Comparison of the Anterior Hip Approach vs. Posterior Hip Approach

I see numerous patients each week for all concerns, ailments and questions about their hips. The hip is likely the most important joint in the body. I have devoted my medical career to the treatment and health of hips. The hip allows us to experience life – it makes fluid movement, walking, dancing and all kinds of activity possible.

It is my aim to provide the best orthopedic care possible for the hip to keep it healthy and functioning so life may be experienced to the fullest. The healthy hip is a structural marvel. If you would like to know more about how the anatomy of the hip click here.

In the United States, there are more than 200,000 hip replacements performed each year. Most people are between the ages of 50-80. As each person is an individual so is each hip. If and when hip replacement is required, the approach that is taken depends on the condition of the hip, the patients health and particular disease or issue that is affecting the hip. The ultimate goal of hip replacement surgery are:

  • excellent results: a stable, long lasting hip
  • minimal risk of injury
  • decreased complications
  • increased quality of life both short term and long term

The posterior approach is from behind and the anterior approach is from the top or front of the body.  Both approaches have  risks and precautions and while the risks are low, they can include infection, nerve injury, blood clots, and general stiffness. It is important to consider the amount of experience the physician has had performing either procedure when considering hip replacement surgery. One of the questions I get asked most are about comparisons of the anterior approach and posterior approaches for hip replacement. An ‘approach” is simply from which direction we approach the surgery.

Posterior Approach

The posterior approach is the most traditional and is commonly used approach in the United States. The majority of teaching institutions in the United States continue to instruct as well as perform the traditional posterior as their primary approach. In this approach the patient lies on their stomach for the surgery. The posterior approach must cut through the buttock muscles to reach the hip joint. The buttocks muscles are repaired once the hip is in place. Recovery is usually slightly longer than the anterior approach without any swelling of the leg and thigh.

Anterior Approach

The anterior approach has been taught and used in the United States and around the world since the late 1940’s. In this approach the patient is lying on their back and enables easier imaging that in turn typically allows for easier component sizing and positioning. With the anterior approach there is typically less injury to the sciatic nerve but can be increased femoral nerve injury. A recent study in the Journal of Bone and Joint Surgery noted significantly less muscle damage with the anterior approach. This decreased muscle damage usually results in fewer dislocated hips after surgery as the muscle and the strength that they provide keeps the hip socket more stable. Typically there is less pain and a faster return to mobility. I recently gave a lecture on the latest developments in hip and knee replacement. Below is a summary comparing the Anterior Hip Replacement Approach and the Posterior Hip Replacement Approaches – if you click on the image below it will open to a large, easy to read chart:

CHART: Comparison of Anterior and Posterior Hip Replacement Approaches

Comparison between Anterior Approach Hip Replacement and Posterior Approach Hip Replacement

Anterior Approach

Posterior Approach

Origin

Smith-Peterson    1947 Older approach

Incision   Length

8-10   cm 8-10   cm

Blood   Loss

Equivalent Equivalent
Muscle   preservation Split   Tensor,   Reflect Rectus muscle, cut Piriformis muscle Split GluteusCut and repair Piriformis
Potential Nerve Impact Lateral   Femoral Cutaneous Sciatic/Peroneal
Risk of Improper Implant Positioning Higher   Femur Higher   Acetabulum
Dislocation Lower risk
Postoperative   Precautions None needed None needed
Hospital   Stay No Difference No   Difference
Leg Length More Accurate
 Inflammation  Same  Same

While these charts are fairly technical, they help to understand the pros and cons of the anterior and posterior approaches. Discussing the approach of hip replacement surgery is an important step in considering surgery. The overall outcome of surgery, regardless of the approach, is dependent upon the experience your surgeon has with the approach and their ability to reliably assess what is best for the patient and make recommendations based on information.

We are here to run through and answer any questions you or your family members may have. We are available for same day or next day appointments.

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