Robotic Anterior Approach Hip Replacement

Hip replacement involves surgically removing the ball and socket joint, and inserting a prosthetic ball and socket. The materials used in this process are diverse, but ostensibly include metal such as titanium to bond to bone, plastic such as highly cross-linked polyethylene to softly take weight, and ceramic materials to make a smooth-gliding joint. On occasion, “bone cement” is used to bond the components to the bone.

Hip replacement is an extremely successful operation for restoring people’s quality of life, eradicating pain and restoring the ability to walk.

This is regardless of the surgical approach used, and regardless of the use of technology such as robotic guidance for its implantation.

Mr O’Bryan underwent a year-long fellowship in multiple hip approaches including the anterior approach, and uses the anterior approach for the majority of hip replacements. These are performed with robotic or computer assistance to help ensure implants are optimised for each patient’s situation. Specifically, that means using software to identify where to position an implant to minimise the risk of dislocation and recreate the patient’s leg length and optimise muscle power with millimetre accuracy.

The anterior approach is perhaps most valuable due to its decreased rate of hip dislocation, an otherwise significant risk of hip replacement surgery. This is offset by an increased risk of fracture to the femur during surgery or in the early period after a hip replacement done through the anterior approach. Factors that appear to limit the risk of femur fracture include surgeon experience with the anterior approach (namely doing an appropriately supervised and structured hands-on fellowship), using implants that are known to decrease the risk of fracture (collared, cementless implants or cemented implants), and the use of X-Ray guidance during surgery. Mr O’Bryan uses implants that have proven low rates of femur fracture and X-Ray to avoid this devastating complication.

While it is true that the anterior approach is more “muscle-sparing” than some other approaches, and true that the very early recovery period may be accelerated, this is of very little importance in the scheme of hip replacement.