Specialist in Direct Anterior Total Hip Replacement

Total Hip Replacement

The goal of total hip replacement is to provide a pain free hip that allows you to return to most pursuits. The procedure has been widely accepted as one of the most successful surgeries ever invented, improving your quality of life. When performing hip replacement Dr Fleming is aiming at providing you with a joint that will last a lifetime however it is currently difficult to predict the exact longevity of an implant. It is best to look after your new joint avoiding injury as the first surgery will usually carry the best outcomes.

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There are numerous ways to perform hip replacement surgery, Dr Fleming has used posterior, anterolateral and direct superior in the past but prefers using the minimally invasive direct anterior approach for 98% of his patients.

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Should your anatomy or arthritic pattern make anterior approach surgery unfeasible or should you require revision surgery Dr Fleming performs these surgeries through the posterior approach.​

 

The reasons Dr Fleming prefers the Anterior Approach

• The surgery is performed whilst the patient in lying supine (on your back) - this gives me an excellent appraisal of the functional position of the pelvis allowing individualised cup position.

• The muscles and tendons are not removed from the femur during surgery facilitating less pain and faster recovery.

• The surgery is inherently stable with a lower dislocation rate than posterior approach.

• The joint registry reports lower infection rate with anterior surgery.

• I use mobile xray and associated navigation whilst performing surgery allowing accurate assessment of leg length, offset, cup & stem position and sizing. 

  • This is done using image-based navigation that seamlessly pairs with my pre-operative planning.

• Pain has been reported to be lower than other hip replacement techniques.

• Recovery is quicker with better patient reported outcomes during the first 6 weeks following surgery.

• The scar is usually very small.

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Other aspects of anterior hip surgery -

• Although the scar is on average 8 cm long, it is visible when looking in the mirror.

• 10% of patients will have a small area of numbness on the outside of the scar. 

Despite the recovery being faster, Dr Fleming is conservative when is comes to early exercise. Dr Fleming advises short gentle walks both on land and in the pool in the first 6 weeks following surgery. There is no benefit to attend formal rehabilitation in the first 6 weeks.

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Examples of return to sport:

Golf: putting and chipping from 4 weeks, half swing from 6 weeks, full swing 3 months, return to reasonable competitive play at 4 months.

Surfing: paddling a large volume board for exercise at 6 weeks, dry land practice of 'pop by 10 weeks, surfing small waves by 12 weeks and back into better waves by 4 months- expect the flexibility and control to improve for a year after surgery. I advise avoiding surfing critical waves for at least 9 months.