After a bad fall in a carpark in February
2023, retiree Tang Yau
Chng’s right hip started to really
trouble him.
The active 75-year-old, who enjoys
badminton, running and golf,
had previously experienced occasional
stiffness, but now the pain
was starting to affect his daily life.
“I couldn’t really walk long distances
and found it difficult to
climb stairs,” said Mr Tang, a
grandfather of five who used to
work in sales marketing.
He sought help at Changi General
Hospital (CGH) and was diagnosed
with osteoarthritis, a degenerative
joint disease which commonly
causes gradual damage to
the hip joint.
In November 2023, Mr Tang underwent
hip replacement surgery
using a new surgical technique
that promises faster recovery, less
pain and fewer complications.
Patients who underwent it at
CGH spent an average of one to two
days in hospital.
Known as the anterior-based
muscle-sparing (ABMS) approach,
this procedure does not require
cutting through muscle – some
other methods do, which results in
longer recovery times.
“My wound healed without any
complications or infection, and
about a week after surgery I could
walk unsupported,” said Mr Tang.
Since July 2023, 30 CGH patients
have had their hips replaced using
this new surgical approach.
Dr Moo Ing How, a consultant at
CGH’s department of orthopaedic
surgery, and the first surgeon at
CGH to be trained in this technique,
said: “Unlike the conventional
methods for hip replacement
surgery, the new approach is
more versatile as it can be applied
to a wider range of patients, especially
senior patients, to achieve
faster recovery and an enhanced
quality of life post-surgery.”
There are several surgical techniques
that can be used for hip replacements,
said Dr Moo.
Conventional methods include
the posterior approach, in which
the surgeon cuts through the buttock
muscles for a clearer view of
the hip joint; and the lateral approach,
in which the muscle that
supports standing and walking, the
gluteus medius, is split to expose
the hip joint.
These two methods have a longer
recovery time and cause more pain
as they cut through muscles, said
Dr Moo.
Some time after 2016, CGH began
using a technique called the direct
anterior approach, in which doctors
make a cut near the groin area
to place the hip implant, thus sparing
the muscles.
However, as the incision is near a
naturally moist area and sensory
nerve of the thigh, a study published
in 2019 in The Bone & Joint Journal
found that 8.5 per cent of patients
experienced wound complications.
Dr Moo said the newer ABMS approach
cuts through a space between
two muscle groups in the
front of the hip, which makes for
less blood loss and pain as the hip
joint is accessed without cutting or
splitting a single muscle.
As the incision is smaller and
made further away from the groin
area, patients’ surgical wounds are
able to heal faster and with significantly
less chance of wound complications
and infections. Total recovery
is expected within just one
month after surgery, said Dr Moo.
In a study published in July 2022
in the Arthroplasty Today journal,
the average blood loss during surgery
was lower for patients who
underwent the newer ABMS approach,
compared with those who
underwent the direct anterior approach,
and only 0.5 per cent of
ABMS patients required a blood
transfusion post-surgery.
The ABMS method was first described
in 2004, and has gained
popularity in the last 10 years. But
while it is widely practised in countries
like the United States and
Germany, it is relatively new in Singapore.
Dr Moo underwent a year’s training
starting in August 2022, which
included a trip to the US to observe
procedures.
CGH also carried out specialised
training for the care team in the
operating theatres, including nurses,
to perform the operation.
An average of 1,900 patients undergo
hip replacement surgery
each year in Singapore, and with
the ageing population, demand for
hip replacements is expected to remain
high.
“All the approaches have their
uses, and it’s a multifactorial decision-
making process on which approach
we choose for a patient,”
said Adjunct Associate Professor
Andy Yeo Kuei Siong, chief of
CGH’s department of orthopaedic
surgery.
For example, the posterior approach
is ideal for complex hip surgery
or patients who require a second
revision surgery.
Meanwhile, the direct anterior
approach is suitable for patients
who are not significantly overweight,
have no femur deformities
and have normal pelvis anatomy.
“This new ABMS approach has
been gaining popularity and, based
on studies so far, there are additional
benefits. That’s why we are
aiming to increase our repertoire
of approaches, such that we can offer
any of the approaches to our patients,”
said Prof Yeo.