Hip Replacement Surgery Explained
This week I will discuss two types of surgical procedures used in Hip replacement surgery. This will help readers gain an understanding of the medical terms used by their Orthopedic Surgeon when Hip replacement surgery is being proposed. The first surgical method is called the Posterolateral Approach and as its name suggests the surgery is performed by accessing the Hip joint through the interval between the gluteus maximus and Gluteus minimus region of the Hip. The second method of surgery is called the Anterolateral Approach with the Hip Joint being accessed through the interval between the Gluteus medius muscle and the Tensor Fascia Late muscles of the Hip (see illustration below).
With Posterolateral surgical approach, the following muscles of the Hip are preserved during surgery; Gluteus Medius, Gluteus Minimus and Vastus Lataralis. This preservation of these key muscles makes rehabilitation of these muscles easier after surgery. This surgical approach can in some cases provide a quicker return to normal coordinated walking ability; however this statistic is disputed by Orthopedic Surgeons who favour the Anterolateral approach.
The Anterolateral approach involves surgical interference with the following Hip Muscles; Gluteus Medius and Gluteus Minimus, Tensor Fascia Latae and Vastus Lateralis and the head of the Rectus Femoris Muscle. However, unlike the Posterolateral approach, the short external muscles of the Hip that are responsible for turning the leg outwards, are preserved. With both surgical approaches, the use of a walker or crutches (depending on your health, weight and age) are used for the first 3 weeks after surgery followed by a walking stick or single crutch for an additional 3 weeks.
Patients should note that the new Hip joint is vulnerable to dislocation at extreme ranges of movement after surgery due to the release of muscles bone and the joint capsule during surgery. In the immediate weeks after Posterolateral and Anterolateral approach Hip replacement surgery, patients should avoid bending their hips above 90 degrees which is achieved by not sitting in low chairs. In addition the patient should avoid turning their foot inwards and crossing their legs. In addition to this, patients who have had Anterolateral approach surgery should avoid turning their leg outwards (externally rotation of hip joint). Hence extreme caution should be exercised when moving from a seated to a standing position and when walking with crutches or walking aid.
Next week I will discuss Hip Replacement surgery further.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles.
Contact Number: 0504 26672
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