Reprinted from Health & Wellness Magazine, October 2009
By John K. Wiggill, Staff Writer

October 8, 2009 There's a revolutionary improvement in hip replacement surgery called the Anterior Approach being practiced in a few operating rooms around the country. Anterior means from the front. Patients heal faster, with fewer restrictions and complications, but it's still not offered as an option in most US hospitals.

Dr. Jonathan Yerasimides is an orthopedic surgeon in Louisville who specializes in hip and pelvis surgery and has performed over 1,100 hip replacements since completing his residency at the University of Louisville in 2005.

"The funny thing is," Dr. Yerasimides reflected " I was looking for a sub-specialty fellowship centered around pelvis fractures and I never intended to specialize in hip replacements, but that's mostly what I do now." He has quickly become an authority on the anterior approach and has performed the procedure more than any other surgeon in Kentucky.

He studied under the foremost authority on surgery of the hip and pelvis in the United States, Dr. Joel Matta of St. John's Health Center in Santa Monica, California.

The first hip replacement using the anterior approach was performed by Dr. Robert Judet in 1947 at Hospital Raymond Poincare in Garches outside of Paris, France. The surgery was done on a special table, the Judet Table, with the patient lying on their back. The special table helped position the patient's legs and hips during surgery.

The reasons for Judet's choice of this approach for surgery were:

1. The hip is an anterior joint, closer to the skin anterior than posterior.

2. The approach follows the space between the muscles, causing less trauma.

3. The approach exposes the hip without cutting muscle from the bone.

He learned the frontal approach to hp replacement from Letournel and was intrigued by it, but never actually used the technique until 1996 when a patient who had one hip replaced in France tracked him down and asked him to replace his other hip the same way.

Dr. Matta has taught over 100 surgeons the procedure and now accepts one orthopedic surgeon per year to assist him and learn in depth from him.

Dr. Yerasimides says "there are three major problems patients have when dealing with hip replacement surgery and the anterior approach solves two of them."

Infection The same with any surgery.

Differing leg length after surgery With the anterior approach, the patient lies on their back during the surgery. In this position, fluoroscopy is used to determine leg lengths, correct position and proper sizing of the implants.

Joint dislocation Dr. Yerasimides says "after performing over 1,100 hip replacements not one patient has had a dislocation." The other approaches have a three to four percent dislocation rate of first time surgeries and about 15 percent for revision hip replacements.

Other advantages of the anterior approach:

Faster Recovery While it may take patients four to six months to fully recover following conventional hip replacement surgery, the anterior approach enables patients to recover in four weeks or less.

Less Restrictive - Because the anterior approach allows the surgeon to reach the hip joint from the front of the hip as opposed to the lateral (side) or the posterior (back) approach, the hip can be replaced without detaching muscle from the pelvis or femur during surgery. The surgeon can simply work through the natural interval between the muscles and, therefore, does not require as much healing time to recover.

Less Physical Therapy Typically, patients meet with physical therapists in the hospital to practice walking and other functional activities. Full weight bearing is allowed and patients can go home after achieving basic therapy goals. In general, additional physical therapy isn't necessary since walking and general activity is all that's needed. Again, you don't have to worry about dislocating your hip after surgery. Patients are allowed to bend, twist or cross the legs in any position that is comfortable. Patients are commonly discharged in two to three days.

Now there's a way to reduce the pain and time it takes to recover from total hip replacement. Instead of going to a doctor who uses the traditional method, find one that will use the anterior approach. That's what Dr Jonathan Yerasimides did when his mother needed hip replacement during his fellowship with Dr. Matta, but now, Louisville is a lot closer.