Renowned Orthopaedic and Sarcoma Surgeon, Mr. Panos Gikas, MD on Anterior Hip Replacement: Better Outcomes and Faster Rehabilitation

Dr. Panagiotis Gikas, MD, Ph.D. (also referred to as Dr. Panos Gikas) is a London-based orthopedic surgeon and an expert in hip replacement and minimally invasive surgery. His medical focus and specialization are in primary and revision hip and knee reconstruction as well as the treatment of bone and soft tissue tumors. His specialist clinical interests also include revision hip and knee joint replacements, complex hip and knee revisions and reconstructions, knee arthroscopy and cartilage as well as stem cell transplantation for articular cartilage damage, bone and soft tissue sarcomas and surgical management of metastatic bone disease.

Dr. Panos Gikas’ approach to joint reconstruction encompasses the use of the anterior muscle sparing technique to the hip joint, custom-made implants and instruments, robotic joint surgery, arthroscopic knee surgery as well as stem cell and cartilage implant surgery. During his bone and soft tumor procedures, he implements excision of malignant and benign tumors of the bone and soft tissues. This includes massive endoprosthetic and bespoke joint replacement. He conducts his tumor-related procedures in association with the London Sarcoma Service, and he is a consultant orthopedic and sarcoma surgeon at Spire Bushey Hospital, a private hospital that is just minutes outside of the center of London.

Dr. Panos Gikas has several private practice locations. His NHS practice is located at the Royal National Orthopaedic Hospital (Private Patients Unit) in Stanmore, North London. He has a location at the Spire Bushey Hospital (Clinic and Theatres) as well as at the Lister Hospital in Chelsea (Clinic and Theatres).

Dr. Panos Gikas consults on the anterior hip replacement procedure, which is a minimally invasive surgery whereby a damaged hip joint is replaced with a new artificial one.

Hip Anatomy and Hip Replacement

Anatomically speaking, the hip is a ball-and-socket joint mechanism, whereby the thighbone, or femur, bends inward near the hip. The upper end also called the head, is round. The part that bends inward is the neck, while the shaft is the long straight part. The cup-shaped cavity – also called the acetabulum – in the pelvis enables the head of the femur, or thighbone, to fit inside it. Both the inside of the acetabulum as well as the head of the femur are covered by a sheath of sturdy and protective tissue that is called cartilage. It is partly responsible for bones being able to slide easily against each other. The other aspect of this smooth sliding is a fluid that is produced by tissue around the joint. The fluid and the cartilage are responsible for human smooth movement. The joint is held together by strong fibrous tissues called ligaments.

Hip replacement surgery was first developed in the early 1960s and was a relatively rare procedure until the late 1980s. At the time, the number of cases increased from an approximate 9,000 patients in 1984 to 119,000 in 1990. A total hip replacement is done as a means to replace a damaged hip joint in order to ease the pain as well as help improve or enable movement. During this common procedure, the hip joint is exchanged for an artificial one. While the ultimate goal of replacement remains the same, the way by which surgeons access the hip joint that is located deep within the body at the junction of the pelvis and the top of the thigh bone is where the kinds of hip replacement operations differ. In other words, the surgery can be performed either from behind the hip (posterior hip replacement), to the side of the hip (lateral or anterolateral replacement), or from the front of the hip (anterior hip replacement).

The number of hip replacement surgeries in the United States has increased dramatically in recent years. Approximately 2.5 million Americans are living with an artificial hip, with higher numbers being found among women. A study that was conducted between the years 2000 and 2010 has found that the number of surgeries grew by 92 percent, from 138,700 patients in 2000 to 310,800 in 2010 among those aged 75 and older. The main speculation is that with osteoarthritis becoming more common, the need for hip replacement surgeries has also increased. In particular, degenerative osteoarthritis that is triggered by wear-and-tear has contributed to the high increase in hip replacement surgeries.


Posterior Hip Replacement Surgery

During hip replacement surgery, the surgeon typically makes an incision along the side of the hip in order to access the hip joint. That incision is approximately eight to ten inches long. During the operation, the surgeon removes damaged parts of the hip joint and replaces what has been removed with prosthetic parts. Anatomically speaking, the surgeon replaces the acetabulum as well as the head, neck, and part of the femur shaft with an artificial joint or prosthesis. This hip prosthesis consists of a stem that is inserted into the thighbone – also referred as the femur – the head joint (or ball) that fits into the stem, as well as a cup that is placed into the socket of the hip joint. While the stem is typically made of metal, ceramic or titanium, a metal or ceramic cup is used as a means of joint socket replacement. The cup liner may be a plastic or ceramic material. Both cemented as well as uncemented prostheses are the most common two kinds of artificial hip prostheses used. The former creates an attachment to the bone via surgical cement, whereas the latter attaches to the bone via a porous surface. During some procedures, a mixture of the two materials is used to create a link between the bone and the artificial material. The bone subsequently grows onto the surfaces and attaches to the prosthesis.

Following the procedure of removal and replacement, the surgeon closes the incision with either stitches or surgical staples. If needed, a drain may be placed in the incision site in order to remove fluid. The site is ultimately covered with a sterile bandage or dressing in order to prevent bacteria from accessing the wound. After the surgery, the patients are typically escorted into their hospital rooms where they stay for several days and their recovery is monitored. Movement shortly after surgery is strongly advised, and each patient is provided with a rehabilitation and exercise plan that will ensure patients begin using their hips as soon as possible as that is a crucial aspect of a proper healing process.

Posterior hip replacement surgery is also referred to as the traditional procedure because anterior hip replacement surgery has advanced in such a way that its benefits outweigh that of the traditional approach. While the essence of the replacement still remains the same, the way surgeons access the joint location has changed, and this has made all the difference between the two approaches.

Anterior Hip Replacement Surgery

There has been a recent surge in interest in conducting hip replacement surgery via less invasive methods. As such, total hip replacement with the anterior approach is also called mini, modified, minimally invasive, or muscle-sparing surgeries. While the actual surgery is not novel, the aspect that makes it minimal, namely the smaller and less invasive incision is what is novel about it. It is also performed with more specialized instrumentation so that the overall process is much less traumatic to the patient. In terms of the procedure, by means of approaching the hip joint from the front, the surgeon follows an inter-muscular and inter-nervous plane to get to the hip joint. In doing so, the surgeon is able to split the muscles in order to reach the destination rather than removing and subsequently reattaching the tissue. This results in a quicker rehabilitation and much less painful procedure as the muscle tissue does not have to heal after the surgery.


While the anterior approach to surgery is very similar to that of the traditional (or posterior) hip replacement method, there are marked differences between the two. For one, anterior approach, by virtue of its name, accesses the hip joint from the front of the hip. This forgoes the need to cut through the muscles surrounding the hips, and it only requires one to two incisions that are typically three to six inches long (much smaller than the eight to ten inches that are needed for accessing the joint during the posterior approach), after which the subsequent steps of the procedure are the same as the traditional surgery. Another marked difference is the surgical table. Anterior surgery is conducted on a specialized table that enables the hip joint to be placed in an optimized position for surgery. Following anterior hip replacement surgery, patients are able to go home after short hospital stay that typically lasts no longer than a day or so.


Risks of Total Hip Replacement with Anterior Approach

Even though total hip replacement via the anterior approach is a fairly safe procedure, some minimal risks are involved just as is the case with the traditional operation. The possible troubles following the procedure include infections as well as the risks of bleeding and blood clots. There is also the risk of injuring nearby nerves, hip joint dislocation, changes in the lengths of the leg as well as joints loosening. A very small risk exists that the surgery may not get rid of the pain and that it may not improve mobility, but this is very rare. There may be a few other risks associated with the procedure that are related to age as well as health problems, all of which ought to be discussed with a physician.

There is the potential risk of injuring nearby nerves during the anterior approach. This is particularly unique to the anterior approach hip replacement, namely a possibility of injury to the femoral cutaneous nerve, a large skin nerve that runs adjacent to the incision of the anterior operation. Injuring this nerve can lead to chronic pain as well as abnormal sensations along the front and side of the thigh.



By virtue of the procedure’s incisions being much smaller, the process is somewhat less invasive and there are several benefits associated with it. These include less trauma to the muscle which immediately means that the healing and recovery process is a lot less painful than the traditional procedure. Recovery is much quicker as well as easier, and this makes the hospital stays much shorter. Furthermore, some surgeons believe that the anterior hip replacement procedure is associated with less frequent dislocations. This is because the surgery did not result in damage to the surrounding muscle tissue, and hip stability is thus preserved. Lastly, the anterior approach is also associated with the prevention of post-operative limping. Again, the surgical technique protects the various muscles, blood vessels as well as nerves that are encountered during exposure of the hip joint. Minimizing damage on the way to the hip joint to the surrounding areas reduces the chances that the patients will limp after the procedure.

As a specialist and expert of both the hip and knee replacement procedures, Dr. Panos Gikas strongly recommends the anterior approach to hip replacement. “As an experienced hip surgeon, I believe firmly that the anterior approach provides improved outcomes and faster rehabilitation. All of my patients receive an individual assessment, allowing me to take all factors into account before making a decision regarding which surgery is most suitable for them. This ensures everyone receives the best clinical outcome, with the least chance of complication,” Dr. Gikas comments.


Mr. Panos Gikas’ Education and Training

The clinical and research pursuits of Dr. Gikas have primarily revolved around reconstructive surgeries of the hip and knee as well as the treatment of bone and soft tissue cancer. He is widely published within these fields having researched and written about as well as presented on various aspects of hip, knee, and bone cancer surgery. He currently holds leadership positions in both clinical and laboratory research within those fields. His research has been awarded several grants as well as several competitive academic prizes throughout his career. He authored a total of 7 book chapters as well as over 30 peer-reviewed research papers, of which several have had a profound impact on Dr. Panos Gikas’ fields of expertise as they have been adopted into current national guidelines for management of cartilage defects of the knee joint. Dr. Gikas is currently focusing his research endeavors on developing the next generation of endoprosthetic joint replacements for tumor and complex revision surgery. He is also working on developing new applications of photodynamic therapy as means to prevent infection.

Dr. Gikas obtained his BSc in Medical Genetics at the University of London (First Class Honors) and his MBBS at St George’s, University of London (First Class Honors). He obtained his Ph.D. in General Surgery from the University of Athens, after which he obtained his MD as well as a residency at University College in London. He was then Fellow of the Royal College of Surgeons of England within the Trauma and Orthopaedics unit where he specialized in primary and revision hip and knee arthroplasty, knee cartilage injuries and the surgical management of primary and metastatic bone cancer. He further sharpened his skills in the management of bone tumors during a Seddon Travelling Fellowship in orthopedic oncology at the Royal Prince Alfred Hospital in Sydney. Furthermore, during his clinical fellowship in Geneva, he developed the anterior muscle-sparing implementation to the hip joint, after which he came on board the world-renowned Royal National Orthopaedic Hospital in London as a consultant.


Teaching Posts

Dr. Panos Gikas is passionate about sharing his knowledge and expertise with others in his field. This is particularly true for future orthopedic surgeons whom he teaches and trains. He is also the organizer of the London North Thames Orthopaedic Specialty Teaching Programme. Furthermore, Dr. Gikas is the mentor of junior surgeons in the clinical setting as well as the Ph.D. supervisor of students at the Royal National Orthopaedic Hospital in collaboration with the University of Portsmouth. He also has an honorary lecturer post at the Department of Medical Physics and Biomedical Engineering, University College London, where he lectures during BSc and MSc courses in the Musculoskeletal Sciences.


Professional Memberships

Panos Gikas is a Fellow of the Royal College of Surgeons of England as well as on the Specialty Register of the General Medical Council. His many other orthopedic organization and society memberships include The Royal Society of Medicine, the British Orthopaedic Association, the European Musculo-Skeletal Oncology Society, the British Orthopaedic Oncology Society, the Seddon Society as well as the International Society Of Limb Salvage.

During his free time, Dr. Gikas loves to travel. He also enjoys sailing as well as water-skiing. He is multilingual, as he is fluent in English, French and Greek languages.

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