Surgery

Steps of Hip Prosthesis Placement

The minimally invasive direct anterior approach respects the musculature. The skin is incised in front of the hip, then the muscles are spread apart. The worn femoral head is extracted after cutting the femoral neck. The acetabular cup is positioned in the pelvis, and the stem is implanted in the femur through a non-cemented mechanical fixation, which is immediately stable and later allows for a durable biological bone fixation (osseointegration). At the end of the operation, muscles that were not cut close back like the pages of a book.

Before the operation, 3D planning requires a CT scan according to the specific Symbios protocol. The size and position of the implants are determined to precisely reconstruct the anatomy of the hip. Less precise, 2D planning on radiographs is therefore abandoned.

In practice, the operation lasts 60 to 90 minutes, and hospitalization is 1 to 3 nights. eight-bearing assisted by crutches is allowed on the evening of the operation. Normal walking is achieved between three and six weeks, and sports are gradually resumed after 6 weeks. The duration of work stoppage depends on the patient’s personal conditions and can vary from one to eight weeks.

The custom prosthesis implanted through the direct anterior approach typically offers the following advantages: no forbidden movements, virtually zero risk of dislocation, complete preservation of hip muscles, no sports limitation, no inequality in leg length, and no torsion issues. Compared to the implantation of a standard prosthesis, the risk of complications is greatly reduced.

Which Surgical Approach for My Hip?

In the spirit of overall preservation of the musculoskeletal system, hip musculature should be respected whenever possible when implanting a prosthesis.

The direct anterior approach allows for the safe implantation of a hip prosthesis without cutting any muscles. The 3D planning technique improves the ergonomics and reproducibility of the procedure. The benefits for the patient are as follows: no forbidden movements, no forbidden sports, near-zero risk of dislocation, 100% muscle recovery, no risk of limping.

The posterior approach cuts the external rotator muscles of the hip. Although widespread, this prosthesis technique cannot be recommended as a first choice, as it generates a risk of posterior dislocation. However, it is the preferred approach for complex revisions, offering broad access to the hip and femur.

The Hardinge approach cuts a part of the gluteal tendons, which are repaired at the end of the procedure. An older, also widespread technique, it is less practiced by young surgeons and is expected to be abandoned in the coming years in favor of anterior approaches that do not cut any muscle. In case of limping or residual pain after the Hardinge approach, one should look for a rupture of the tendinous attachments and intervene to repair them.

Trochanterotomy and its variants should also give way to muscle-preserving techniques as it involves fixing the cut bone with steel cables, which is cumbersome and unnecessary. Trochanterotomy retains specific indications in very complex hips or some surgical revisions.

Managing Surgical Risks

It is legitimate to be concerned about surgical risk when undergoing a hip prosthesis operation. Informed patients positively contribute to reducing the overall complication rate as they become active in their care.

Before the operation, any active or latent infection in the body should be treated (dental, ENT, digestive, urinary infections). A dental consultation is thus recommended. Depending on risk factors, a cardiological consultation with an electrocardiogram may be desirable. A complete biological assessment is systematic. The pre-operative surgical and anesthetic consultation helps identify risks and prevent them.

After the operation, it is important to follow anticoagulant prescriptions and actively participate in rehabilitation (moving, walking, contracting muscles) to limit the risk of venous thrombosis. Patients of Doctors Nogier, Tourabaly, and Courtin are not restricted in movements, but basic safety measures must be taken to limit the risk of post-operative falls (be cautious of slippery floors, obstacles, and inappropriate footwear). Care of the surgical wound is entrusted to a nurse to limit the risk of contamination of the surgical site.

Finally, the patient and their family should report any abnormal symptoms such as fever, wound discharge, respiratory difficulty or chest pain, calf pain, difficulty urinating, etc.