1. What is osteoarthritis of the hip?

Osteoarthritis of the hip is caused by wear and tear to the hip joint. The hip joint is a ball-and-socket joint. Normally the cartilage (slippery tissue that covers the end of the bones) ensures that the ball (top part of the thighbone) moves smoothly in the socket (part of the pelvis bone). The wear and tear of the hip joint causes the cartilage to become thinner or disappear completely. The subsequent bone-to-bone contact causes pain. When physiotherapy and medicine no longer help, an operation to replace the hip joint is a solution. In this case the whole hip joint is replaced.

2. Is osteoarthritis of the hip joint coxarthrosis?

Yes, osteoarthritis of the hip joint is also referred to as coxarthrosis or wear and tear of the hip.

3. What are the symptoms of osteoarthritis?

You experience pain such as joint pain and joint stiffness that make your movements less supple. It becomes more difficult to support yourself on your leg. For example, you may experience problems when getting up and starting to move as well as difficulties in walking, climbing stairs and bending. The pain and stiffness can be felt in the area of the groin and the buttocks. It may also extend to the thigh, lower back and knee.

4. What is a specialist clinic?

A specialist clinic is an institution that offers specialist medical care. It brings together pace, quality and service. The Van den Eeden Hip Clinic focuses on delivering optimal care for patients with hip problems caused by coxarthrosis.

Central to our clinic’s philosophy are short waiting lists, a compact and accessible treatment process and personal service.

5. What is the Direct Anterior Approach (DAA)?

The Direct Anterior Approach is a technique of surgery utilised to replace the hip joint through a small incision on the front of the upper leg. This means that there is no need to cut soft tissue or detach muscles and tendons. It, therefore, is a tissue sparing surgery. This means less tissue disruption and less trauma to underlying structures.

6. What are the pros and cons of the Direct Anterior Approach (DAA)?

The recovery is faster, safer and less demanding. Tendons and muscles stay intact. Patients feel less pain. They are able to stand up three hours after the surgery and allowed to full weight bearing. The hospital stay is shorter.

The DAA, however, is a technically complicated surgery method. Usually, the surgery lasts longer, which may cause more blood loss. It is important, therefore, that your medical specialist is experienced in using and applying this method. If that is not the case and the medical specialist does not regularly use this method, it may result in increased complications.

With traditional hip replacement patients are required to stay three to five days in hospital. And it takes about six weeks before one can start rehabilitating after surgery. In addition, after surgery the hip remains a “weak point”, muscles and tendons having been cut. Complications are more likely.

7. Who is eligible for the DAA?

By and large, 98% of the patients with hip complaints caused by wear and tear are eligible for DAA. During the first meeting, the medical specialist will assess your eligibility for this method. Age, weight and general state of health (ASA) play a role. It is important that hip complaints are caused by osteoarthritis and that you did not have a hip surgery before.

In some cases you are not eligible for DAA. Examples are people with a body mass index (BMI) of 33 or higher or with a poor health status (ASA3 or ASA4*). Old age might also be a reason. For older patients the treatment path might be too fast. For them it is more appropriate to have a surgery in a normal hospital, so they can stay in hospital longer.

* What is ASA? This classification system defines the physical condition of surgery patients. It determines his or her eligibility for surgery. For the direct anterior approach only patients in good to excellent health can be considered. These patients are labeled ASA1 and ASA2 in the classification system. Few problems are expected for patients in this group. Patients with a poor physical condition need more care. They are classified as ASA3 and ASA4. These classifications are internationally valid, established by the American Society of Anesthesiologists (ASA).

8. Is there a waiting list?

In our specialist clinic, we can help you in a short time. There is no waiting list.

9. Does my health insurer cover the surgery?

More information on costs and reimbursements are to be found here.

10. Do I need a referral of my general practitioner (GP)?

Yes, to see our medical specialist we require a referral of your GP or treating physician. If you experience hip joint pain, your GP or treating physician can refer you to us.

11. How long after surgery can I stand up again?

Three hours after surgery, you can stand up again. You are allowed to full weight bearing. You can walk with one, two or no crutches. You can walk stairs. In bed, you can lie on your side as well as your back.

12. Can I walk (up stairs) immediately after my hip surgery?

Yes, after surgery you are immediately allowed to bear full weight and walk. The muscles keep your new hip joint in place as they did with your old hip joint. Limit your activities to 5 to 10 minutes per hour during the first week. You will have sore muscles for about three to five days after surgery. In the second week after surgery, you will have less muscle ache and you will be able to be more active.

You will also be able to climb stairs the day after your hip surgery. It is desirable to use one crutch. Before you go home, we practice this in the clinic. Your body, nevertheless, will need some time to completely eliminate the anesthetic medicines from your system. Take enough rest and carefully rehabilitate after your surgery. Please always follow your medical specialist’s orders.

13. How long after hip surgery will I be able to drive?

Two weeks after surgery, some patients can drive their car again. With the direct anterior approach, no muscles or ligaments are cut. Depending on your recovery, on which hip was replaced and on whether you have an automatic or manual transmission car, you can start driving again in consultation with your medical specialist.

14. How long is the rehabilitation period?

You can stand up and take up walking immediately after surgery. After two weeks most patients can walk without post-surgery assistive devices (f.e. crutches). After four to six weeks most patients can fully take part in an active and social everyday life. It can take up to six weeks before your body has completely eliminated the anaesthetic medicines from your system. Taking sufficient rest in the first period after surgery is essential for a speedy recovery.

Traditional hip replacement is performed through an incision on the side (lateral) or the back (posterior) side of the hip. As the muscles supporting the hip joint were cut and need to grow together again, rehabilitation after surgery lasts longer. Only six weeks after surgery you can start rehabilitating. With the direct anterior approach the rehabilitation period is much shorter.

15. What is fast track?

Fast track means that medical treatment is followed by fast recovery and a short rehabilitation period. Someone suffering wear and tear in the hip joint (coxarthrosis) is not ill: after a total hip replacement via the direct anterior approach the rehabilitation period is short. After two weeks the majority of the patients is walking without crutches. Hence, the treatment of coxarthrosis via the direct anterior approach is called fast track.

16. Do I need post-surgery aids?

With the direct anterior approach you neither need a toilet seat riser nor a grabber. During the surgery, muscles remain intact. After the surgery, you can do everything, yet carefully. You will facilitate an ideal recovery by taking sufficient rest in the first period after surgery.

17. Why is this surgery accessing the hip joint from anterior side performed by so few specialists?

Despite the fact that the Direct Anterior Approach (DAA) has many advantages, only few specialists use this technique in total hip replacement surgery. The DAA is technically complicated. Learning this technique takes time and only 3% of the orthopaedic surgeons successfully perform this technique.

18. Is it possible to have both hips replaced at the same time?

No, in our clinic we have decided not to replace both hips at the same time.

19. What does the treatment path look like?

The treatment path has three phases: The preparation phase, hospitalisation phase and the rehabilitation phase at home.

The preparation phase is the time before the surgical operation. In the preparation phase an appointment is made and the first consultation takes place. When a hip surgery is necessary, a date for surgery is booked. Prior to the surgery, medical tests are done and an information day is organised.

Hospitalisation is the second phase of our treatment path. Usually, the surgery takes place on the day you are admitted to hospital and you are released from hospital on the second day. In some cases the surgical procedure is performed on an ambulatory basis. Patients are released from hospital on the day of their surgery.

The third phase is the period of rehabilitation at home and follow-up treatment. This third phase starts the day you are released from hospital. You are allowed to bear full weight immediately postoperatively, yet carefully. Think of 5 to 10 minutes activity per hour in the first week after surgery. Additionally, you do not need post-surgery aids, like a toilet seat riser or a grabber. In the second week the check-up takes place. After six weeks you should no longer experience pain.

20. What do I have to pay attention to after surgery?

In preparation of the surgery, you will receive detailed information about the treatment and the various phases of the treatment path. You will receive a brochure, in which you will find a comprehensive description of how to prepare yourself and what to expect.

Usually, the complication rate is low. After surgery it is essential to take enough rest. Think of 5 to 10 minutes activity per hour in the first week after surgery. In the second week the check-up takes place. In the first six weeks after surgery you may experience fatigue, caused by the after-effects of anaesthesia and the surgery. It is a common part of the body’s recovery process.

What pain can I expect after surgery?

The experience of pain differs from person to person. Common drugs and medications to treat pain give general pain relief. It goes without saying that during surgery you will not feel any pain due to general anaesthesia. After surgery you will receive a structured treatment plan for pain relief. You can assume that after two weeks you will not feel any pain anymore. Nevertheless, taking sufficient rest in the first period after surgery is essential for a speedy recovery.

21. Do I need (professional) help after surgery?

In the first week after surgery you have to bear in mind that you will not be able to function fully independently. In the first week after surgery you will need help from family or friends.

If you do not have a partner, family member or friend to fall back on during the first rehabilitation period, then you have the possibility to stay in a care hotel.

22. I would like to recover in a care hotel? Would that be possible?

Yes, that is possible. After having consulted your medical specialist, we can organise a stay in a care hotel dedicated specifically to post-operative recovery care. From the moment you are discharged from hospital until the check-up appointment two weeks later you can stay in the care hotel. We recommend patients who are alone or when the circumstances do not allow for a peaceful recovery at home, to temporarily stay in a care hotel after surgery. If you have any further queries, please don’t hesitate to contact us!

23. Do I need physiotherapy after surgery?

During the first two weeks after surgery we advise against physiotherapy. At the check-up two weeks after the surgery physiotherapy can be prescribed. In most cases, however, physiotherapy is not necessary. Please always confer with your medical specialist.

24. Do you also use traditional method for hip replacement?

No, performing hip replacement surgery, we do not utilize the traditional method.

25. Do you perform hip resurfacing surgery?

No, in our clinic we do not perform any hip resurfacing surgery. Hip resurfacing causes more damage to connecting tissues than the Direct Anterior Approach (DAA) in replacing the hip joint. The rehabilitation period thus lasts longer. In addition, over the long run a total hip replacement is still necessary. Due to the damage that is done to the tissue in hip resurfacing surgery it is no longer possible to replace the hip joint via the DAA. Traditional surgical techniques are the only available option left. We deem this undesirable. The DAA yields lasting results and causes minimal damage to the soft tissue.

26. Is AMIS the same as Direct Anterior Approach?

Yes, AMIS means Anterior Minimal Invasive Surgery. The Direct Anterior Approach is this minimally invasive surgery technique used in total hip replacement surgery.

27. What is minimally invasive or MIS?

MIS means minimally invasive surgery. This means a surgery causes minimal damage to the soft tissue. Sometimes MIS also refers to the Direct Anterior Approach (DAA) in total hip replacement surgery. However, MIS only refers to minimally invasive surgery and can also involve other surgery techniques.

In the following examples total hip replacement surgery causes more trauma to underlying structures than the DAA in joint hip replacement: operating the hip from the posterior or back of the hip or operating the hip from the side (lateral). Muscles, tendons and ligaments are damaged or cut, even if these operating techniques are called minimally invasive.

To conclude: only in performing a total hip replacement via the DAA, which means making a small cut on the front of the hip, muscles and tendons are left intact. Damage to the soft tissue is kept at a minimum.

28. What is BVOT, BHS, DHS and NOV?

These abbreviations mean Belgian Association for Orthopaedics and Traumatology, Belgian Hip Society, Dutch Hip Society and Netherlands Orthopaedics Association respectively. These scientific professional associations for orthopaedic surgeons in the Netherlands and Belgium represent quality and excellence. Our medical specialists are affiliated with the BVOT, BHS, DHS as well as the NOV.

29. How to make an appointment?

You can make an appointment by telephone, by e-mail or online at our website. Please click ‘Make an Appointment’ to access the registration form.

30. The aim of this website?

This website is purely informative. Hence, no rights can be derived from the contents of this website. Any enquiries regarding your personal situation and/or that of third parties should be directed to your treating physician.