Total hip replacement is major surgery, and anyone considering hip replacement wants to reduce their risk of complications, lessen recovery time, minimize pain, maximize their chances of positive outcomes, and generally get back to a normal life as quickly as they can.
The good news is that’s quite possible. Hip replacement is considered a highly successful surgery with low complication rates that accomplishes its purpose – improving pain and function for patients with advanced hip arthritis.
However, information around hip replacement and the two approaches to hip replacement surgery – anterior and posterior – have led to confusion over what’s the best approach and why.
Let’s try to clear up some of the confusion.
Anterior vs. Posterior
You’ll often hear the terms “anterior” and “posterior” when hip-replacement surgeries are discussed, because those terms say a lot about the differences in surgical approach.
The terms themselves are really simple. “Anterior” means “front” and “posterior” means “back,” and they refer to where the incision is located. The anterior approach starts at the front of the hip and the posterior approach starts at the back of your hip, close to the buttocks.
Both approaches have been used successfully for many years. The posterior approach remains the most common approach worldwide, but the anterior approach has become more popular recently due to early studies that found potential benefits, and strong marketing campaigns by companies and clinics that use the approach.
However, as we’ll soon see, the messaging and reporting doesn’t always tell the whole story.
Benefits vs. Risks
Over the last decade, all types of hip replacements have seen improvements in techniques, components, and medications, resulting in better outcomes, reduced complications, and faster recovery regardless of approach.
However, when studies compare anterior and posterior approaches, most conclude that the anterior approach offers no substantial long-term benefit over the posterior approach; in fact, it can introduce new complications or increase the severity of existing complications.
Despite scientific evidence to the contrary, clinics and companies touting the anterior approach claim a variety of short- and long-term benefits, including:
- Faster recovery
- Less pain
- Lower dislocation rate
- Fewer muscles involved with the surgery
However, out of all of these purported benefits, the only benefit consistently shown in studies has been slightly better walking during the first six to eight weeks. After that, there’s no difference.
Downsides to the Anterior Approach
There is a tradeoff, however. In return for this short-term benefit, there are a number of downsides with the anterior approach, including:
- Longer surgical time – which also means longer time under anesthesia
- More technically demanding – so it takes longer for the surgeon to learn and practice
- More blood loss – and a higher risk of needing a blood transfusion
- More difficult visualization of the femur – so X-rays are typically required during surgery
- Higher risk of fracturing the femur – and if a fracture occurs, it’s more difficult to fix due to poor exposure to the femur
- It’s not truly “muscle sparing” – small muscles near the hip joint still need to be released in order to access the joint
- Increased risk of stretch injury to a nerve near the front of the hip – which can result in numbness or pain in the outer thigh
- Not suitable for larger patients
Some studies also show an increased risk of infection with the anterior approach.
Anterior vs. Posterior – which should you choose?
As we mentioned at the start of this post, hip replacement is major surgery. You need to be comfortable with the process, the procedure itself, the surgeon performing the procedure, and the care you receive after surgery.
SPO’s unique Joint Journey program provides you with unmatched support from long before surgery to long after surgery. Your health, recovery and long-term well-being are at the center of everything we do.
And as far as the surgery itself goes, the surgeons at SPO that perform hip-replacement surgeries are continually evaluating the most up-to-date information on these surgeries to provide the best outcomes for our patients.
Have questions on joint-replacement surgeries? Contact us for answers.