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Anterior approach hip replacement with minimal PT

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Category: Specialty Forum for PTs/Healthcare Professionals
Forum Name: Orthopedics
Forum Description: Discussion on Orthopedics
Printed Date: May 27 2022 at 1:55pm
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Topic: Anterior approach hip replacement with minimal PT
Posted By: HSwierczekMPT
Subject: Anterior approach hip replacement with minimal PT
Date Posted: Nov 02 2012 at 3:35pm
I am a home care PT in the suburbs of Philadelphia. I'm seeing an increase in the number of patients having anterior approach hip replacement surgery. While I love this new approach, since it spares the muscles and eliminates THPs, I'm questioning if what I am seeing is a trend or just a preference of the Rothman Institute. I have had multiple clients come home within 24 to 48 hours of surgery. They had PT at the hospital to teach them how to use an assistive device, usually a SPC, and how to do stairs. Depending upon the hospital, they may or may not come home with a protocol exercise packet which basically consists of quad sets, glut sets, ankle pumps and heel slides. I have had at least one Rothman doc say he wanted gait training only, no ther ex, with a lateral total hip revision, and another Rothman doc discontinue PT after my initial eval was done because the client had referred pain to his knee. (his pain started the day prior to my eval.) Of course he has pain! He only had surgery three days ago!

Is this a trend with the docs performing anterior approach THA? Or is this just a Rothman Institute thing? Yes, less PT is needed because muscles are spared, but soft tissue is still cut, and edema is still present. Those two things lead to balance and strength deficits which need to be addressed with PT. Not ignored. My first client was walking around but wondered why he couldn't get off his cane and didn't have his strength back. It was all I could do to not say, "well, if your doc would let you do your exercises, you'd get that strength back sooner."

Heather Swierczek, MPT
VNA of Pottstown and Vicinity

Posted By: Ask a PT
Date Posted: Nov 28 2012 at 9:44pm
Hi Heather - I think it just depends on the ortho docs and their training and it may just be a trend. The patients that I see from the hospital system in Kenosha, WI who have undergone a THA continue to undergo a posterolateral approach and receive PT. In the private practice I am at part time I saw a total of 1 patient with an anterior approach and he did get hospital, home and outpatient PT. PT for THA in an outpatient setting is just not as commonly ordered vs TKA.

The anterolateral procedure really isn't that new of a procedure. Advantages of anterolateral approach include joint visualization, protection of neurovascular structures, maintenance of soft tissue integrity with minimal associative postoperative complications, and a decrease incidence of heterotrophic bone formation. A review has shown that good stem positioning, adequate medial calcar cement, and satisfactory acetabular cup positioning can be achieved regardless of the approach.

Some articles I found informative dealing with this include:
1) Woolson S, et al. Risk factors for dislocation during the first 3 months after primary total hip replacement. Journal of Arthroplasty. 1999 14(6):662-8.
2) Macedo C, et al. Comparison between the antero-lateral and posterior approaches in primary total hip arthroplasty. Revista de la Facultad de Ciencias Medicas/Universidad Nacional de Cordoba. 199, 56(1):91-6.
3) Yuan L, Shih C. Dislocation after total hip arthroplasty. Archive of Orthopedic Traumatic Surgery. 1999, 119:263-6.
4) Barber T, et al. Early outcome of total hip arthroplasty using the direct lateral vs the posterior surgical approach. Orthopedics. 1996, 19(16):873-5.
5) Malloray T, et al. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. Clinical Orthopaedics and Related Research. 1999, 358;166-171.
6) Soni R. An anaterolateral approach to the hip joint. Acta Orthopedic Scandanavia. 1997, 68(5):490-4.
7) Pelllicci P, et al. Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clinical Orthopaedics and Related Research. 1998, 355:224-8.
8) Vicar A, Coleman C. A comparison of the anterolateral, transtrochanteric, and posterior surgical approaches in primary total hip arthroplasty. Clinical Orthopaedic and Related Research. 1984, 188:152-9.

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