Learn about this less-invasive hip replacement technique that helps keep muscles intact.
A hip replacement can provide pain relief and dramatically improve quality of life by getting you back to activities you enjoy and making daily life easier. But there are different surgical techniques for this total joint replacement. If you’ve heard about the anterior approach for hip replacement, you may be wondering what it is and if it has advantages.
“There are two predominant approaches to hip replacement right now: posterior and anterior,” said Ryan Martin, M.D., an orthopaedic surgeon with Vanderbilt Orthopaedics. “The anterior approach goes in between the muscles at the front of the hip, whereas the posterior approach cuts through some of the muscles and tendons and goes through the back of the hip.”
Both types of hip surgeries have similar goals. However, they differ in how the surgeon accesses the hip joint. They also have subtle differences in implant choice, Martin added.
What are the benefits of anterior hip replacement?
“The benefit of the anterior approach is that it goes in between the muscles rather than cutting them,” Martin explained. “There have been some demonstrated improvements in the ability to rehab more quickly with the anterior approach.” The anterior approach also offers a slight decrease in the risk of joint dislocation, where the ball comes out of the socket.
Component placement — how precisely the cup and stem are positioned during surgery — tends to be more accurate with the anterior approach than with the posterior approach, Martin added. He credits the improved accuracy to the ability to use X-rays more easily during surgery.
During an anterior hip replacement, a patient is lying on their back. “We’re able to take intraoperative x-rays or fluoroscopic images during the surgery,” Martin said. “I spend a lot of time looking at their leg lengths and their offset and mirroring what I think their hip should be based on their other leg, or, if they’ve had another hip replacement, mirroring what the other hip replacement looks like.”
With a posterior approach, a patient is lying on their side, making imaging and matching of the leg length and offset more difficult, he added.
Who is a candidate for anterior hip replacement surgery?
If you meet the general criteria for a total hip replacement, then you are likely a candidate for either the anterior or posterior approach, Martin said. Whether you are a hip replacement candidate will depend on your age, your body mass index (BMI), your smoking status, underlying conditions and how well they are controlled, as well as other factors.
“Typically, surgeons will do the approach they are most comfortable with,” Martin explained. “Some patients will specifically select surgeons who do anterior hip replacement.” Martin said he’s had patients seek out an anterior hip replacement after they’ve heard about the technique from a friend who has done well with that approach.
“It is amazing to see how quickly patients recover after surgery. Within a week or so, they’re back to doing things that they haven’t done in years, which is fun to see.”
Vanderbilt has a specialty bed used for anterior hip replacement. “It standardizes the process and makes the surgery more reproduceable,” he explained.
With Vanderbilt’s outpatient surgery center, patients generally go home the same day, usually within a few hours of their procedure. “It is amazing to see how quickly patients recover after surgery,” Martin said. “Within a week or so, they’re back to doing things that they haven’t done in years, which is fun to see.”
Outpatient surgery is also possible with the posterior approach. “Fortunately, Vanderbilt performs both surgical approaches,” Martin added. “Therefore, patients have their option of which approach they prefer.”