Enhanced Recovery (Eras) Direct Anterior Approach Total Hip Replacement

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Enhanced Recovery (Eras) Direct Anterior Approach Total Hip Replacement

Are you or a loved one considering Total Hip Replacement (THR) surgery? At Alps Orthopaedic Centre, we specialise in Enhanced Recovery After Surgery (ERAS). The ERAS Direct Anterior Approach in Total Hip Replacement (THR) technique not only holds the potential of effectively restoring the hip joint, but can also significantly reduce the average days spent in hospital. By making the hip replacement surgery a day surgery, we boost patient well-being and optimise every aspect of the surgical journey.

When non-surgical treatments like medication, physical therapy, and lifestyle modifications no longer effectively manage knee pain or mobility issues, total knee replacement may be considered as an option.

While knee pain can stem from traumatic injury, arthritis remains the primary reason for undergoing total knee replacement surgery. Arthritic pain typically develops gradually over time because of the wear and tear of the knee joint, often becoming more apparent in older individuals. On the other hand, younger patients are more likely to experience knee pain as a result of sudden injuries, such as those sustained during trauma episodes or sports activities.

What is Direct Anterior Approach (DAA) in Total Hip Replacement (THR)

Total hip replacement, also known as total hip arthroplasty, is a procedure in which orthopaedic surgeons replace a damaged or worn-out joint with an artificial one. It is typically recommended for patients suffering from degenerative diseases such as osteoarthritis and osteonecrosis. The goal of this surgery is to alleviate pain, improve joint function, and enhance the quality of life for patients who have not found relief from non-surgical treatments like painkillers or physical therapy.

While the prospect of surgery can be daunting for some patients, hip replacement procedures are known for their high success rates. The direct anterior approach is particularly noted for being the least invasive method in total joint arthroplasty.

The Direct Anterior Approach (DAA) to Total Hip Replacement (THR) is a surgical technique used to replace a dysfunctional hip joint with an artificial implant. Unlike traditional hip replacement approaches that involve accessing the hip joint from the side (lateral) or back (posterior) of the body, the DAA involves accessing the hip joint from the front (anterior) of the body, avoiding major muscles and tendons.

This minimally invasive surgical technique reduces tissue damage, typically resulting in pain relief and faster recovery times compared to traditional approaches. Patients undergoing DAA THR often experience shorter hospital stays and quicker return to daily activities, improving their overall quality of life.

What is Enhanced Recovery After Surgery (ERAS) Direct Anterior Approach in Total Hip Replacement

At Alps Orthopaedic Centre, we utilise Enhanced Recovery After Surgery (ERAS) protocols to prioritise the wellbeing of our patients. ERAS is a holistic approach that aims to improve clinical outcomes and most importantly, to expedite the recovery process of patients. ERAS typically involves medical professionals to be involved in all three phases of a patient’s journey, mainly, before, during and after surgery.

Furthermore, the ERAS protocol complements the DAA THR approach by optimising preoperative preparation, intraoperative techniques, and postoperative care. This comprehensive approach includes personalised pain management strategies, early mobilisation, and nutritional support, all aimed at enhancing recovery outcomes. This approach not only improves patient outcomes but also contributes to a more efficient healthcare system by reducing hospital stays and enhancing overall patient satisfaction.

Total Hip Replacement Pre-Surgery Procedure

Preoperative optimisation is key to a successful surgery and speedy recovery. Under the ERAS protocol, patients undergo thorough assessments and receive personalised care plans, including nutrition counselling and exercise regimes.

During the pre-surgery stage, patients can expect comprehensive and proactive steps to optimise their physical and psychological well-being before the surgery. For instance, patients would:

Receive information and knowledge of the surgical process. This helps to facilitate a smoother transition from pre to postoperative.
Restrict consumption of alcohol and smoking for at least 4 weeks.
Avoid eating solid foods for at least 6 hours before the surgery.

These measures enhance overall health, reduce surgical risks, and pave the way for a smoother recovery.

Total Hip Replacement Surgery Procedure

During the intraoperative stage, steps will be taken to facilitate a smooth surgery and minimise risks:

Skin preparation to prevent surgical site infections.
Use of local anaesthetics to ensure minimal pain for patients during the operation.
Utilisation of blood loss management tools, such as tranexamic acid, to prevent or reduce excessive bleeding.
Making a small incision to remove damaged bone tissue and cartilage as necessary, followed by the placement of a prosthesis.

Total Hip Replacement Surgery Post-surgery

After undergoing the ERAS Direct Anterior Approach (DAA) day surgery, your orthopaedic surgeon will recommend physiotherapy and wound care options to regain strength, flexibility, and stability in the operated hip and aid in a swift return to normal activity. Attending a structured rehabilitation programme supervised by healthcare professionals is recommended.

Postoperative care under the ERAS protocol focuses on early mobilisation. Patients are encouraged to engage in gentle exercises soon after surgery, walking with assistance, and physiotherapy interventions, promoting joint flexibility and muscle strength.

Advanced pain management techniques, such as multimodal analgesia, help alleviate discomfort while minimising opioid use and its associated side effects.

After the surgery, patients can expect a comprehensive plan to facilitate their recovery process, some of which would include:

Physiotherapy sessions to restore movement and strength on the operated hip
Information on activities to refrain from, such as lifting heavy objects or doing any form of intense physical activity
Follow-up appointments with your orthopaedic surgeon to minimise post-surgery complications

Direct Anterior Approach in Total Hip Replacement Procedure

Compared to traditional hip replacement surgeries, which involve incisions of 10-12 inches, the direct anterior approach is significantly less invasive. Orthopaedic surgeons access the hip by making a small frontal incision of up to 3-4 inches on the front of the thigh (anterior).

This approach allows surgeons to navigate through the space between key thigh muscles such as the sartorius, rectus femoris, and tensor fasciae latae without the need to cut or detach these muscle tissues. It helps minimise tissue trauma and scarring, contributing to a rapid, less painful recovery and improved cosmetic outcomes for patients.

Direct Anterior Approach Benefits

The Direct Anterior Approach offers distinct advantages when compared to conventional surgeries such as:

Earlier Postoperative Recovery

As this procedure does not require the removal or detachment of any muscle tissues, it significantly reduces the risk of muscle atrophy and strength loss, which are common concerns for patients undergoing surgery. This helps patients maintain a healthy baseline of muscle function post-surgery, which often translates to a reduced hospital stay and an expedited timeline for patients to resume their normal routines.

Lower Hip Dislocation Rate Post-Operation

With the preservation of soft tissue tension, the direct anterior approach promotes the preservation of the hip’s soft tissue tensions, minimising undue stress on the joint. This ensures that the hip joint remains stable post-surgery which significantly lowers the risk of dislocation.

Accuracy in Prosthesis Placement

The intraoperative imaging used during the direct anterior approach process allows surgeons to evaluate a patient’s leg length, enabling them to place the hip prosthesis with precision. Precise placement is critical for patients as it influences their hip’s joint range of motion, implant longevity and, most importantly, reduces the likelihood of revision surgeries.

Risks of Direct Anterior Approach

While there are benefits with the direct anterior approach, as with any other surgery, it still comes with risks, this approach has several risks such as:

Nerve Injury

There is a small risk of damaging nerves at the surgical site or around it. This can come in the form of numbness around the thigh area.

Wound Complications And Infection

Although the direct anterior approach is minimally invasive, the small incision made still has a small risk of wound or deep infection.

Intraoperative Fractures

When handled with inexperienced hands, there’s a possibility that fractures may occur during the surgery, which may lead to the extended duration of the surgery or even longer hospital stays. Rest assured, at Alps Orthopaedic Centre, our experienced orthopaedic surgeon, Dr Jerry Chen, will discuss these potential risks with you to help you make an informed decision.

Precautions After Total Hip Replacement Surgery

Following a total hip replacement, you can anticipate a lifestyle similar to before surgery, but free from pain. That said, returning to your regular activities will require time. Engaging actively in the recovery process can speed up your return and enhance the overall success of the procedure.

More importantly, there are certain precautions to be mindful of after a hip replacement including:

Avoid bending your leg greater than 90 degrees: This helps avoid stressing the hip joint and the surrounding muscles, which are still healing and adapting to the new joint.
Avoid crossing your legs or ankles for at least 6 to 8 weeks: Crossing legs or ankles can place undue stress on the hip joint and increase the risk of dislocation.
Avoid pivoting on your hips: Pivoting puts direct pressure on the hip joint, which can be risky soon after surgery. Using your entire body to turn distributes the movement and reduces strain on the hip joint.
Avoid turning your feet excessively inward or outward when you bend down: This can strain the hip joint and its surrounding muscles, potentially leading to discomfort or instability in the newly replaced hip.

For comprehensive guidance and demonstrations on post-total hip replacement care, consult your orthopaedic team at Alps Orthopaedic Centre for personalised advice and support.

If you are considering an ERAS hip replacement approach or looking for a suitable treatment option for your knee pain, schedule an appointment with our experienced Consultant Orthopaedic Surgeon, Dr Jerry Chen, for a thorough assessment and treatment plan.

Frequently Asked Questions

How long does it take to recover from a hip replacement?

Patients tend to return to normal activities within a few weeks, but full recovery may take 10-12 months.

How much does a hip replacement cost in Singapore?

Patients can expect a total cost of $35,000 to $45,000 for a total hip replacement day surgery.

How many hours is a hip replacement surgery?

On average, the procedure will take 2 hours to complete.

Can you go home the same day as hip surgery?

It is possible for patients to return home on the same day as their surgery; however, this may depend on a case-by-case basis.

What is the oldest age for hip replacement?

There is no age limit for a hip replacement as long as the benefits outweigh the risk for a patient to undergo the surgery.

References

American Academy of Orthopaedic Surgeons. (2021). Minimally invasive total hip replacement. OrthoInfo. Retrieved July 10, 2024, from https://orthoinfo.aaos.org/en/treatment/minimally-invasive-total-hip-replacement/
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (n.d.). Hip replacement surgery. National Institutes of Health, U.S. Department of Health and Human Services. Retrieved July 10, 2024, from https://www.niams.nih.gov/health-topics/hip-replacement-surgery
American Academy of Orthopaedic Surgeons. (2022). Activities after hip replacement. OrthoInfo. Retrieved July 10, 2024, from https://orthoinfo.aaos.org/en/recovery/activities-after-hip-replacement/
NHS. (2024). Recovering from a hip replacement. Retrieved July 10, 2024, from https://www.nhs.uk/conditions/hip-replacement/recovering-from-a-hip-replacement/
Ministry of Health, Singapore. (n.d.). Hospital bills and fee benchmarks search results. Retrieved July 10, 2024, from https://www.moh.gov.sg/cost-financing/hospital-bills-and-fee-benchmarks-search-result/detail?Code=SB839H–1&HasSurgicalProcedure=true

Practice Plus Group. (2023). How long does hip replacement surgery take? Retrieved July 10, 2024, from https://practiceplusgroup.com/knowledge-hub/how-long-hip-replacement-surgery-take/#:~:text=On%20average%2C%20the%20procedure%20takes,same%20day%20as%20their%20surgery.

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Dr Jerry Chen

MBBS (S’pore), MRCSEd, MMed (Ortho), FRCSEd (Ortho)

Fellowship-trained Consultant Orthopaedic Surgeon & Medical Director

Before starting Alps Orthopaedic Centre, Dr Jerry Chen was a Consultant at Singapore General Hospital (SGH), where he accumulated over 13 years of experience in Orthopaedic Surgery.
Dr Chen spearheaded the workgroup for Enhanced Recovery After Surgery (ERAS) for hip and knee replacement surgeries at SGH, where he successfully employed ERAS, benefiting more than 2,000 patients thus far.
Having performed over 500 surgeries in a year, he has been instrumental in helping numerous patients recover from injuries and diseases and return to their active lifestyles.
His clinical interests include Enhanced Recovery After Surgery (ERAS) for Hip and Knee, Sports Injuries, Minimally Invasive Surgery and Robotic Surgery.

Why Alps Orthopaedic Centre?

At Alps Orthopaedic Centre, we specialise in Enhanced Recovery After Surgery (ERAS). Performed as a Day Surgery, the ERAS Direct Anterior Approach in Total Hip Replacement (THR) technique as well as ERAS Total Knee Replacement (TKR), reduces the average hospitalisation stay, utilising techniques which enable the patient to suffer from less pain and recover faster. We are an Orthopaedic clinic in Singapore, which specialises in ERAS and do our utmost to enable patients to return to everyday activities as early as possible.

Our Orthopaedic clinic provides specialised diagnosis and effective treatment of musculoskeletal problems, especially Day Surgery / Enhanced Recovery After Surgery (ERAS) For Hip and Knee Surgery, Sports Injuries and Trauma Fractures. If you are considering hip or knee surgery or minimally invasive treatments, book an appointment with our experienced Consultant Orthopaedic Surgeon, Dr Jerry Chen, for a thorough assessment and treatment plan.

Our aim is to boost patient well-being, optimising every aspect of the surgical journey. By minimising the recovery period, patients are able to go back to activities that they love. The Alps team offers comprehensive financial counselling sessions to ensure our patients understand their options and make informed decisions regarding their treatment plans.

Has this article been insightful? Share it!

Dr Jerry Chen

MBBS (S’pore), MRCSEd, MMed (Ortho), FRCSEd (Ortho)

Fellowship-trained Consultant Orthopaedic Surgeon & Medical Director

Before starting Alps Orthopaedic Centre, Dr Jerry Chen was a Consultant at Singapore General Hospital (SGH), where he accumulated over 13 years of experience in Orthopaedic Surgery.
Dr Chen spearheaded the workgroup for Enhanced Recovery After Surgery (ERAS) for hip and knee replacement surgeries at SGH, where he successfully employed ERAS, benefiting more than 2,000 patients thus far.
Having performed over 500 surgeries in a year, he has been instrumental in helping numerous patients recover from injuries and diseases and return to their active lifestyles.
His clinical interests include Enhanced Recovery After Surgery (ERAS) for Hip and Knee, Sports Injuries, Minimally Invasive Surgery and Robotic Surgery.

Why Alps Orthopaedic Centre?

Has this article been insightful? Share it!

Dr Jerry Chen

MBBS (S’pore), MRCSEd, MMed (Ortho), FRCSEd (Ortho)

Fellowship-trained Consultant Orthopaedic Surgeon & Medical Director

Before starting Alps Orthopaedic Centre, Dr Jerry Chen was a Consultant at Singapore General Hospital (SGH), where he accumulated over 13 years of experience in Orthopaedic Surgery.
Having performed over 500 surgeries in a year, he has been instrumental in helping numerous patients recover from injuries and diseases of the musculoskeletal system.
As a driven and valued member, Dr Chen spearheaded the workgroup for Enhanced Recovery After Surgery (ERAS) for hip and knee replacement surgeries at SGH.
Over the course of his career at SGH, Dr Chen has successfully employed ERAS and reduced the average hospitalisation stay for hip and knee replacement surgeries.
Going through these ERAS day surgeries has benefited more than 2,000 patients thus far, enabling them to suffer from less pain and recover faster.
The Alps team is committed to providing specialised orthopaedic care tailored to your unique condition. We offer comprehensive financial counselling sessions to ensure our patients understand their options and make informed decisions regarding their treatment plans.