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Total Hip Replacement: Anterior vs Posterior Approach?

A woman standing with her hands on her hipsMany patients considering hip replacement are asking whether the anterior approach is better than the posterior approach. Some are actually even demanding the anterior approach!! I assume this is because of the incredible power of medical marketing on television and the internet, because the scientific data does not support such a blanket thought process.

Let me make this very simple for you. When you want to go into your house, you have a few options, right? You can simply do the most common thing and walk in the front door, but you do have the option of going through the back door too. In fact, if you want to be crazy, you can even climb in a window!! They all will get you to the kitchen ultimately, but you might have to take a different hallway once in the house, depending on where you enter.

The same is true for the hip joint. There are a few different surgical approaches that will get you into the hip joint and allow you to do a total hip replacement.

The most common and traditional approach is the posterior approach. This approach is performed with the patient laying on his side with the surgical hip up in the air. The intervals for the surgery go behind the prominent bone on the side of your hip.

The anterior approach is done less commonly, but has gained traction in the past few years. This approach is done with the patient laying on his back and sometimes is done with X-ray assistance. The intervals for the surgery go in front of the bony prominence on the side of the hip and tend to go between muscles.

There is no scientific study that demonstrates clear superiority of one approach over the other. Each approach has its own unique set of advantages and disadvantages. Complications can occur with both approaches, but are rare. Each approach can be used to successfully get patients out of bed on the same day as surgery and discharged from the hospital within 1-3 days. The pain levels are similar and patient-dependent.

Excellent outcomes in the long-term are no different with either approach. Your surgeon’s experience is likely the most important factor in your outcome.

Don’t fall victim to marketing efforts!! Have a candid conversation with your surgeon and trust them to do what is right for you!!