As soon as your walking gets back to normal, your life can get back to normal.
With a minimally invasive anterior hip replacement ─ done through a small incision at the front of the hip ─ you can reclaim your active lifestyle quickly with minimal surgical pain or discomfort.
Dr. Scott Appell trained extensively with Dr. Joel Matta, who developed the anterior hip approach used in the United States. Dr. Appell was the first orthopedic surgeon in Alabama to begin doing anterior hip replacements in 2010, and continues to do more anterior hip procedures than any surgeon in the state
His Enhanced Recovery After Surgery (ERAS) approach, which avoids narcotics during surgery and addresses pain management with minimal to no opiates, enables patients to recover quickly, be active immediately, and resume independence as soon as possible.
In addition to minimally invasive anterior hip replacement, Dr. Appell’s areas of expertise include robotic total knee replacement, partial knee replacement, and total shoulder replacement. He and his team achieve consistently excellent results with predominantly outpatient joint replacement, which allows most patients to return home the same day, fully prepared to manage their recovery with the team’s support.
Why Choose Anterior Hip Replacement?
Nearly 400,000 patients have a total hip replacement in the United States every year. Regardless of the approach, hip replacements have close to a 95% success rate for relieving pain, regaining function and improving quality of life for up to 20 years or more.
- A posterior hip replacement, approached from the back, requires making an 8–12-inch incision and detaching muscles and tendons to replace a damaged joint. This can be more painful and prolong recovery for months, or even years.
- An Anterior hip replacement allows surgeons to approach the joint from a more natural position, through a 3–4-inch incision at the front of the hip, and move muscles aside along their tissue planes without cutting them or detaching tendons. This generally results in quicker recovery, less pain, less scarring, and a quicker return to more normal function.
Dr. Appell, a high-volume posterior hip surgeon for 15 years, switched to anterior hips exclusively* after studying with anterior hip pioneer, Dr. Joel Matta, in 2010. He is also a member of the Anterior Hip Foundation, a collaborative enterprise founded by Dr. Matta, and other like-minded orthopedic surgeons, to continue improving patient care.
*He will still use a posterior approach for revisions and other more complex procedures.
Anterior Hip Procedure: a Better Way
Anterior hip replacement is a 45-minute surgery that utilizes X-rays, enhanced with precision software, to get exact leg measurements, capture the exact position of components, and measure other key parameters in real time during the procedure.
- Patients lie on their back facing upward, which allows surgeons to approach the hip from a more natural position.
- An AI-enhanced imaging system turns a two-dimensional X-ray into a 3D model that allows surgeons to calculate and visualize precise hip cup angles, positioning, and leg length.
- Precise measurements allow surgeons to place the artificial joint in the exact center of the hip, which prevents dislocation and allows muscle to function normally.
- If the muscle is too short, it won’t be strong.
- If the muscle is too long, it will be painful.
- Centering the hip is key for achieving optimal function.
Posterior hip replacement requires more guesswork. Surgeons may need to manually pull and rotate the hip to gauge stability, and leg length may need to be addressed post-surgery.
Anterior Hip Replacement Benefits
Anterior hip replacement is a muscle sparing procedure that allows 90% of patients to go home the same day and function independently, along with someone to help for the next day or two.
- Patients are up and walking within three hours of surgery.
- They can go to the bathroom and walk up and down stairs on their own.
- Pain level is significantly less than posterior hip replacement.
- There are no motion restrictions.
- No pillows between the legs, special seats, or high toilet seats.
- A 3.5-inch incision leaves minimal scarring.
- Patients show gait improvement quicker than with posterior hips.
Enhanced Recovery After Surgery
Dr. Appell and his team utilize an Enhanced Recovery After Surgery (ERAS) system developed by the ERAS Society to minimize opiate use, reduce recovery time and improve patient outcomes.
This begins with educating patients thoroughly to make sure they understand what their surgery entails, what to expect when they return home, and the general timeline for recovery.
- Spinal anesthetics allow Dr. Appell’s team to operate without narcotics.
- Propofol puts patients in a twilight stage.
- Spinal anesthetics last for two hours so that patients don’t wake up in pain
- Eliminating narcotics eliminates the post-op nausea and vomiting that has prevented people from going home post-surgery.
- Nerve medication, Tylenol, and non-steroidal anti-inflammatory drugs (NSAIDS) limit the need for opiates.
Recovery Timeline After Anterior Hip Replacement
Walking is important to our quality of life. Once you can walk without pain again, you can return to a more normal, full life.
- Patients typically progress from a walker to a cane within a week.
- By the time patients go for their three-week checkup they are walking independently.
- Most patients can drive after three weeks with a right hip replacement; 10 days with a left.
- Physical therapy helps patients with proper gait mechanics after walking with a limp for so long.
- No sleeping restrictions or special pillows are needed.
- The implant will set off metal detectors at the airport.
- You should avoid extreme, high impact sports such as aggressive basketball or parachuting.
- Patients are free to resume golf, tennis, biking, hiking, and most other low impact sports.
Anterior Hip Replacement in Birmingham, Alabama
Dr. Scott Appell is a board-certified orthopedic surgeon specializing in total joint replacement. He was the first surgeon in Alabama to do anterior hip replacement surgeries, and he has done more of these minimally invasive procedures than anyone in the state. He and his team are dedicated to providing patients with the education, attention, and opiate-free pain management resources needed to recover quickly and get back to living a pain-free, active life. If you would like to schedule a consultation with Dr. Appell, please call (205) 397-5200 or book an appointment online.