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anterior hip replacement


My surgeon talks about “approach.” What is this?

The way a surgeon gains access to the hip during hip replacement surgery is referred to as an “approach”. There are various types of approaches named according to the direction that the surgery is performed. The most common approach today is referred to as the “posterior approach,” which is done from the back of the hip. Another variation that is becoming more popular is known as the “Anterior Approach”.  An Anterior Approach Hip Replacement procedure is completed from the front surface of the hip. The lateral approach is a much less frequently used procedure. There are pros and cons of each type of hip replacement approach. Surgeons often tend to have a preferred approach or comfort level with one particular approach based on their training and experience. The bottom line is that often the best approach for your hip replacement is the one your doctor is most comfortable with to allow safe and precise implantation of your hip replacement components. A conversation with a board certified, experienced surgeon should help you decide which hip replacement approach is best for your situation.

anterior hip vs. Posterior (traditional) hip replacement

The main difference between Anterior Hip Replacement and Posterior Hip Replacement is the location of the initial surgical incision. The location of the incision determines which muscles will have to be cut or pushed aside to complete the surgery. Anterior Hip Replacement involves an incision at the font of the hip. More traditional hip replacements use incisions at either the back of the hip (posterior incision) or the side of the hip (lateral incision).

Compared to Posterior Hip Replacement, an Anterior Hip Replacement often involves less damage to muscles and other soft tissues. However, the anterior approach is considered a more technically challenging surgery. In a study at Mayo Clinic in Rochester, Minnesota, patients who underwent Anterior Hip Replacement had objectively faster recovery than patients who had Posterior Hip Replacement. According to the study, Anterior Hip Replacement patients showed improved recovery by: Discontinuing use of a walker (10 days after surgery versus 14.5 days), Discontinuing use of all gait aids (17.3 versus 23.6 days), Discontinuing use of narcotics/pain medications (9.1 versus 14 days), Climbing stairs with gait aid (5.4 versus 10.3 days), and Walking six blocks (20.5 versus 26 days).

Anterior Hip Replacement is considered less invasive that Posterior or Lateral approaches. People generally think of a minimally invasive surgery as one that requires a smaller incision(s). Although Anterior Hip Replacement surgery typically uses a standard-sized incision, it is often referred to as minimally invasive. The reason Anterior Hip Replacement is considered less invasive is because it involves much less or no muscle damage and cutting. Experts agree that the amount of damage to muscles and other soft tissues during surgery is a main factor in recovery and post-surgical function. Less muscle damage during hip replacement is usually associated with a faster and less painful recovery.
hip replacement xray and hip joint anatomy illustration, cory calendine, md
*Anterior Hip Replacement Incision Location. Source: https://www.mayoclinic.org/

location of incision and muscles affected

Anterior Hip Replacement is accomplished via an incision that typically starts at the top of the pelvic bone (iliac crest) and extends down toward the top of the thigh. Less commonly, the incision is made horizontally. Once the surgical incision is made, muscles are pushed aside or cut to access and help visualize the hip’s ball-and-socket joint. Anterior Hip Replacement is more challenging since it requires the surgeon to work between the muscles to gain access to the hip joint. However, the natural anatomical separation at the front of the hip allows ready access to the hip joint with minimal or no muscle cutting.

All hip replacements require dislocation of the hip and shaping the bones of the ball and socket joint in order to implant the prosthetic hip joint components. Since the anterior approach to hip replacement provides the surgeon with a more limited view of the hip joint during surgery, the surgery is technically challenging and requires an experienced surgeon. Compared to a more traditional Posterior Hip Replacement, Anterior Hip Replacement involves less damage to the muscles and other soft tissues around the hip. Even though the anterior approach is a technically much more challenging for surgeons, it is becoming the more popular choice for many. When considering Anterior Hip Replacement, it is imperative to consult with a surgeon that has extensive training and experience with anterior hip replacement.

anterior hip replacement surgical procedure

The surgeon makes the incision at the front of the hip instead of through the buttocks or the side of the hip. This approach permits the doctor to reach the hip socket without cutting through major muscle groups. For some patients an Anterior Approach Hip Replacement procedure results in less pain and fewer complications for patients than standard hip replacement.
Source: American Academy of Orthopaedic Surgeons, https://orthoinfo.aaos.org/; American Association of Hip and Knee Surgeons, https://hipknee.aahks.org/total-hip-replacement/
Cory Calendine, MD is an Orthopedic Surgeon and founding partner of the Bone and Joint Institute of Tennessee at
Williamson County Hospital in Franklin, TN. Dr. Calendine is an expert in Joint Replacement, specializing in Hip and Knee Surgery. From diagnosis through treatment, the Orthopedic Surgical experts at the Bone and Joint Institute use the latest techniques and technology to improve care for people with musculoskeletal problems. For more information, please contact our office
or schedule your appointment today.