1. Brian L. Lohrbach, MD Board-Certified Orthopedic Surgeon
Anterior Supine Intermuscular Hip Replacement
Brian L. Lohrbach, MD
Board-Certified Orthopedic Surgeon

2. Preview of Topics Basic hip anatomy Arthritis Signs & symptoms
Treatment options
Direct anterior hip replacement

3. Anatomy of the Hip
Pelvis
Femur

4. Anatomy of the Hip
Acetabulum
(Socket)
Femoral Head
(Ball)

5. Cartilage Covers bones in joint Lubricating tissue
Cushions and protects the ends of bones
Smooth gliding surface for bones
Cartilage

6. What is Arthritis? Defined as inflammation of the joint
More than 100 different types
Two primary types
Osteoarthritis
Rheumatoid

7. Arthritis Cartilage wears away Painful bone-on- bone contact
Inflammation

8. What Causes the Two Main Forms of Arthritis?
Osteoarthritis
Prior trauma, high activity levels, excess weight, age, and malalignment, such as bowlegs or knock-knees.
Genetic predisposition to weak cartilage
Rheumatoid
Seems to be related to an abnormality of the immune system
May be genetically linked

9. Signs and Symptoms Groin/thigh pain Grinding and clicking
Loss of motion
Difficulty with shoes
and socks
Decreased activity
Impaired lifestyle

10. Getting a Proper Diagnosis
Proper treatment
Medical history
Symptoms
Health
Activity
Exam affected joint
Range of motion tests
Pain with hip rotation
X-rays
MRI if X-rays normal

11. X-Rays Helps determine severity of joint damage
Cannot see cartilage on an X-ray
Space on normal X-ray is healthy cartilage

12. Hip X-Rays
Healthy Hip X-ray
Arthritic Hip X-ray

13. X-Ray Analysis
Joint space narrowing
Abnormal bone formation “spurs”

14. Treatment Options Activity Modification Self-help/assistive devices
Heat and Cold Treatments
Over-The-Counter Medications
Topical Creams
Prescription Medications
Injections
Joint Replacement

15. Activity Modification
Weight loss
Physical therapy
Workspace modification
Cane/walker

16. Medications Acetaminophen (Tylenol) NSAIDs Supplements Ibuprofen
Naprosyn
Celebrex
Supplements
Glucosamine/chondroitin sulfate

17. Injections Cortisone Synvisc One Under fluoroscopy 3-4x/year
Lubricates
Not FDA approved for hips

18. When is joint replacement recommended?
Conservative treatments fail to provide relief
Diminished quality of life
After discussing with orthopedic surgeon
After deciding what is best for you

19. Benefits of Joint Replacement
Can eliminate or reduce joint pain
Improve movement and mobility
Improve quality of life
Return to normal activity
Low-impact sports and activities

20. Joint Replacement Also called “arthroplasty”
Implants to resurface/replace damaged bone and cartilage
Metal alloy and medical-grade plastic

21. Primary Hip Components
Shell
Liner
Head
Stem

22. Traditional Hip Replacement Incision
Located on side or back of hip
Cut muscles and tendons to
get to hip
Extensive physical therapy

23. ASI Incision Located on front (anterior) side of hip
Healthy muscles and tissues preserved by separating
muscles rather than cutting
Less tissue damage
Not all patients are candidates (very obese or hip revision)

24. ASI Technique Animation

25. Anterior Hip Advantages
No muscles cut
Precise implant placement with use of live X-ray in surgery
Check leg length in surgery
Low dislocation rate
Faster recovery

26. Potential Complications may Include but not Limited to…
Infection
Blood clots
Hip dislocation (rare)
Implant breakage
Premature wear
Implant loosening
Leg-length
discrepancy

27. Outcomes 95% patient satisfaction rate
Longevity of implants years
Weight
Activity level
Age

28. Returning to Low-Impact Daily Activities
Driving at two to four weeks
Golfing, swimming between one to two months
Patients restricted from high-impact activities such as:
Running
Jumping
Jogging
Contact sports
Heavy manual labor

29. Thank you!