Is the ‘Anterior Approach’ Total Hip Replacement Better?

There is a lot of advertising, especially around metropolitan areas, regarding hip replacement surgery and the approach to surgery. The ‘approach’ is how the surgeon gets access to the hip joint to perform the replacement. 

While the posterior approach to hip replacement, in which the surgeon performs the hip replacement from the back of the hip, has been the industry standard for decades, much of the advertising lately has touted the anterior approach as better than other approaches.

The anterior approach, which involves making the incision at the front of the hip, is claimed to offer faster recovery, be less invasive, and possibly be less damaging to the tissue and muscle around the hip. Some surgeons have increased their surgical volume by making these claims and, naturally, patients gravitate to something that is perceived to be better.

So, is the anterior approach superior to other approaches? Let’s refer to what the experts in the field of orthopedics have said about approaches to the hip. The American Association of Hip and Knee Surgeons (AHKSS) is the leading organization in the world for joint replacement surgery with a wealth of patient education on their website (https://hipknee.aahks.org). Regarding approaches, the AHKSS website states: 

“There are pros and cons of each [hip] approach and little science to endorse one over the other. Surgeons tend to have a preference and comfort level with one particular approach over the others. The bottom line is that the best approach is the one your doctor is most comfortable with to allow safe and precise implantation of your hip replacement components. A conversation with your surgeon should help decide which approach is best for you.”

As you can see, overall, there is not much evidence that the anterior approach to the hip is better than other approaches. Recovery time and possible damage to the tissue and muscle around the hip are about the same for both the anterior and posterior approaches, as is return to activity. And, here’s a little secret about hip replacement surgery: most patients with hip arthritis do very well after hip replacement surgery, regardless of the approach.