Dr Glase is Australia’s most experienced surgeon in the AMIS® technique and since 2007 has successfully performed over 4,000 cases. He is one of a small number of surgeons who will routinely replace both hips during the one surgical procedure ( bilateral ). He has Australia’s largest series of bilateral AMIS® procedures with over 150 cases. He is widely regarded as the pioneer of the AMIS® technique in Australia after visiting French orthopaedic surgeon Dr Frederick Laude in Paris in 2007.
The published data in the orthopaedic literature and the Australian National Joint Replacement Registry clearly shows that more experienced surgeons have better patient outcomes. This is particularly relevant for the AMIS® method which is regarding as a technically more demanding procedure compared to other approaches to the hip.
Total hip replacement is a safe and reliable procedure that is used to treat painful and debilitating arthritic and post traumatic conditions of the hip joint. The operation relieves the pain and restricted movement, thereby allowing the patient to return to the activities of daily living pain free. Total hip replacement is indicated for patients that have failed non-operative treatment options.
Total hip replacement is a safe and reliable procedure that is used to treat painful and debilitating arthritic and post traumatic conditions of the hip joint. The operation relieves the pain and restricted movement, thereby allowing the patient to return to the activities of daily living pain free. Total hip replacement is indicated for patients that have failed non-operative treatment options. The prosthetic implant consists of the acetabular component, the femoral component and the bearing or articular interface (ball and socket). The acetabular component is placed into the pelvis after the hip socket has had any residual cartilage removed and the bone prepared using an instrument called a reamer. Dr Glase rarely cements the acetabular component preferring to use uncemented (bone ingrowth) components. These are usually made from titanium. The femoral component fits into the femur (thigh bone) after the femoral head has been removed and the femur prepared with instruments called broaches. Dr Glase usually prefers cementless fixation with titanium implants. He will sometimes use cement depending on the bone quality.
There are four types of bearing surface or articular interface:
Metal ball on a polyethylene acetabular liner
Ceramic ball on a polyethylene liner
Ceramic ball on a ceramic liner
Metal ball on a metal liner
Dr Glase does not recommend metal on metal. Recent studies have shown significant failure rates with metal on metal bearings. Dr Glase has been a long standing advocate of ceramic on ceramic or ceramic on polyethylene. The type of prosthesis and bearing interface will be discussed in detail at the time of consultation.
This approach for hip replacement has evolved over decades, beginning with the Judet Operating Table in 1943 and the first hip replacement using this method in 1947. In 2007, Dr Glase introduced a refined version of this technique to Australia after training with Dr Frederick Laude, who developed specialised instruments to improve precision and minimise invasiveness. This approach avoids cutting through key stabilising muscles, preserving hip strength and function. By accessing the hip between the tensor fascia lata and rectus femoris muscles, there is no damage to the gluteal muscles, which are the main providers of power and stability to the hip. There is also no damage to the short external rotator muscles at the back of the hip, which are very important for hip stability. The nerve supply to the muscles remains undamaged, so muscle function is minimally affected.
A common question is whether all hip replacements are suitable for the AMIS® method. Since 2007, Dr Glase has performed over 4,000 primary total hip replacements using this technique, with only two requiring a different approach. In the hands of an experienced AMIS® surgeon, most primary hip replacements can be safely performed, including cases with hip dysplasia, Perthes disease, or previous trauma.
Both very obese patients and heavily muscled younger males can also undergo hip replacement using this method. Typical surgery time is 40–60 minutes, with a hospital stay of around three days. The key to a successful hip replacement is choosing a skilled and experienced surgeon, especially for the technically demanding direct anterior approach.
References:
1. Rachbauer F et al. The History of the Anterior Approach to the Hip. Orthop Clin North Am. 2009 Jul; 40(3): p311-20 2. Kreuzer S et al. Single incision anterior approach for total hip arthroplasty: Smith-Peterson approach. Limited Incisions for Total Hip Arthroplasty. AAOS Rosemont. p 1-14. 2007. 3. Pfirrmann C et al. Abductor tendons and muscles assessed at MR Imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology. 2005 Jun; 235(3): p969-76 4. Bremmer AK et al. Soft tissue changes in hip abductor muscles and tendons after total hip replacement: Comparison between the direct anterior approach and the transgluteal approaches. JBJS Br. 2011 Jul; 93(7): P886-9 5. Dora C et al. MR Imaging of the abductor tendons and muscles after total hip replacement in asymptomatic and symptomatic patients. EFFORT 2007, Florence, Italy. May 11-15. 6. Muller DA et al. Anterior minimally invasive approach for total hip replacement: Five year survivorship and learning curve. Hip Int. 2014 7. Dora C. Der anteriore Zugang fur die minimal invasive HTPE. Leading Opinions, Orthopadie 1. 2006 8. Dora C Minimalinvasive Zugangean an der Hufte ( Minimally invasive approaches in hip surgery ). Orthopaedie Mitteilungen 6/07: p574-6 9. Dora C et al. Muscular damage after total hip arthroplasty : conventional versus minimally invasive anterior approach. Podium presentation at the 68th Annual Scientific Meeting of the AOA, Australia, October 12-16,2008 10. Siguier T et al. Mini incision anterior approach does not increase dislocation rate: a study of 1037 consecutive total hip replacements. CORR. 2004 Sept; (426): p164-73 11. Goebel S et al. Reduced postoperative pain in total hip arthroplasty after minimally invasive anterior approach. Int Orthop. May 2011 12. Alecci V et al. Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol. 2011 Sept 12(3): p123-9 13. Rachbauer F. Minimally invasive total hip arthroplasty: anterior approach. Orthopaede. 2006 Jul 35(7): p723-4, 726-9 14. Nakata et al. J Arthroplasty. 2008 15. Meneghini R et al. Muscle damage during MIS total hip arthroplasty : Smith- Peterson versus posterior approach. CORR. 2006 Dec 453: p293-8 16. Field R. Gait analysis study. Br Hip Society, Manchester 2012 17. Giannine et al. SICOT 2007 18. Matta J et al. Orthop Clin N Am.2009(40): p351-6 19. Matta J et al. CORR. 2005(441): p115-24 20. Keggi et al. JBJS Am. 2003 21. Sariali et al. J Arthroplasty. 2008 23(2); p266-72 22. Anterior Total Hip Arthroplasty Collaborative Orth Clin N Am 2009
There are several approaches to total hip replacement surgery, including posterior, lateral, and anterolateral. Each of these methods involves cutting, splitting, or detaching muscles from the bone and may risk damaging the nerve supply. The posterior approach, which is not Dr Glase’s preferred method, involves splitting the gluteus maximus and tensor fascia lata muscles to access the hip joint from the back. This also affects the gluteus minimus and the short external rotators, which are crucial for hip stability.
Dislocation rates for this approach range from 3–4% according to published literature. The anterolateral approach involves splitting the gluteus maximus and tensor fascia lata, as well as detaching the gluteus minimus and part of the gluteus medius from the femur. This can put the nerve supply at risk, potentially leading to a permanent limp and joint stiffness.
The vast majority of patients who undergo total hip replacement recover without any complications and obtain a pain free hip with a full functional range of movement and return to a full and active lifestyle. Dr Glase will discuss the potential risks and complications in detail at the time of consultation.
Deep infection involving the prosthesis is uncommon with rates reported in the literature of around 1%. Infection can rarely spread from other parts of the body to the prosthesis. It is advisable that any necessary dental procedures be undertaken prior to surgery. Acute infection can be treated by surgical washout. Rarely revision of the prosthesis is necessary.
Despite all steps to prevent DVT, including early postoperative mobilisation, thromboembolic compression stockings and blood thinning medication following surgery, some patients will still develop a DVT. Pulmonary embolism is where a blood clot travels to the lung. This is a very uncommon complication and requires longer treatment with blood thinning medication.
This is where the ball comes out of the socket. This can occur especially in the first six weeks after surgery, usually when the hip is placed in an extreme position. Dr Glase and the physiotherapists at the hospital will advise you on a few simple precautions in the first six weeks to avoid this. Dislocation rates with the anterior approach in most reported series are less than 1%. This is significantly lower than the 3 to 4% reported dislocation rates for the posterior approach. Dr Glase is aware of two dislocations in his series of over 2500 anterior cases.
Often related to concerns regarding dislocation. This is particularly relevant with the posterior approach where the external rotator muscles are detached and stability is thus compromised. The operated leg is often lengthened to compensate for this loss of dynamic hip stability. With the direct anterior approach these muscles are not compromised. Combined with the more predictable acetabular cup placement with the anterior approach, the concerns regarding dislocation are not so great and so leg length inequality is less of a problem.
Periprosthetic fracture is uncommon and usually follows a fall in the early postoperative period. Those most at risk are the very elderly and those with significant osteoporosis. Treatment may involve further surgery.
This is where the bond between the bone and the prosthesis fails. This is rare but can be corrected with further surgery.
Areas of numbness on the skin around the surgical wound occur occasionally. This usually resolves over time. Injury to the Sciatic, Femoral or Obturator Nerve causing a loss of motor function is a very rare complication.
such as stroke, heart attack or allergic reaction to medication are uncommon.
Dr Glase consults and has surgical appointments at The Mater Hospital in North Sydney, Sydney Adventist Hospital in Wahroonga and North Gosford Medical Centre.
.svg){kind=icon}
