Anterior vs. posterior hip replacement: Which approach is the best for you?

Hip joint replacement surgery is one of the most successful surgeries performed in orthopedics, with some of the best outcomes. So, when a hip is causing severe pain that affects daily life, a total hip replacement surgery (hip arthroplasty) can be an effective way to relieve pain from arthritis, hip dysplasia or osteonecrosis.

“Hip replacement surgery can be life-changing and help you regain your natural mobility,” said Dr. Leonard Buller, orthopedic surgeon at IU Health. “If pain in your hip is affecting your daily life–you struggle to tie shoes or get up or down from a chair—total joint replacement surgery could help you regain movement and experience lasting pain relief.”

Hip replacement surgery is a straightforward procedure to replace a damaged hip bone with a prosthetic ball and socket, but the surgical approach can vary depending on whether the doctor begins surgery on the anterior (front) or posterior (back) side of the body. While the choice of which orthopedic surgeon performs the procedure may matter more than the surgical approach they use, it’s important to understand the difference between the two types of hip replacement surgeries.

Anterior vs. posterior hip replacement

Replacing the ball-and-socket hip joint can be achieved through a surgical incision made in the front or back of the pelvis.

The most common approach to hip replacement is the posterior approach, in which the patient lies on the unaffected hip, and the surgeon accesses the hip joint by splitting muscle and tendons near the buttocks. This procedure lasts about an hour and offers the surgeon a clear view of the hip and top of the femur, or thigh bone. Most patients are candidates for posterior hip replacement, especially those who have complex joint issues or previous procedures on the hip.

In an anterior approach to hip replacement surgery, the patient lies on their back and the surgeon accesses the hip bone through either a vertical, or “bikini,” incision on the upper thigh. In this approach, the surgeon moves aside the muscles and tendons to access the hip area. This spares these muscles from surgical incisions and shortens recovery time but has the potential to limit the surgeon’s view of the hip area. Because of complexity, anterior hip replacement may take a little longer and requires a surgeon with technical expertise in this specific approach. Anterior hip replacement is not intended for patients who are severely overweight, as the extra tissue makes the hip more difficult to access and increases the risk of complications.

Which method of hip replacement is the best?

It’s important for patients to discuss any questions about hip replacement surgery with the surgeon to determine which approach is best.

Because it avoids cutting through as much muscle and tissue, the anterior approach is associated with:

• potentially faster short-term rehabilitation
• shorter hospital stays
• less time using mobility aids, like crutches and walkers
• potentially lower hip dislocation rate (when the ball pops out of socket)

However, studies show that the posterior approach offers:

• a quicker operation
• no increase in complications rates
• similar long-term function as the anterior approach

The recovery for both surgical approaches is relatively similar in that patients can return to sedentary work in a couple weeks, light activities within four to six weeks (though the anterior approach may be a couple weeks sooner) and sports within a few months.

“The posterior approach to total hip replacement has been a mainstay for decades and is still the most commonly performed operation,” Dr. Buller said. “Despite the early benefits of the anterior approach, after the first couple months following the operation, the two types of surgery typically have the same excellent results.”

Every patient brings specific needs and goals to hip replacement surgery. Selecting the best approach begins with finding an experienced orthopedic surgeon. Discuss any concerns about the procedure with your surgeon so you can make informed decisions about your care.