Separating Fact from Fiction: Advertising Anterior Hips

Separating Fact from Fiction: Advertising Anterior Hips

Some of you may have noticed the plethora of radio ads for orthopedic care. Total Hip Replacement has become a very common operation. In a competitive orthopedic medical market, great emphasis is placed on the joint replacement “experience.” It is projected that the need for hip replacements will increase an estimated 18% and knee replacements an estimated 24% in the next 10 years.

The current trend in Orthopedic Surgery is in promoting and marketing the “Anterior Approach” in total hip replacement. This effort has been extremely successful. Physicians who are promoting this have increased their patient volume. Supporters of this approach devote extended resources promoting it as “new, advanced or revolutionary” to the public. This “new” technique has actually been around for decades. By implication, it would seem those surgeons not using it must be “old fashioned” or behind-the-times.

It is my concern, however, that the public will misconstrue this information as accepted fact within the circles of orthopedic medicine. This is far from true. There is still much controversy with literature supporting both sides of the argument. This sudden gain in popularity of this approach is good “Salesmanship” in an effort to gain higher market share of patients. I think this is a disservice to the patient community.

As with many new procedures or implants, early favorable literature is typically from supporters who are susceptible to the influence of bias. Some early literature does support some benefits of the anterior approach. However, there are many studies to the contrary that show no significant difference in outcomes between the anterior incisions versus lateral or posterior incisions. (Reference list available). The three general promotional themes in literature are: a) discussing only the potential advantages, b) the supposed benefit on the ease of actual recovery, and c) the influence on the successful long term outcome. These purported benefits are being highly distorted.

No doubt, the “Anterior Approach” is here to stay. Each approach has its own set of advantages and disadvantages. The recent modifications involve smaller incisions, better perioperative pain medicine, and more rapid rehabilitation protocols. It is misleading to compare the “new” Anterior Approach to the “old” data with the other incisions. The Anterior Approach requires extensive stretching of front muscles of the hip which are essential for sufficient exposure. In the Posterior Approach, small less important muscles are released from the bone and then securely reattached. It is debatable whether extensive stretching to some muscles (in order to be able to say they were not “cut”) is any less injurious than releasing small, less important muscles and reattaching them securely to the bone. In fact, the Anterior Approach actually can decrease access to the bone and affect the selection of implants options to use.

All approaches to the hip have advantages and disadvantages. It is not necessarily a bad thing to have highly motivated enthusiasts advocate their interests and opinions. However, when it comes to medicine, the public may have difficulty separating “advertising” from generally accepted medical facts. I will admit that these are my professional opinions and may have my bias, but I ask those on the other side of the argument to admit the same. There are many important issues and factors involved in successful long term outcomes a Hip Replacement procedure. The type of approach used is certainly not one of them.

I urge patients to fully examine all the options available them. It’s never a bad idea to get more than one opinion, but I encourage patients not to make decision based on promotional “marketing”.

John G. Mayer M.D.
Greenleaf Orthopedic Associates
Libertyville, Illinois