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Anterior Approach Total Hip Replacement

Overview

Should I have an anterior or posterior hip replacement surgery? Is one approach really better than the other? If you’re preparing for a hip replacement surgery, you’ve probably asked yourself this very question.

There are many more than two approaches to the hip, each approach has had its glory days. In other words, in the same way that the anterior approach is popular today, the other approaches have been just as popular with surgeons and patients at one time or another.

Is Anterior Approach Better Than Posterior?

First things first both the anterior and posterior approaches, when utilized appropriately, result in a well-functioning hip replacement. The difference between the approach’s is where the incision is made to access the hip. 

In an anterior approach, the replacement is done through the front while you lay on your back. The anterior approach involves a true internervous / intermuscular plane. This means that the surgeon performs the surgery working between nerves and arteries without detaching or cutting muscles or releasing ligaments and tendons.” As a result of not cutting muscles, less of the patient’s natural anatomy is disturbed. This can mean faster healing. Patients return to their normal gait more rapidly and with less pain in the early post-op period. Many recent studies have shown that, in the early post-operative period (the first 4 – 6 weeks), after anterior approach surgery the recovery seems to be faster and less painful. Another added advantage is that the anterior approach is often “more accurate” because x-ray guidance is often used during the procedure. As such the anterior approach has a much lower dislocation rate than the posterior approach

An additional benefit stems from the fact that patients have fewer hip precautions after surgery. People who have had the anterior hip surgery have no restrictions on bending, stooping, reaching their feet, crossing their legs, or sleeping on their side after surgery. This may give the perception of an easier recovery to the patient.

Benefits Of The Anterior Approach

In summary the pros of the anterior hip approach are:

1.   Lower dislocation rate

2.   Less invasive, leaving more muscles and tissues intact

3.   Early recovery may be faster

4.   Recovery may be less painful

5.   Closer to a “normal gait” in the first six weeks after surgery

6.    Fewer hip precautions after surgery

Now that we have gone over the pros of the anterior approach, we would be remiss if we didn’t also go over the cons or the downside of the anterior approach. 

The anterior approach is done less commonly than the posterior approach. Less than 5% of all orthopedic surgeons are comfortable with the anterior approach. This means that most surgeons are not as well-versed in the anterior approach. The anterior approach can take longer to perform as it is more technically complicated. Although the risk is small, the anterior approach has a higher risk of intraoperative fracture when inserting the prosthesis in the femoral canal.

In summary the cons of the anterior hip approach are:

·       Less common with fewer high-volume surgeons who specialize in the approach.

·       Longer procedure 

·       Higher intra-operative fracture rate

Since there are both pros and cons to
the anterior approach, why is it currently so popular with patients? 

In patients who have had an anterior hip replacement on one side and a posterior hip replacement on the other side, they routinely prefer the hip replacement on the anterior approach side. The reason being they report fewer restrictions, faster recovery, easier rehabilitation, and less pain. These are big advantages from the patient’s standpoint.

Who Should Perform My Hip Replacement Surgery?

As with any surgical procedure your choice of surgeon is paramount. You should seek out a surgeon who is well trained and has extensive experience in anterior approach total hip replacement. No matter the approach you want a surgeon who you are comfortable with and has performed a high volume of the type of surgery you are seeking. The more procedures the surgeon has performed, the better they will be at providing you with a great outcome.” 

Conclusion

So, what can you make of all of this? Let’s sum it up: anterior approach shows some serious pros when it comes to a faster “return to normal” in early recovery. In saying this, having a replacement done by an experienced surgeon you’re comfortable with is the top priority. A great, high-volume surgeon is the “trump card” over approach. In the end, patients who’ve had both anterior and posterior replacement have very successful, lasting recoveries.

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