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Anterior vs. posterior approach for hip replacement—what’s the difference?

Undergoing a total hip replacement is major surgery. Anyone considering hip replacement wants to reduce their risk of complications, lessen recovery time, minimize pain, maximize their chances of positive outcomes, and get back to a normal life as quickly as they can.

The good news is that the Joint Journey team at SPO can help make those goals 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 the best approach is and why.

Let’s clear up some of the confusion.

Anterior vs. Posterior

You’ll often hear the terms “anterior” and “posterior” when hip replacement surgeries are discussed. 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 with the same long-term outcomes. Stevens Point Orthopedics offers both approaches. The decision on which approach to use is based on surgeon training, experience, and philosophy, as well as a patient’s individual risk profile.

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.

Available studies are very clear that a well-done total hip arthroplasty has the same function and pain relief, 6 months postoperatively, regardless of which approach is used. There are numerous exaggerated benefits to the anterior approach touted on medical device and practice websites which are frankly just that, exaggerations; the consistent proven finding is improved walking for the first 2 months postoperatively.

Another advantage to the anterior approach from a surgeon’s standpoint is that the patient is supine (on their back) during the procedure. This allows the surgeon to obtain quality x-rays throughout the procedure, ensuring that the hip components are placed in the desired position. This essentially lets the surgeon “double-check” their work. These same x-rays cannot be readily obtained during a posterior approach which relies more on anatomic landmarks.

Appropriate Patient Selection for the Anterior Approach

There is a tradeoff, however, and the anterior approach is not appropriate for all patients. Some of these tradeoffs include:

  • Higher wound complications in obese patients (delayed healing and infection).
  • High risk of femur fracture during the surgery if the femur is difficult to access during the surgery.
    • Obese patients, very muscular or stiff patients, certain findings that can only be discovered on an x-ray such as a short femoral neck
  • Higher risk of the femoral stem loosening over time
    • Surgeons who may be inexperienced with the approach tend to place a component which is too small for the patient’s bony anatomy.

Anterior vs. Posterior – which should you choose?

As mentioned earlier, 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.

Some patients are good candidates for an anterior approach and likely experience an enhanced early recovery due to the approach. Patients eligible for the anterior approach will also get to forgo hip precautions for the first 12 weeks after surgery, unlike patients who receive the posterior approach.

  1. Not bending your hip past 90 degrees.
  2. Not crossing your legs.
  3. Not turning your operated leg inward in a pigeon-toed position.

In other patients, however, an anterior approach is a longer procedure with elevated risks, in which case they would be better served with a posterior approach.

SPO’s unique Joint Journey program provides you with unmatched support throughout the entire hip replacement process. Your health, recovery and long-term well-being are at the center of everything we do. The surgeons at SPO are continually evaluating the most up-to-date information on joint replacement surgeries to provide the best outcomes for our patients.

Have questions about joint replacements? Contact us for answers or to start your Joint Journey!

For additional educational material, a video is also available, The Difference Between an Anterior and a Posterior Hip Replacement.

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