By William K. Alcorn
Ruth Scarabino of Lisbon is the perfect person to compare the traditional hip-replacement technique, known as the posterior approach, with the newer anterior approach being used by a growing number of orthopedic surgeons.
After suffering with pain for about 10 months, Scarabino, 68, had an artificial hip implanted on Oct. 21, 2012, using the posterior approach.
A second artificial-hip operation on her other hip was performed by orthopedic surgeon Dr. Dominic Peters on Feb. 8 using the anterior approach.
Specializing in adult hip and knee replacement surgery, Dr. Dominic Peters trained in using the anterior-approach technique during a yearlong fellowship at Hoag Orthopedic Institute, Irvine, Calif. The anterior approach is used by about 26 percent of surgeons performing hip-replacement surgeries, he said.
A Poland native who practices at Salem Regional Medical Center, Dr. Peters, the son of Dominic and Georgette Peters of Poland, graduated in 2003 from Poland Seminary High School, completed a bachelor’s degree in combined sciences at Youngstown State University in 2005 through the Northeastern Ohio Medical University program. He earned his medical degree from NEOMED and was chief resident at the Michigan State University Kalamazoo Center of Medical Studies.
The difference between the traditional posterior and anterior approaches is how the surgeon opens the body to reach the hip joint.
With the anterior approach, there is a minimal incision located on the front of the hip. Using this technique, the surgeon moves muscles aside rather than cutting through them thereby creating less damage and trauma to the soft tissues around the hip and allowing for a quicker recovery time, Dr. Peters said.
Using the posterior approach, the surgeon cuts through the buttock muscles to implant the artificial hip joint. The posterior approach results in muscle damage leaving less support for the prosthesis and increasing the chance of dislocation, Dr. Peters said.
Also, he said, less pain medication is needed using the anterior approach, and there is less chance of blood clots, constipation, respiratory compromise and delirium or confusion.
Scarabino said the posterior approach used in her first hip replacement left her with a large incision that required daily cleaning by a caregiver.
She had to lie in bed on her back at night for six weeks; was on strong pain medication, primarily at night, for two or three weeks; had to give herself blood-thinner shots; and needed help from her husband getting in and out of the bathtub and the bed.
From a patient’s perspective, Scarabino said the anterior approach technique “is wonderful” in numerous ways.
“I had very little pain after surgery. The only thing I felt was some soreness when I walked on the leg, and I used pain medication only intermittently at night for a week or 10 days,” she said.
Also, Scarabino said, postoperative physical therapy was much easier with the anterior approach.
With the posterior approach, the physical therapist came to her home three times a week for the first two weeks and then, after resting for two weeks, she had to travel for physical therapy.
After her anterior approach surgery, Scarabino said she was “up and walking the first day” and had physical therapy three times a week at home, which she said is much easier than having to travel to a therapist’s office.
“It’s just great, and my husband is so glad he doesn’t have to take care of me,” she said with a laugh.
There are other benefits to using the anterior approach from a surgeon’s point of view, Dr. Peters said.
Patients are up right after surgery and the majority go home after one night in the hospital. With some, the surgery is done on an outpatient basis, Dr. Peters said.
Also, there are advantages to patients lying on their backs rather than their sides during surgery, he said.
Surgeons can perform right and left hip replacements at the same time. Also, the on-the-back position makes it easier to anesthetize the patient, and the surgeon can use X-ray technology to better locate anatomical landmarks to determine precisely where to place the prosthesis, Dr. Peters said.
The precision with which the artificial hip is placed in relation to the pelvic components and the femur or thighbone determines to a large degree the total survival of the hip replacement, Dr. Peters said.
Also, he said, there are no postoperative precautions with anterior hip approach. With the posterior approach, patients can’t cross their legs or bend over sideways or forward from six weeks to forever.