem designs do you typically use for hip replacements via the direct anterior approach, and how do they affect the risk of periprosthetic femur fractures?

  4. Are there any steps that can be taken during surgery to reduce the risk of periprosthetic femur fractures?

  5. What is the expected recovery time and rehabilitation process following a hip replacement surgery via the direct anterior approach?

  6. How will I know if I have developed a periprosthetic femur fracture after surgery, and what treatment options are available?

  7. Are there any lifestyle modifications or precautions I should take to prevent periprosthetic femur fractures after hip replacement surgery?

  8. How long can I expect the hip replacement to last, and what factors can impact the longevity of the implant?

  9. Are there any specific exercises or physical therapy routines that can help strengthen the femur and reduce the risk of fractures post-surgery?

  10. What follow-up appointments and monitoring will be necessary after the hip replacement surgery, particularly in relation to detecting and addressing any potential periprosthetic femur fractures?

Reference

Authors: Crawford DA, Berend KR. Journal: Orthop Clin North Am. 2021 Oct;52(4):297-304. doi: 10.1016/j.ocl.2021.05.002. PMID: 34538342