Anterior or Posterior Approach for Hip Replacement Surgery: Which is Better?

Anterior or posterior? Should I have an anterior or posterior hip replacement surgery? Which approach is better? Is one approach really better than the other? If you're preparing for a hip replacement surgery, you've probably asked yourself these very questions.

To get to the bottom of the "anterior vs. posterior" debate, we spoke with top orthopedic surgeon, Dr. Aaron K. Salyapongse. Dr. Salyapongse is a popular orthopedist who operates out of Dublin, California and Pleasanton, California. He's performed thousands of successful hip and knee replacements, making him a true topic expert.

Read on as we explain what the anterior approach is, how it differs from posterior, and share the pros and cons of an anterior hip replacement.

Different Hip Replacement Approaches

There's more to a hip replacement surgery than meets the eye. There are actually a variety of hip replacement approaches including: anterior approach, posterior approach, direct superior approach, anterolateral approach and direct lateral approach. Over the years, each approach has had its day in the sun. In other words, in the same way that the anterior approach is popular today, the other approaches have been abuzz with surgeons and patients at one time or another.

So, which hip replacement approach should you request from your orthopedic surgeon? Is one really preferred? Read on as we try to help you answer this tough question.

Learn about the different types of hip replacement implants and materials.

Ask a Surgeon: What's the Difference Between Anterior and Posterior Hip Replacement?

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In our conversation with Dr. Salyapongse, we wanted to understand the difference between anterior and posterior. In short, both approaches result in a hip replacement. However, the difference between the approach is where the incision is made to access the hip. In a posterior approach, the incision is made through the back of the hip while you're on your side. This approach is considered the "traditional", "tried and true" method. In an anterior approach, the replacement is done through the front while you lay on your back. This approach is often considered the  "latest and greatest" in hip replacement surgery.

Dr. Salyapongse explains, "Although the basic concepts of hip replacement surgery remain the same with both the posterior and anterior approach surgery, there are some key differences." He elaborates, "the anterior approach involves a true internervous/ intermuscular plane. This means that the surgeon can perform the surgery working between muscles without detaching or cutting them." As a result of not cutting muscles, less of the patient's natural anatomy is tampered with. This can mean faster healing.

Dr. Salyapongse adds that the anterior approach can sometimes be "more accurate" because x-ray guidance and technology is used during the procedure.

What are the "Pros" of an Anterior Hip Replacement?

In addition to the anterior approach being "more accurate" and "leaving more muscles attached and unaffected", Dr. Salyapongse pointed out other benefits. Dr. Salyapongse adds, "recent studies have shown that early recovery (the first 6-8 weeks) after anterior approach surgery seem to be faster and less painful."

Another benefit that the surgeon points out is that there are fewer hip precautions after surgery. He explains, "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." Without a doubt this can make for an easier "return to normal"  and underscores a possible jumpstart on recovery.

To recap, here are the pros:

  • Less invasive, leaving more muscles and tissues in tact

  • Early recovery may be faster

  • Recovery may be less painful

  • Closer to a "normal gait" in the first six weeks after surgery

  • Fewer hip precautions after surgery

What are the "Cons" of an Anterior Hip Replacement?

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Some of the commonly cited downsides to the anterior approach is that it is less common and hasn't been done for as long as the posterior. This means that some surgeons are not as well-versed in the anterior approach. The anterior approach can also take longer to perform as it is slightly more complicated. A longer procedure time means greater potential for increased blood loss (although this is low risk).

Another con that Dr. Salyapongse points out is  "the occasional sense of numbness over the side of the thigh after surgery." He adds that "not all patients experience this, but when they do, it can last for a year or so."

To recap, here are the cons:

  • Less common with fewer "expert" surgeons who specialize in the approach.

  • Longer procedure (this increases risks associated with surgery, like "blood loss".)

  • Greater potential for post-op numbness in the upper thigh.

Why is "Anterior" Preferred by Some Patients & Surgeons?

Since there are both pros and cons to the anterior approach, why is it preferred by many patients and surgeons? Dr. Salyapongse explains what he has seen first hand: "patients who have had anterior hip surgery on one side and posterior hip surgery on the other, most often prefer the anterior hip side." In other words, in cases of patients who've had bilateral hip replacements (whether staggered by weeks or years, or done at the same time), notable feedback is that they preferred the anterior replacement.

The reason being, Dr. Salyapongse shares it that "they report faster recovery, easier rehabilitation, and less pain". In addition, not having as many restrictive "hip precautions" after surgery is a massive bonus for many patients.

Dr. Salyapongse touches on later recovery, sharing that "some studies show that even at 6 weeks, anterior hip surgery patients are still doing better than the posterior hip patients. But as time goes on, anterior and posterior hip replacement patients both do very well."

Should Most Patients Get an Anterior Hip Replacement?

As Dr. Salyapongse (and friend of PeerWell, Dr. Trevor North) explains, it may not be such a simple, clear-cut answer. Both surgeons point out that the most important determining factor actually lies in your choice surgeon.

When asked whether or not most patients should go for anterior, Dr. Salyapongse said "in my opinion, yes." He adds to this by saying, "however, there's one caveat: patients should seek out a surgeon who is well-trained and experienced with the anterior hip surgery. The more procedures the surgeon has performed, the better they will be at providing you with a great outcome." In other words, Dr. Salyapongse believes that the anterior approach is superior to posterior (hehe, we rhymed!). However, the most critical factor to the success of an anterior hip replacement is having a surgeon who you're comfortable with, has performed a high-volume of anterior replacements, and matches your individual needs.

Learn more about 'how to choose the right surgeon for your joint replacement surgery.'

Orthopedic surgeon, Dr. Trevor North echoes a similar perspective, saying "the most important thing when deciding your joint replacement approach is the relationship you have with your surgeon".

So, if you have a surgeon but they specialize in posterior replacements, should you find a new surgeon?

We asked Dr. Salyapongse whether or not an anterior approach is worth switching surgeons for. Here's what he had to say:  "If you have a good relationship with your surgeon, I would trust them to perform the procedure for you with which they have the most experience (anterior OR posterior)." As such, trust in your preferred surgeon is the top priority. In saying this, Dr. Salyapongse adds that "if you have the means and time to seek out an experienced anterior hip surgeon (e.g. they've performed more than 1000 procedures) then I would consider doing so."

Before we end our interview with orthopedic extraordinaire, Dr. Salyapongse, he adds that "after a year or so, all patients typically have the potential to be doing equally as well regardless of approach."

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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Are you in the California-area? Looking to have a hip or knee replacement surgery? Get matched to a top surgeon near you or book a free consultation with Dr. Salyapongse.

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Hi, I'm Grace. I write all things surgery for the PeerWell blog. You may remember me from such titles as: "Diabetes & Joint Replacement 101" & "Sex After a Joint Replacement".

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