Mr Freedman - Orthopaedic Surgeon
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The Direct Anterior Approach for total hip replacement is a muscle-sparing alternative to traditional hip replacement surgery, which involves accessing the hip joint between two muscles at the front of the hip rather than detaching any muscle at the back or side of the hip as occurs with the other techniques used for hip replacement.
As no mucles are detached during the anterior hip replacement procedure, it offers the potential for quicker recovery, shorter hospital stay and less post operative pain.
Also, as the back of the hip is not opened during surgery there is no requirement for traditional post operative restrictions and lower risk of post operative dislocation.
Anterior hip replacement surgery can be performed through either a short straight skin incision or through a short oblique skin incision hidden in the groin crease or bikini line (what some surgeons have called a bikini approach or “Bikini Hip Replacement”). Suitability for one skin incision over another will depend on patient body shape.
The anterior approach is relatively new to Australia but is not new in Europe, where it was first developed and refined.
Mr Freedman received a prestigious research scholarship from the European Federation of Orthopaedics and Traumatology (EFORT) to travel to Paris to be trained in the Anterior Minimally Invasive (AMIS) Direct Anterior approach for total hip replacement in by Dr Frederic Laude. Dr Laude developed and is the world expert in this technique. Mr Freedman is the only surgeon in Melbourne to have undertaken an EFORT fellowship in Anterior Hip Replacement with Dr Frederic Laude in Paris.
This anterior approach for hip replacement is not strictly a “new” surgical approach as it was actually described by an American surgeon by the name of Marius Smith-Peterson from Mass General Hospital (MGH) in Boston in the 1930’s.
However, at first this technique was technically very difficult, hard to learn, not reproducible and so was not feasible for total joint replacement surgery. It therefore did not gain wide attention or popularity.
However, more recently, Dr Frederic Laude, a surgeon from Paris under whom Mr Freedman directly trained, devised many improvements to the technique.
This included development of new surgical instrumentation, better prostheses and an advancement new operating table and operating theatre equipment that allows the leg to be carefully positioned and held in position for the operation.
This has revolutionised the use of a direct anterior approach to the hip and has enabled this approach to be reliably applied for minimally invasive direct anterior total hip replacement surgery. Mr Freedman has trained directly with Dr Laude in Paris to learn his operating techniques and still regularly discusses cases with his former mentor.
Direct Anterior Total Hip Replacement Technique:
Compared to traditional anterior hip replacement, which involves the patient in a lateral (side-lying) position and an incision on the side or back of the hip, the direct anterior total hip replacement is a front (anterior) approach with the patient supine (lying on their back).
Surgery is performed between the muscles at the front of the hip, which avoids the need to detach any muscles on the side or back of the hip.
The gluteal muscles at the side of the hip are extremely important for balance and walking. Avoiding surgery near these muscles facilitates a quicker post operative recovery.
As the patient is supine (lying on their back), x-rays can be obtained during the procedure to verify correct implant placement and to check leg length. This is very helpful to the surgeon to ensure that the implant position is correct.
The Direct Anterior approach offers several potential advantages over other approaches:
There are some potential disadvantages to this technique:
Direct Anterior Approach requires training and experience:
The success of technically complicated surgery depends on several elements, but one important factors is having a highly-trained and experienced surgeon.
Mr Freedman completed a orthopaedic research fellowship at Harvard University’s Massachusetts General Hospital, where the direct anterior approach was first described, and then completed two International Hip Surgery Fellowships.
Mr Freedman trained] in the UK and then in Paris, where he worked directly with Dr Frederic Laude – a world expert in Direct Anterior hip surgery.
Dr Laude devised many of the new instruments used for anterior hip surgery and regularly travels internationally as an expert mentor to teach surgeons.
Mr Freedman has participated in multiple instructional courses in direct anterior hip replacement and has learned the technique directly from the most some of the most experienced direct anterior hip surgeons in the world.
The Direct Anterior Approach for total hip replacement is an exciting advance in joint replacement surgery that potentially allows for a smaller incision, less post operative pain and a quicker and easier post operative recovery.
However, the surgery can be technically challenging and so should only be performed by surgeons with extensive training.
In Mr Freedman’s hands the Direct Anterior approach can be offered to most patients requiring a hip replacement.
To discuss whether you may be a candidate for the anterior approach please contact our office to make an appointment. Tel (03) 9532 3333.
Frequently Asked Questions about Anterior Hip Replacement: