• By Shawn Bishop

Before Hip Replacement, Consider All Options for Treating Hip Arthritis

December 21, 2012

Before Hip Replacement, Consider All Options for Treating Hip Arthritis

December 21, 2012

Dear Mayo Clinic:

I have severe arthritis in my hip and have been looking into hip replacement surgery. Would the direct anterior approach work for someone like me? When can I expect to resume my normal activities after this surgery? I am 53 and in excellent health.


Hip replacement surgery can be done several ways. The one you mention — the direct anterior approach — is an option that spares more tissue than other hip replacement surgeries. It may involve a shorter hospital stay and quicker recovery time for some people. Before you decide to have any type of hip replacement, though, you should carefully consider all your options for treating hip arthritis.

Hip replacement surgery involves removing part of the hip joint and replacing it with an artificial joint that has a ball component made of metal or ceramic and a metal socket that has a liner made of plastic or ceramic. Using the direct anterior approach for hip replacement, the surgeon makes an incision directly in front of the hip and performs the procedure from that approach. During some other surgical approaches for hip replacement, the incision is made over the outside of the hip.

The advantage of the direct anterior approach is that the incision can be small and no muscles are split to gain access to the hip joint. With some other approaches, muscles are split and that can potentially increase recovery time after surgery.

In general, the director anterior procedure is an option for most people who need hip replacement. Other approaches may be better, however, for those who have a lot of bone loss in the hip socket or in situations where the top of the femur bone that fits into the hip socket is significantly deformed.

After surgery, people who undergo the direct anterior approach typically stay in the hospital for two nights. They leave the hospital with crutches or a walker to use until they can walk stably without pain. That can vary from a few days for some people to six weeks for others. Most people take some pain medication after hip replacement surgery. The amount of pain medication required for those who have the direct anterior approach can be less than for those who have other hip replacement procedures.

Typically, you can begin driving again about three weeks after surgery. For physical activity, normal daily tasks and walking usually are recommended for the first eight weeks. After that, low-impact exercises such as swimming and biking are a good idea to start building strength.

In the long term, most people can return to their usual routines. The only activities that are not recommended for people who have had a hip replacement are running and sports like basketball that place a lot of impact on the hip joint.

Keep in mind that no matter what type of hip replacement procedure is used, this is a significant surgery. So before you decide to go ahead with hip replacement, I would encourage you to talk with your doctor to make sure you have tried all the nonsurgical options that fit your situation.

For example, in some people a combination of an anti-inflammatory medications and weight loss along with changes in activities are enough to ease hip pain caused by arthritis. In addition, injections of corticosteroid medications may relieve pain in your hip joint temporarily. For some people, using an aid such as a cane or walker can take some of the load off a hip joint and ease pain, too.

If you have tried a variety of these treatments and pain or loss of function is still disrupting your daily activities, then hip replacement may be a good choice. Talk to your doctor and an orthopedic surgeon to learn more and to find out if the direct anterior approach for hip replacement could be right for you.

— Michael Taunton, M.D., Orthopedics, Mayo Clinic, Rochester, Minn.

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