For my patients:

Anterior Approach Total Hip Replacement: Post-operative Instructions
Joseph John Ciotola, MD


Physical therapy: There is minimal physical therapy required after a total hip through the anterior approach. There are no muscles cut with the anterior approach so extensive rehab is not necessary. The therapy after surgery is simply to get up and start walking, first with a walker, then a cane, then nothing. A home therapist will be arranged upon discharge home from the hospital to help you with this progression. Outpatient physical therapy is usually not necessary. You may put full weight on your leg unless otherwise specified by the doctor. “Hip precautions” are not necessary after anterior approach hip replacement. You may sit, bend, move, sleep and cross your legs however you want.

Equipment: No special equipment is required after anterior approach hip replacement. You will be given a walker and a cane. You will not need a special pillow, elevated toilet seat or bed.

Incision: Your incision has been closed with sutures that dissolve under the skin. Keep the incision clean and dry. Cover it with a dry gauze. Do not put any lotions, peroxide or ointments on the incision. You may shower when there is no further drainage from the incision. No baths of swimming allowed until cleared by the doctor.

Blood clots: To prevent a life threatening blood clot from forming in your deep veins you will be placed on Coumadin after surgery. You should also continue to where the compression stocking for two week after surgery. A home nurse will be out to the house to check you blood level to monitor your Coumadin dose.

Driving: You may drive as soon as you feel able and comfortable

Work: You may return to work as soon as you feel able and comfortable

Exercise: You may resume light exercise such as riding an exercise bike and walking 6 weeks after surgery.

Follow up: You should follow up with the doctor in the office 2 weeks, 6 weeks, 3 months and one year after the surgery. Call for an appointment: (410) 539-2227

Reasons to call the doctor:
1.) Persistent fever greater than 101.5.
2.) Pain in the calf.
3.) Increased pain, redness, drainage, or other signs of infection.

301 St. Paul Place, Baltimore, MD 21202

Questions about the anterior approach?

Please email me your questions regarding the anterior approach to:

Anterior Hip Replacement Surgery

HANA Arthoroplasty Table

From Mercy News Archives, Mercy Hospital, Baltimore, 2006


With thousands of baby boomers facing hip replacement, a new surgery promises less pain and less rehab. Olga d'Arnaud Gerkens, 82, is recovering from a total hip replacement: "I'm doing famously well. We never thought I could recover so quickly," she said.

D'Arnaud Gerkens is reaping the benefits of a new cutting-edge hip replacement surgery that doesn't cut any muscle.

Mercy Medical Center orthopedic surgeon Dr. Joseph Ciotola is the first surgeon in Baltimore City to offer the surgery, and he said it has many benefits for the patient.

"(It offers) faster recovery time, less pain, less tissue trauma, smaller incision and less risk of dislocation," he said.

The procedure is made possible by a special operating table called the Hana hip and knee arthroplasty table that is designed exclusively for hip and knee patients. The table allows the surgeon to replace the hip through a single front incision without detaching the muscle.

D'Arnaud Gerkens said she had been dreading the restrictions of traditional surgery. "They cannot bend past 90 degrees, (you) have to sleep with a pillow between your legs, you can't cross feet, can't touch toes. All those things are not an issue with the anterior approach," Ciotola said.

D'Arnaud Gerkens said she never used her post-surgery morphine pain pump and she was driving in six weeks.

Dr. Ciotola said he expects most hip replacements will be done this way in about five years, but surgeons have to take time out of their busy schedules to learn to do it, and hospitals have to be willing to make the investment in the Hana table.

Dr. Ciotola said he believes that will happen once people start seeing the results.

View the HANA arthroplasty table and read about it. Click here.

View WBAL TV 11 news coverage of Olga d'Arnaud Gerkens' surgery by Dr. Ciotola. Click here to view the video.

In addition, read a WJZ TV 13 article about Sherman Williams and his surgery by Dr. Ciotola. Click here to read the article.

A Patient's Story

My mom, Olga, is an 82 year old woman recovering from hip replacement surgery. She is so enthusiastic about anterior hip replacement surgery procedure, that she is instrumental in the development of this blog. She wants everyone to know how fabulous she feels! Her progress is indeed remarkable since my Mom's surgery happened a little over two months ago. (This picture was taken only 7 days after her surgery!)

Her operation was scheduled for a Monday and she was home by Thursday afternoon. Within ten days she was driving a car, and within two weeks she was shopping alone. It has been some time now since she has used a cane. What a remarkable and swift recovery! Here is a video showing her walking six weeks after surgery (Double click on the photo!) Notice that her limp was barely noticeable even then, and it's almost completely gone now.

This past summer Mom could barely walk. She was in such agonizing pain that she had to fore go her favorite activities of swimming and snorkeling when she went on vacation. Returning from the airport and negotiating those long terminals were agonizing activities. Eventually, Dad had to do much of her work for her. At times Mom could only sit and direct him to do the housework, and it took all her spare energy to cook. This was a sad development, as it had been her custom to take a long walk daily, do her stretches, and work in the garden.

In July Mom had scheduled a traditional hip replacement surgery. But then she read about the HANA arthroplasty table and something called a minimal invasive procedure. Further research led her to Dr. Ciotola, who had perfected the technique of anterior hip replacement surgery. Mom eagerly signed on to be his next patient.

We were enthusiastically behind her decision. And these were the reasons:

  • The procedure has been proven to be effective, and surgeons performing the procedure can point to a large number of successful results.

  • Patients no longer have to go to California abroad for the anterior approach.

  • Because the incision would be from 2"-4," (in my mom's instance 6 "), Mom would be moved in and out of the hospital quickly. (A real concern, since Mom has other medical conditions, such as high blood pressure and a goiter.)

  • Her recovery time would be reduced by half, placing less strain on her and my dad, who would be her caregiver.

  • She would be able to do her physical therapy at home.

  • Reduced costs to Medicare because of fewer home delivered medical services, such as blood tests, and visiting nurses and physical therapists.

  • Less chance of contracting a bacterial infection in the hospital because of a prolonged stay

Mom has always been a pioneering spirit and fearless in everything she approaches. She couldn't wait to have this breakthrough surgery. As you can see from the results in this video taken just six weeks after her surgery, her gamble paid off. She looks just like an ordinary (well-preserved) 82-year-old woman going through the motions . . . and more. She's walking again, and cooking and doing light household chores.

Way to go Mom! Godspeed! Dr. Ciotola!!

Click here for illustrations of anterior hip replacement surgery.

Minimally Invasive Hip Replacement

Traditional vs. Minimally Invasive Hip Replacement Surgery

How short is the recovery time for the anterior approach to hip replacement surgery? The following chart (from Smith and Nephew website) shows some general advantages to hip replacement surgery using minimally invasive surgical techniques when compared to traditional hip replacement surgery.

Chart from: Surgical Techniques: Advancements in Surgical Technigues (Click on bold words.)

Read here about recovery time with Anterior Hip Replacement Surgery. (Click on bold words.)