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Is Anterior Total Hip Replacement Better Than Posterior?

Is hip pain getting in the way of living your life? Is osteoarthritis making it difficult to walk or complete daily tasks? Are non-surgical treatments no longer working? If so, a hip replacement surgery might be the right option to get you back on your feet and decrease pain.

Hip replacement surgery replaces damaged or diseased bone with a metal or plastic implant, which is designed to replicate a healthy hip joint. The surgery not only improves quality of life but it is also associated with an increased life expectancy as well.

According to the Centers for Disease Control and Prevention (CDC), more than 310,000 hip replacements were done in the U.S. in 2010.

The most commonly utilized total hip replacements are the posterior and anterior approaches. Both have been around for decades, but anterior surgery has recently grown in popularity and prevalence in the U.S.

To help us better understand anterior hip replacement, we sought the expertise of Marc Rosen, MD, an orthopedic surgeon at Banner Health Clinic in Glendale, Arizona, who sees patients with hip and knee problems.

What is an anterior hip replacement?

“The anterior hip replacement is not new and has been around just as long as posterior surgery,” Dr. Rosen said. “What is new is its popularity, and more active patients wanting a less invasive technique allowing for a quicker recovery.”

Unlike lateral (side of the hip) and posterior (back of the hip) approaches, the anterior approach uses an incision in the front of the hip while the patient is laying on their back.

Below highlights what we know about the advantages and disadvantages of hip replacement surgery.

Advantages

Some potential advantages of anterior hip replacement surgery may include:

  • Use of a fluoroscopic X-ray for prosthetic positioning adds another margin of safety, because it can provide surgeons an immediate view of the hip and surrounding structures.
  • There are fewer muscles in the front of the hip, which means less damage to major muscles.
  • Because the surgery doesn’t require cutting major muscles, typically patients experience less pain after surgery and require less pain medication.

“The anticipated advantages of the anterior hip approach are reduced pain and a more rapid recovery,” Dr. Rosen said. “This was popularized more widely with the advent of new operating tables allowing more freedom of exposure and control of the surgical field to the surgeon. The manipulation of the limb can be affected outside the sterile field by adjustments of the mechanical operating room table.”

While the anterior approach may offer some advantages, it isn’t without its limitations.

Disadvantages

For anterior hip replacement, some disadvantages may include:

  • Not everyone is a good candidate. The surgery might not be appropriate for the very obese. Because of the additional soft tissue, it can make it more challenging to access the hip joint.
  • It is a longer procedure. The surgery takes about 90-100 minutes versus 60-70 minutes for a posterior hip replacement.
  • The surgery has a steep learning curve. Many surgeons were not trained in this advanced technique, so training and experience is necessary.

“The anterior approach is a matter of surgeon preference and training,” Dr. Rosen said. “The surgery “learning curve” is high with the anterior approach and complications are more likely to be seen in a surgeon’s first 50 cases.”

Similarities to Other Hip Replacement Surgeries

While some proponents have promoted the anterior approach as a superior method, new research says there’s no long-term difference.

“It was recently shown that at six weeks post-operatively there was no difference in outcomes with respect to return to activities, muscle recovery and pain relief regardless of surgical approach,” Dr. Rosen said.

For many years, experts believed the anterior approach had lower rates of hip dislocation and potential nerve damage. Research now suggests the potential is there for both approaches. Most complications associated with anterior approach hip replacement are similar to standard hip replacement complications.

Should I consider an anterior hip replacement?

While the anterior hip replacement may provide some benefits, it’s not without its disadvantages. It’s important to discuss these issues with your doctor when it’s time to consider a hip replacement.

“As in any joint replacement, it’s what you leave behind that matters – not how you get there,” Dr. Rosen said. “When it comes to dictating which surgical approach should be used, it really just comes down to safety, surgeon familiarity and expertise. As long as the implant is properly installed and of modern design, you can expect a lifetime of pain-free activity after hip replacement.”

Schedule an Appointment

Are you experiencing persistent pain in your hips? Is arthritis affecting your quality of life? Schedule an appointment with a surgeon skilled in total hip replacement surgery to determine if you are a good candidate for surgery.

To find a Banner Health surgeon near you, visit bannerhealth.com.

Orthopedics Pain Management Innovation

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