Anterior vs. Posterior Hip Replacement

If you have osteoarthritis in your hip, you might be considering a total hip replacement. Hip replacements swap out damaged or diseased bone with a metal or plastic implant that’s designed to replicate a healthy hip joint.

There are two main ways hip replacements are done. The posterior approach relies on an incision at the back of the hip. The patient lays on his or her side during the surgery. It is the more common way to do a hip replacement, and it has been used in the United States for decades.

For the anterior approach, the incision is at the front of the body. The patient lays on his or her back. It is a much newer way to perform the procedure. Both methods have benefits and drawbacks, but first let’s address what they have in common.

Both procedures require that the surgeon dislocate the hip and shape the bones to implant the prosthetic hip joint components. The hospital stay is the same for both procedures. At Southwestern Vermont Medical Center, both the anterior and posterior hip replacement can be accomplished as outpatient procedure for qualified patients. Other patients may stay in the hospital as long as 2 days.

The risk of post-operative complications are the same for both procedures. Both procedures come with a low risk of dislocation. The medical equipment needed is the same for both: a front-wheeled walker and cane. And the risk of nerve damage is similar for both procedures. Even the size of the incision, which depends on the body size and can be as short as 2 inches or as long as 6 inches, is the same for both.

So, how are they different? The perceived benefit of the anterior approach is that it requires the surgeon to cut through less muscle tissue. Less damage means less pain after surgery. Therefore, patients typically discontinue the use of a walker 1 – 3 weeks sooner than those who have the posterior surgery.  There is a small increased risk in wound healing issues and infection associated with the anterior approach, though most are self-limiting, meaning that they clear up on their own.

Deciding which procedure to get will rely on a careful conversation with your surgeon. Not all surgeons offer the anterior approach. It is more technical, because it offers a more limited view of the joint. If your surgeon offers it, it is wise to ensure they have done many hip replacements in this way. You want someone who has plenty of experience.

Once you’ve made your decision, other factors—including thorough preparation and adherence to the post-surgical rehabilitation plan—will make the greatest impact on your outcome and recovery.

Dr. Michaela Schneiderbauer is the medical director of the Orthopedics Department at Southwestern Vermont Health Care.