Patients often ask me which is better? An anterior hip replacement? Or a posterior hip replacement? The answer is neither.
While one approach is not clearly superior, there are advantages and disadvantage of each approach. These are the reasons I prefer anterior approach total hip arthroplasty and why I think this approach is better for my patients.
Quicker Recovery
There are no studies that tell us that an anterior approach is better than a posterior approach in the long run. When you compare two different people who had the surgery done 2 years ago, they look the same.
There are studies, however, that show us that patients who have an anterior hip replacement get better than patients who have a posterior hip replacement. They are able to get rid of an assistive device sooner. They are able to return back to normal activities sooner. They have less muscle inflammation.
When you compare two different patients at 2 weeks after surgery, those who have an anterior hip replacement are able to do more than those who had a posterior hip replacement.
This benefit matches with my goal to help patients recovery quicker and with less pain.
No Precautions
Many patients ask me what they are allowed to do after surgery. I enjoy explaining to them that I only have 1 rule for them after surgery
Don’t fall.
Otherwise, as soon as their muscles allow them, they can do what they feel like doing.
The reason for this question is that traditionally, especially with posterior hip replacements, the surgeon will often tell the patient not to do certain things withe their hip in order to prevent dislocation. One of the risks of the surgery is that the hip could pop out of the joint afterwards. This is more common in posterior hips than anterior hips. The risk is so low in anterior hips, that I do not give my patients any type of precaution.
Anatomic Precision
In the end, I do believe that patients who have an anterior hip replacement are more likely to have their hip last them longer. Although this hasn’t been proven with a study, my belief comes from the idea that the anterior approach allows me to more closely match a person’s normal hip anatomy.
One of the huge advantages for me as a surgeon is that while performing an anterior approach, I can take X-rays through out the procedure. This is possible simply because the surgery is performed with the patient laying flat on their back. During a posterior approach, the patient lays on their side, making it much more difficult to get X-rays.
Not only do I take X-rays through each step of the procedure, I also have access to computer software that helps me measure what I am doing down to a millimeter.
When performing an anterior approach, I have the ability to try to restore anatomy to within a millimeter.
In the long run, I think this will allow hip replacements to last longer.
A Better Question
I don’t think that asking whether anterior or posterior hips are better is the right questions after all.
The right question is how do we help patients recover faster?
When I decide how to perform hip replacement surgery, this is my primary motivating factor. Our goal is help people get back to what they want to do in life.
Anterior hip replacement helps patients experience a quicker recovery with less pain.
