Ask a Doctor: Dr. Simon Amsdell, Orthopedic Surgeon

Traditionally there have been 4 common ways to approach the hip joint for a total hip replacement- posterior, lateral, anterolateral and direct anterior.  All of these approaches can provide excellent long-term outcomes.  Most of the focus in recent years has been comparing the direct anterior and posterior approach, as the posterior approach is most common in the U.S., and anterior approach has gained some popularity in recent years.  The posterior approach utilizes an incision on the side of the hip, splitting superficial muscle and removing some small muscle from the back of the femur to gain exposure to the hip.  The anterior approach uses an incision over the anterior groin/thigh and is more muscle splitting. 

There may be an earlier return to ambulation without assistive devices in the first few weeks after an anterior hip, with no long-term differences in outcome.  A special table is typically utilized for the anterior approach which can bring significant upfront costs to a hospital system.  The anterior approach is technically demanding, and carries an elevated risk of injury to a nerve on the front of the thigh.  The posterior approach is more extensile, when needed, for difficult anatomy or large patients.  The AAOS (American Academy of Orthopedic Surgery) has adopted the following statement regarding approaches to the hip:

EXPOSURE APPROACH High quality evidence supports that there are specific risks and benefits to each surgical approach and that there is not a preferred surgical approach for patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty. Quality of Evidence: High

I utilize a posterior approach as it has yielded excellent results, with a low complication rate, and can be applied to all our patients regardless of body habitus/size.