ABLE Hip Replacement

What is ABLE Hip Replacement?

Hip replacement, also referred to as total hip replacement or total hip arthroplasty, is a surgical procedure in which the worn-out or damaged parts of the hip joint are removed and replaced with artificial hip components called prostheses or implants made of metal, ceramic, or plastic.

ABLE hip replacement is a minimally invasive, muscle sparing, anterior approach hip replacement surgery performed to replace the hip joint without cutting through any major muscles, enabling a quicker return to normal activity.

Traditionally, with a total hip replacement, the surgeon makes the hip incision laterally, on the side of the hip, or posteriorly, at the back of the hip. Both approaches involve cutting major muscles to access the hip joint. With the ABLE anterior approach, your surgeon is able to repair your painful hip through a natural space between the muscles of the anterior (front) portion of the hip, rather than making the incision on the lateral or posterior side, which has the potential of damaging the muscles that make up the primary support system for the joint. These are the muscles you spend weeks and months rehabilitating after surgery.

To put simply, the ABLE hip replacement technique changes the direction from which your surgeon can access your hip joint. A special operating table is utilized that facilitates various anatomical positions allowing your surgeon to replace the hip joint anteriorly.

Anatomy of the Hip

The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables frictionless movement of the joint. The bones are held together by bands of tissue called ligaments that provide stability to the joint.

Indications for ABLE Hip Replacement

ABLE hip replacement is typically indicated in patients with arthritis of the hip joint.

Arthritis is a condition in which the articular cartilage that covers the joint surface is damaged or worn out causing pain and inflammation. Some of the causes of arthritis include:

• Advancing age
• Congenital or developmental hip diseases 
• Obesity
• Previous history of hip injury or fracture
• Increased stress on the hip because of overuse

Preparation for ABLE Hip Replacement

Preoperative preparation for an ABLE hip replacement may involve the following steps:

• A review of your medical history and a physical examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Diagnostic tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the surgery and to design a personalized plan based on the specifics of an individual’s hip anatomy.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
• You may be asked to stop taking medications such as blood thinners and anti-inflammatories, or other supplements for a week or two prior to surgery.
• You should refrain from alcohol or tobacco at least a few days prior to the surgery and several days after as it can hinder the healing process.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You should arrange for someone to drive you home after surgery.
• A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for ABLE Hip Replacement

In general, the muscle-sparing ABLE anterior approach hip replacement surgery involves the following steps:

• The procedure is performed under general anesthesia or regional anesthesia.  
• You will lie down on your back, on a special operating table that enables the surgeon to perform the surgery from the front of the hip. Your surgeon may use fluoroscopic imaging during the surgery to ensure the accuracy of component positioning and to minimize leg length inequality.
• Your surgeon will make an incision, about 4 inches long on the front of the hip. The hip joint is exposed between the anterior muscles, without the need to cut tissue or detach tendons.
• Next, the femur bone is separated from the acetabular socket.
• The acetabular surface is prepared using a special instrument called a reamer. 
• The acetabular component is cemented or fixed with screws into the socket. 
• Then a liner made up of plastic, metal, or ceramic is placed inside the acetabular component.
• The femoral head that is worn out is cut off and the femur bone is prepared using special instruments so that the new metal component fits the bone properly. 
• Then the new femoral component is inserted into the femur bone either by a press fit or by using special bone cement. 
• The femoral head component made of ceramic or metal is then placed on the femoral stem.
• Once the artificial components are fixed in place, the instruments are withdrawn and incisions are closed with sutures and covered with a sterile dressing.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after muscle-sparing anterior approach ABLE hip replacement may involve the following:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• Most patients may need to stay in the hospital for 2 to 3 days before discharge to home.
• You may notice pain, swelling, and discomfort in the hip area. Pain and anti-inflammatory medications are provided as needed to address these.
• You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent the risk of blood clots.
• Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
• Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities over a period of time is recommended.
• An individualized physical therapy protocol will be designed to help strengthen hip muscles and optimize hip function once you are off assistive devices.
• Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, returning to sports may take at least 6 months or longer.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of ABLE Hip Replacement

Some of the benefits of muscle-sparing ABLE anterior approach hip replacement over traditional approach hip replacement include:

• Smaller incision
• Shorter recovery period
• Shorter hospital stay
• Reduced postoperative pain
• Minimal blood loss
• Minimal muscle trauma
• Less scaring
• Earlier mobilization
• Faster healing time

Risks and Complications

ABLE hip replacement surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

• Hemarthrosis- excess bleeding into the joint after the surgery
• Infection at the incision site or in the joint space
• Nerve injury
• Implant failure
• Leg length discrepancy
• Adverse reactions to anesthesia
• Blood clot or deep vein thrombosis (DVT)