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Anterior Hip Replacement

Over the past 5 years a major advance in the surgical approach to performing a hip replacement has been developed. In addition to remaining minimally invasive, this approach avoids cutting any major muscle groups. The incision is placed over the front of the upper thigh and avoids lateral hip pain when sleeping on one’s side.


This anterior approach to the hip has been quite successful, offering excellent results, and is appropriate for nearly every primary total hip. With more than 200,000 hip replacements performed in the U.S. each year, this approach will dramatically change the future of this great operation.

The Main advantages of the Anterior Supine Hip Approach are:

  • No muscle cutting, allowing improved hip strength after surgery

  • Lowest dislocation rate compared to all previous approaches (0.5% currently)

  • Improved leg lengths – allows more accurate equalization of leg lengths

  • No restrictions after surgery – sitting, crawling, stooping are all allowed with no postoperative limitations

  • No restriction on weight bearing or exercises

  • Reduction in postoperative pain

  • Decreased hospital stay and quicker recovery

James R. Ramser, MD is one of a few orthopaedic surgeons in Virginia that routinely performs anterior supine intermuscular hip replacement surgery. This unique procedure uses the most advanced surgical techniques to replace an entire hip joint through a small 4-5 inch incision.

The incision is made in front of the hip and does not cut through any muscles or tendons. This technique results in less pain, minimal dislocation risk, and quicker recovery. Most importantly, since the hip is immediately stable, it does not require any lifestyle modifications such as not being able to bend over to tie your shoes or not sitting in low seats. Traditional approaches restrict bending past your waist or sitting in very low chairs for varying periods of time (sometimes permanently). In most cases, you will be back on the golf course in 6-8 weeks.

This surgery is appropriate for anyone that needs a primary hip replacement. The approach is also used to replace certain types of hip fractures and usually results in much quicker recovery in the elderly population. Hospital stays are usually 1 day.

The Anterior Supine Hip Approach – Younger Patients

“Many of my younger patients are now staying only 1 day in the hospital and do not require physical therapy” says Dr. Jim Ramser. “The anterior approach is now my primary procedure for all total hip replacement patients, including those with hip fractures. Surgery time is about 1 hour avoiding lengthy anesthesia time. I am amazed how quickly people walk independently, giving up their crutches and canes after only 3 weeks.”

Total Hip Replacement

Total hip replacement surgery almost always reduces joint pain. During this surgery, your problem hip joint is replaced with an artificial joint (called a prosthesis).

Total hip replacement surgery almost always:

  • Stops or greatly reduces hip pain. Even the pain from surgery should go away within weeks.

  • Increases leg strength. Without hip pain, you’ll be able to use your legs more. This will build up your muscles.

  • Improves quality of life by allowing you to do daily tasks and low-impact activities in greater comfort.

  • Provides years of easier movement. Most total hip replacements last for many years.​

Surgery Process

​When the surgical team is ready, you’ll be taken to the operating room. There you’ll be given anesthesia. The anesthesia will help you sleep through surgery, or it will make you numb from the waist down. Then an incision is made, giving the surgeon access to your hip joint. The damaged ball is removed, and the socket is prepared to hold the prosthesis. After the new joint is in place, the incision is closed with staples or stitches.

Preparing the Bone

The ball is cut from the thighbone, and the surface of the old socket is smoothed. Then the new socket is put into the pelvis. The socket is usually press-fit and may be held in place with screws or cement. A press-fit prosthesis has tiny pores on its surface that your bone will grow into.

Joining the New Parts

The new hip stem is inserted into the head of your thighbone. After the stem is secure in the thighbone, the new ball and socket are joined. The stem of the prosthesis may be held with cement or press-fit. Your surgeon will choose the method that is best for you.

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