Anterior Vs Posterior Hip Replacement
There are two major surgical approach methods for performing a total hip replacement:
The posterior approach (most common)
The anterior approach (sometimes called the “muscle-sparing hip replacement”)
The incision for the posterior approach is made on the back (posterior) of the hip as compared to the anterior approach on the front ( anterior). The posterior approach is the most commonly used total hip replacement and has been used successfully for decades.
The anterior approach has been utilized as long as the posterior approach but has grown in popularity in the last 10 to 20 years.
There are risks and benefits unique to each type of approach. Most patients are candidates for posterior approach total hip replacement. Those who are significantly overweight or have significant femoral deformities and abnormal anatomy may not be ideal candidates for an anterior approach hip. Both approaches are amenable to minimally invasive techniques. The posterior approach allows complete visualization of the hip and all anatomy. The anterior approach is more technically challenging, and exposure to the hip cup may require muscle and capsule release. There is a higher risk of femur fracture due to more difficult exposure. Intra-operative X-rays are often used in anterior hip replacement to confirm implant positioning due to less visual exposure.
The posterior approach goes through the gluteus maximus and small muscles used to externally rotate the hip—all of which are reattached to the bone and will heal without clinical impact. The anterior approach is not entirely muscle-sparing due to the necessary releases to gain optimal visualization. Most surgeons also cut and do not repair the joint capsule that lines the hip joint.
Both approaches have a low risk of dislocation when performed by specialty-trained surgeons with a high volume. Hospital stays are similar, and postoperative complications are the same for both approaches. In many cases, a healthy person can expect to return to sedentary work in 2 to 3 weeks and physical work in 8 to 16 weeks.