Considerations for the Anterior Approach to Hip Replacement

The posterior approach has been and still is a widely used technique for hip replacement surgery. The industry, however, has seen a shift as more surgeons and their patients are turning to the anterior approach, a tissue-sparing method proven to result in less pain, faster recovery, and improved mobility with fewer restrictions on activity. This technique enables the surgeon to work between the patient’s muscles and tissues without detaching them from either the hip or thighbones.

A 2016 survey from the American Association of Hip and Knee Surgeons found that 34 percent of surgeons are taking the anterior approach to hip replacement surgery. DePuy Synthes, part of the Johnson & Johnson Medical Devices Companies, expects the technique to be used by more than half of orthopedic surgeons within the next five years.

In 2004, very few of DePuy’s orthopedic surgeon customers were performing the procedure; today more than 40 percent of the company’s customers are using this technique to treat patients. Greater interest in the anterior approach from both surgeons and patients has resulted in DePuy Synthes increasing its investment in this space to provide surgeons with the technologies, education, and implants they need to advance patient care. 

The anterior approach is not a new technique. It was pioneered in the 1940s by Robert Judet in Paris, France, and then brought to the United States in 1996 by orthopedic surgeon Dr. Joel Matta, who has worked with DePuy Synthes on professional education and training for more than 10 years. In that time, more than 11,000 surgeons have learned the technique.

Growth Factors
According to GlobalData plc, about 420,000 hip replacement procedures were performed in the United States in 2016, nearly double the total performed more than a decade ago. Much of that increase has been driven by people in their 40s and 50s—who, along with Baby Boomers, are seeking ways to relieve severe hip pain yet maintain an active lifestyle.

As a result, many surgeons are turning to the anterior approach because data shows a quicker recovery, a reduced length of hospital stay, and a lower risk of dislocation when compared to patients treated with other approaches. Evidence shows patients who undergo the anterior approach technique experience shorter hospitalizations (30 percent) and are 18 percent more likely to be discharged home than those who had surgery using traditional approaches. Anterior approach patients also are three times less likely to dislocate their hips compared to the traditional approach.

The anterior approach supports the 90-day insurance bundle goals of looking for solutions that improve outcomes, optimize the patient experience, and reduce overall costs of care. The anterior approach can impact categories that make up 58 percent of the 90-day bundle, including improvements regarding readmission, length of stay, skilled nursing facilities, home care, and self-care. The anterior approach also can be performed effectively in an outpatient setting.

New Anterior Approach Technologies
DePuy Synthes developed and recently launched the ACTIS Total Hip System, the first DePuy Synthes Companies stem specifically designed to be used with tissue-sparing techniques, though it can be used in traditional approaches as well. The implant and instrumentation are designed to balance ease-of-insertion and may potentially provide improved initial implant stability.

The company is also co-marketing enabling technologies for both the anterior and posterior approaches.

The first is with Medical Enterprises Distribution LLC for its ME1000 Surgical Impactor, which delivers constant, stable energy to automate bone preparation, implant assembly, and positioning. This, in turn, may lead to more consistent clinical outcomes and improve patient satisfaction. And because the battery-powered ME1000 automates total hip arthroplasty, there is also likely to be less surgeon fatigue and potentially less work-related injuries that can arise from mallet use.

The second agreement, with JointPoint Inc., allows DePuy Synthes to co-market a proprietary software platform and navigation that integrates easily with the anterior approach technique. JointPoint’s navigation system minimizes adoption challenges of the anterior approach surgical method by providing cup position, leg length, and offset data for a surgeon using as few as three radiographic images.  

The software provides non-invasive computer navigation, pre-surgical digital templating, case planning, and intra-operative feedback during total hip replacement surgeries and easily integrates with the anterior approach.

The Future
These enabling technologies, along with implants that improve initial stability, and new training and professional education opportunities that reduce the learning curve, are driving the adoption of the anterior approach technique throughout the United States. The word is quickly spreading as trained surgeons are now training their fellows on the technique.

Regardless of the approach to hip replacement surgery, however, the ultimate goal is to provide products and solutions that allow surgeons to help patients get back on their feet sooner so they can resume doing what they love.