For patients with osteoarthritis or that have experienced trauma to their hip, a total hip replacement can restore function and decrease pain. This is done by replacing the damaged or diseased bone with a metal or plastic implant, which is designed to replicate a healthy hip joint. The most commonly utilized total hip replacement is the posterior approach (through the back of the hip), which has been performed successfully for decades. The anterior approach (through the front of the hip) has been utilized as long as the posterior approach but its popularity has grown in the US over the past 10-15 years.

If you are considering a total hip replacement, this guide will help compare the two approaches and give you information to discuss with your surgeon. There are risks and benefits to each type of approach. In addition, be prepared to ask your surgeon about their experience, complications, and overall outcomes.

The Surgery

Posterior

  • The majority of patients are a candidate for this type of surgery.
  • The patient is positioned on his or her side during surgery.
  • The surgeon makes a 4-6 inch incision just behind the hip, along the buttock area.
  • The surgery takes 60-70 minutes.
  • It is the most common approach and provides the greatest patient safety.

Anterior

  • Candidates for this approach are not significantly overweight, have no femur deformities, and normal pelvis anatomy
  • The patient is positioned on his or her back on a special surgical table so the surgeon can manipulate the leg during surgery.
  • The surgeon makes a 4-6 inch incision on the upper thigh.
  • The surgery takes 90-100 minutes.
  • This is a technically challenging procedure. Patients should find a surgeon very experienced in this approach.

Intraoperative Visualization and Precision

Posterior

  • Technique allows the surgeon full visualization if the hip cup and femur.
  • No intraoperative x-rays needed.
  • Very low risk of fracture due to easier exposure.
  • When performed with the Mako Robotic-Arm there is a high-degree of precision of implant placement to recreate the patient’s natural anatomy.

Anterior

  • Technique allows excellent visual exposure of hip cup, but challenging exposure of femur requiring muscle and capsule release.
  • Higher risk of femur fracture due to more difficult exposure.
  • Intraoperative x-rays are often used to confirm placement of the implant due to less visual exposure.

Muscle Preservation

Posterior

  • The main incision goes through the gluteus maximus and will heal without repair.
  • Muscles that are used to externally rotate the hip are detached during the procedure and later reattached to bone and will heal without complication.

Anterior

  • This procedure is not entirely muscle sparing. Due to risk of nerve damage, the incision enters the compartment of the tensor fascia latae muscle to expose the hip safely.
  • The indirect head of the rectus femoris is released to allow entry into hip.
  • External rotator muscles are cut and are not reattached during this approach.
  • Most surgeons cut and do not repair the joint capsule.

Nerve Damage

Posterior

  • Very small (less than 1%) risk of sciatic nerve damage from excessive retraction during surgery.

Anterior

  • Higher risk of injury to lateral femoral cutaneous nerve, which may cause numbness in the outer thigh.

Precautions

Posterior

  • Low risk of dislocation when performed by a specialty-trained surgeon with a high volume of hip replacement.
  • Discuss with your surgeon, some do not have post-operative precautions with this procedure.

Anterior

  • Low risk of dislocation when performed by a specialty-trained surgeon with a high volume of hip replacement.
  • Dislocations are usually anterior and can occur with external rotation of the leg during any activity.

Post-operative Experience

Posterior

  • Hospital stay is 1-2 days at St. Charles Medical Center. This procedure may also be performed in an outpatient (returning home the same day) for some patients.
  • Postoperative complications are the same for both approaches, including risk to structures, blood clots, infection, death, anesthesia risks.
  • The medical equipment required for recovery for both approaches is the same. You may need a front-wheeled walker, cane, leg lifter, grab bars, and an elevated toilet seat.

Anterior

  • Hospital stay is the same for both approaches.
  • Postoperative complications are the same for both approaches, including risk to structures, blood clots, infection, death, anesthesia risks.
  • The medical equipment required for recovery for both approaches is the same. You may need a front-wheeled walker, cane, leg lifter, grab bars, and an elevated toilet seat.

Return to Activity

Posterior

  • Sedentary work – 2 weeks
  • Light activity (walking, stationary bike, etc.) – 6 weeks
  • Physical Work – 6-16 weeks
  • Sports – 3 months

Anterior

  • Sedentary work – 2 weeks
  • Light activity (walking, stationary bike, etc.) – 4-6 weeks
  • Physical Work – 6-16 weeks
  • Sports – 3 months
  • Typically discontinue use of walking device 1-3 weeks sooner than posterior approach.