It was only four hours after her surgeon had cut open her leg, sawed off the end of her femur, scraped out her hip socket and fitted it for an artificial replacement. But Elaine Kelley was walking.

Two nurses hovered at her sides as she navigated the hallways in Concord Hospital's orthopedic wing. They told her to walk more slowly and to lean on a walker. She complied, but only because they told her to.

"She's walking better than she did this morning," joked her husband, Barry Kelley.

Kelley, who suffers from severe arthritis due to an infection, has had more than her share of joint replacements in recent years. Her recent hip replacement was her second. She's also had knee and shoulder replacements.

This, she said, was the easiest surgery.

Her surgeon, Dr. Gary Jones, is one of three at Concord Orthopaedics who have begun using an unusual technique for replacing hips that they say is better for doctors and easier for patients. Instead of cutting through the back or the side of patients' legs, they

come in from the front - an approach that allows them to avoid cutting muscles and other tissues that help patients move and stabilize their hip joint.

"The fact is, they feel good, and they feel good faster," Jones said.

The anterior approach

Nationally, surgeons perform more than 120,000 hip replacements a year. The surgery is popular among patients, who generally rate it higher on measures of satisfaction and improved quality of life than any other surgery. For patients with severe arthritis, a creaky hip can make it difficult to get around. By replacing the worn parts of the joint with smooth artificial parts, surgeons are able to help people move more easily and with a lot less pain.

But though long-term satisfaction is high, recovery from a hip replacement can be rough. The two most common ways that doctors perform the surgery are by cutting open the back of the patient's leg - and slicing through muscles and ligaments - or entering the hip from the side - and severing different muscles.

That soft tissue can take months to heal, and patients often limp their way through a long recovery. Hip dislocations, especially during the first months, are also a concern with those procedures because connections that help stabilize the joint are severed.

The anterior approach Jones used in Kelley's surgery was designed to avoid many of those complications. Instead of cutting through soft tissue in the back or side of the hip, Jones made an incision on the front of Kelley's leg and stretched two muscles out of the way so he could access the hip joint itself without cutting any major supporting structures.

That approach means there's less tissue to heal after the surgery and all the muscles that hold the hip in place stay intact.

Anterior hip replacements have been around for a long time, but they've only recently caught on in the U.S. Jones and his colleagues Dr. Jeff Wiley and Dr. Stephen Fox learned the procedure from a California surgeon who trained in France, where the technique is common.

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