Anterior vs. Posterior Hip Replacement

The front (anterior) and back (posterior) of the hip are the most common approaches to hip replacement surgeries. The main distinction between posterior and anterior hip replacement is the incision location. In the anterior approach, the surgeon accesses the joint from the front. Posterior replacement involves cutting through some muscles at the back of the hip. Both approaches involve replacing the head of the femur with a new metal or ceramic joint.

Let’s explore the differences and benefits of both types of hip replacement.

Differences Between Anterior and Posterior Hip Replacement

Around 544,000 hip replacement, or arthroplasty, surgeries happen in the United States every year. Posterior hip replacement has long been the industry standard. In recent years, anterior surgery has gained popularity. Various factors separate these two approaches:

• Incision location: In anterior replacement, surgeons make the incision at the front of the hip. The posterior approach uses an incision at the back of the hip close to the buttocks. 
• Patient position: The patient lies on their back during the anterior procedure. In posterior surgery, they lie on their side on the unaffected hip. 
• Muscle separation: In frontal arthroplasty, the physician works through or around the muscles. Due to more muscles at the back of the hip, the surgeon must cut through some of them in posterior surgery. 
• Time in hospital: The hospital stay for front arthroplasty is shorter. Patients typically go home between one and three days after surgery. 
• Recovery duration: Patients recover faster from anterior procedures. Recovery from posterior surgery takes longer, as the muscles need time to heal. 
• Postoperative instructions: Posterior surgery patients must follow strict postsurgical precautions to avoid injury. With less complication risk, anterior replacements have fewer post-op restrictions. 

Benefits of Posterior Versus Anterior Hip Replacement

Each approach has advantages and disadvantages, making it more suitable for certain patients. 

Anterior Hip Replacement Advantages

The anterior approach offers many benefits, such as:

• Shorter recovery time: Due to minimal muscle interference, recovery time is faster. Patients can put weight on the hip sooner. Studies show increased functional improvements in six months from the procedure date. 
• Reduced muscle damage: Fewer muscles at the front of the hip make it easier for surgeons to work between them. Muscles and fibers remain attached, without significant muscle damage or repairs. 
• Decreased dislocation risk: The muscles around the hip joint prevent dislocation. Since muscles remain intact during anterior replacement, there is less dislocation risk. 
• Quicker mobility: Patients can move without walking aids sooner than posterior patients.  
• Less time in the hospital: The time in the hospital is around eight hours less for anterior surgeries.
• Greater visibility: The patient’s position allows surgeons to take X-rays during the procedure. They can also measure equal leg length more easily than in posterior replacements. 
• Minimized postoperative pain: Patients experience less pain post-procedure due to limited muscle trauma.

Anterior Hip Replacement Disadvantages

Although it has many benefits, anterior hip replacement also has disadvantages:

• Excluded candidates: The anterior approach may not be suitable for everybody. Obese or very muscular patients may not be good candidates. Accessing the hip joint through excess soft tissues is challenging for surgeons. 
• Potential nerve damage: Both approaches carry the risk of nerve damage. The lateral femoral cutaneous nerve (LFCN) connects the lower back to nerves in the legs. If damaged, you may experience numbness in the top of the thigh, but you will not lose any muscle function. 
• Wound healing issues: Anterior arthroplasty wounds have a higher risk of infection. While these issues can be mild, avoiding infection spreading into the new hip joint is essential. 

Posterior Hip Replacement Advantages 

Orthopedic surgeons use the posterior approach to hip replacement because of advantages such as: 

• Shorter procedure time: Posterior surgery takes 16 minutes less on average than anterior. 
• Increased hip joint exposure: The surgeon cuts through muscle to expose the hip joint. The patient’s position allows for increased visibility.
• Same long-term outcome: The long-term results are similar to the anterior approach. 
• More inclusive candidacy: Muscular or obese patients can undergo posterior hip replacement. It is also the preferred method for patients with complex joint issues.

Posterior Hip Replacement Disadvantages

Some of the disadvantages of posterior hip surgery include:

• Increased muscle damage risk: Surgeons cut through muscles and fibers, increasing damage risk.
• Slower recovery time: The muscles and soft tissues need to heal, adding to the overall recovery time. Patients may need to use walking aids for longer than with anterior replacements. 
• Increased chance of dislocation: Muscle separation during surgery can amplify the dislocation risk of the new joint. 
• Longer hospital stay: Patients stay in the hospital for longer after posterior arthroplasty.

Posterior Versus Anterior Hip Replacement: Which Is Right for You?

It’s crucial to consult with an orthopedic specialist when considering hip replacement surgery. A surgeon specializing in joint replacements tailors the surgical approach to your needs. Preexisting medical conditions, previous surgeries and lifestyle can influence the best technique. 

Finding an experienced surgeon is the first step in your hip replacement journey. 

Recovery and Outcomes After Hip Surgery

Hip replacement recovery starts the moment you wake from anesthesia. Patients show improvement within one month, returning to functional normality within three months. You can expect full mobility within 12 months. 

Here are some tips to ensure a successful recovery:

• Rehabilitation: Your surgeon will provide you with exercises to do at home. Keeping up with these exercises helps strengthen the joint. It’s vital to keep moving. You can work with a physical therapist to regain mobility in a safe, gradual way. 
• Pain management: Pain is normal after hip replacement. Take any prescribed or over-the-counter medications recommended by your surgeon. Using an ice pack on the affected area can help alleviate discomfort. It can be tempting to stop exercising the joint when it hurts, but it’s essential to keep it moving.  
• Postoperative care: Your post-surgery guidelines are there to help you heal. Following them ensures a successful recovery and reduces the risk of complications. Be sure to keep your wounds clean to avoid infection. Avoid crossing your legs or feet, twisting your hips or lifting your knees too high. Attend any follow-up appointments with your orthopedic physician.

Why Trust Fondren Orthopedic Group for Your Hip Replacement Surgery?

Fondren is a physician-owned orthopedic group with over 40 fellowship-trained physicians. We have more than 50 years of experience providing world-class care. Our hip surgery specialists use knowledge, skill and cutting-edge technology for successful outcomes. Hip, knee and shoulder surgeries comprise the 4,000 joint replacements performed annually.

We have the highest volume of hip arthroplasty in Texas and one of the largest globally. Research drives our comprehensive knowledge. The Fondren Orthopedic Research Institute (FORI) harnesses data to advance surgical treatment. 

You receive unparalleled care from the moment you arrive at Texas Orthopedic Hospital. Learn more about the difference we make in people’s lives. Read firsthand testimonials and success stories from our patients.  

Contact Our Joint Replacement Specialists

At Fondren, our specialists determine the best hip replacement approach based on your needs. As one of the largest associations of private orthopedic surgeons, patients come from all around the world for treatment. Our priority is getting you on your feet so you can get back to living life to the fullest.

Visit our website to learn more about Fondren’s hip replacement specialists. If you’d like to speak to us, contact us today or schedule an appointment online.