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Hip replacement surgery, also known total hip arthroplasty (THA), is a highly effective treatment for those suffering from severe joint pain and limited mobility due to arthritis or other joint conditions. During hip replacement surgery, a damaged hip joint is replaced with an artificial joint prosthesis. One of the most important decisions that need to be made before the surgery is the approach that will be used to access the hip joint. There are two main approaches to hip replacement surgery: the anterior approach and the posterior approach. (There are several approaches to the hip but the two most common are the anterior and posterior approaches) In this blog post, we will discuss the differences between the two approaches, and the potential risks and benefits of each.

Anterior Approach: The anterior approach, also known as the direct anterior approach, to hip replacement surgery involves making an incision on the front of the hip. The hip joint is accessed by moving the muscles to the side, rather than cutting through them. This approach allows for a more rapid recovery, as there is less disruption to the muscles and tendons surrounding the hip joint. It also allows for a more natural and efficient movement of the hip joint after surgery. It can be beneficial for patients who are concerned about scarring (ask your surgeon about the bikini incision).

Posterior Approach: The posterior approach to hip replacement surgery involves making an incision on the back of the hip. This approach allows the surgeon to access the hip joint by cutting through some muscle tissue and tendons. This approach typically allows for more precise positioning of the hip implant.

Recovery time: The recovery time after anterior hip replacement surgery tends to be faster than the recovery time after posterior hip replacement surgery. This is because the anterior approach is muscle sparing – it preserves more muscle tissue, which leads to less pain and a quicker recovery. There are published studies that show no difference in recovery time between these two approaches.

Potential Risks: Both the anterior and posterior approach have their own set of risks. The anterior approach has a slightly higher risk of nerve injury, wound healing complications, while the posterior approach generally has a higher risk of dislocation.

Each approach has its own advantages and disadvantages. Factors such as previous hip surgeries, complexity of the hip replacement surgery, previous scars, body habitus also play a significant role in determining which approach is ideal for you. I tell all my patients: don’t choose your surgery (approach in this case), choose your surgeon. I have seen patients do extremely well with both an anterior and posterior approach. I have also seen patients do not so well or have complications with both approaches. At the end of the day, I recommend picking your surgeon and doing whichever approach they feel the most comfortable with in order for you to get the best possible result. I typically use the anterior approach on 95% of my patients.