I learned total hip replacement during my residency, using a posteri-
or approach that kept patients in the hospital for at least 3 days. On
the day after surgery, we removed the drain placed during the proce-
dure. We changed the dressing the next day. On the third post-op day
we referred the patient to an inpatient rehabilitation facility for 10
days to 2 weeks. These days, I reserve the posterior approach for
those rare occasions when I need access to the back of the hip for
technical reasons, such as removing previously placed implants from
the posterior hip socket or acetabulum, or augmenting a deficient pos-
terior wall of the acetabulum.
When I initially tried the anterior approach, I still kept patients in
the hospital for 3 days, but I started noticing that they were more
mobile soon after surgery, so I kept them hospitalized for only 2 days.
Then I realized that some patients were ready to go home the day of
surgery, which made me think: "Why am I doing this in the hospital? I
have access to outpatient centers that have 23-hour observation and
the capability to keep patients overnight."
Anterior is superior
That's when I began selectively choosing patients for surgery in the
outpatient facilities, with the intention of keeping them overnight.
That bass fisherman was the first member of this group, which even-
tually included 10 patients. Based on the positive results, I began a
routine protocol in which I use the anterior approach and discharge
the patient the day of surgery. Here's why the transition has proven to
be beneficial.
• It's efficient. Surgery takes about 40 minutes to complete. It's
done under spinal anesthesia, so patients don't have to be intubated.
The anesthesia typically wears off in an hour or 2, and the patient
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