Hip pain hope: The anterior approach to total hip replacement

It had been since high school that Brian Ashley remembers walking so well, and without pain.
March 21, 2018

Brian Ashley knew pain. The arthritis in his hips started almost 10 years ago, in his late 40s, and it only grew worse over the years. In the past three years, that pain started affecting his performance at work, as well as his sleep and overall health.

“I enjoyed hiking years ago, but that was curbed by this condition,” Ashley said. “I still liked to do fun mountain things, but I’d do a drive instead of a hike. I really became less active, so much that if it wasn’t something I had to do for work, I didn’t want to do it.”

Ashley’s work performance suffered to the point that after many years in manufacturing, he was let go from his supervisor position. It was at that time that he and his family decided something needed to be done.

Brian Ashley, with two new hips, proudly helps out at a holiday craft show in Loveland. Now that his pain is gone, he’s able to volunteer more with his church and with a Longmont artist co-op, which hosted the event.

“I was unemployed and needed to make a change,” he said.

With help from his family physician, Dr. Robert Nouhan, Ashley connected with UCHealth Orthopedic Surgeon Dr. Gavin Bishop.

Physical therapy first

Bishop immediately started Ashley in physical therapy.

“When I first met Brian (Ashley), he was having a hard time getting out of a chair and had a lot of pain with walking,” Bishop said. “People can become less active because of their pain, which in turn makes them gain weight, which in turn contributes to their pain.”

Bishop said he likes to see if patients can improve through physical therapy before deciding on surgery. In Ashley’s case, there was little doubt that his left hip would benefit from surgery. Physical therapy helps strengthen the body for surgery, allowing recovery to be more successful.

“I was around 260 pounds, which is very heavy for me, so we talked about me losing weight, and I did shed a few pounds (before) surgery,” Ashley said.

Anterior approach to total hip replacement

After more than a month of physical therapy, Bishop performed a direct anterior approach to total hip replacement on Ashley’s left hip.

A total hip replacement replaces the hip joint with an artificial one. Unlike a traditional replacement, which is performed from the back or the side of the hip and requires muscle to be detached and then reattached, the direct anterior approach involves a surgeon accessing from the front of the hip and going between muscle, Bishop said.

“I like this (anterior) approach because you don’t have to detach any muscle and it results in a faster recovery and better outcomes” he said.

Although the anterior approach has been available for a few decades, Bishop said, it is enhanced with a special table and specific instruments and therefore many orthopedic surgeons don’t offer the option.

The first hip

With the first hip surgery behind him, Ashley returned to rehab, where he continued to do well and increase his physical activity.

“After surgery, the tissue needs to heal so there is some discomfort, but it’s usually less with the anterior approach”, Bishop said.

Ashley said he was noticeably stronger within six weeks of the surgery and was out walking his dogs a couple of miles a day for continued therapy. He even felt well enough to make a road trip to upstate New York.

“I’d had problems for so many years with that hip, but now it was so much stronger and the pain was gone,” he said. “But it was an interesting experience because the other hip, which had always been the stronger one, was now the weaker one.”

The second hip

After his excursion to New York, Ashley felt it was time to explore surgery on his right hip.

“I could have waited a few more years, but since I had the time I wanted to do it now,” he said.

Bishop took the same surgical approach.

“That hip went even better,” Ashley said.

Ashley still participated in inpatient rehab for a week, and he also signed up for at-home physical and occupational therapy.

Again, within six weeks, Ashley was feeling better and taking on more miles of walking.

“After the second surgery, I had this memory of being a kid in high school and walking down the halls,” Ashley recalled enthusiastically. “I was walking like that again, and it was just striking to me because it had been such a long time.”

A new beginning to the rest of life

On a recent business trip to Chicago, Ashley had yet another positive experience: sitting in an airline seat without pain.

“The fact that I could be more active has impacted the rest of my life,” he said. “I’ve lost about 40 to 50 pounds through this whole thing, and am back to my normal walking gait, not hunched over trying to avoid pain.”

Because of Ashley’s weight loss, he was able to stop taking his high blood pressure medications, and though he still has Type 2 diabetes, he is now off insulin. Ashley has also stopped taking Wellbutrin.

“I don’t take anything for anxiety anymore,” he said. “And we are doing more activities. I’m volunteering through the church and an artists’ coalition.

“I went into this process with a bit of trepidation because it was the first surgery I’d ever had in my life,” Ashley said. “But it just went so well. I’ve had no discomfort through the process. I don’t even think I took pain medication after the first day. Everyone took very good care of me. It’s something that I shouldn’t have waited years for. My life is definitely better for it.”

About the author

Kati Blocker has always been driven to learn and explore the world around her. And every day, as a writer for UCHealth, Kati meets inspiring people, learns about life-saving technology, and gets to know the amazing people who are saving lives each day. Even better, she gets to share their stories with the world.

As a journalism major at the University of Wyoming, Kati wrote for her college newspaper. She also studied abroad in Swansea, Wales, while simultaneously writing for a Colorado metaphysical newspaper.

After college, Kati was a reporter for the Montrose Daily Press and the Telluride Watch, covering education and health care in rural Colorado, as well as city news and business.

When she's not writing, Kati is creating her own stories with her husband Joel and their two young children.