Anterior Approach for Hip Replacement: Advantages and Disadvantages

There are many well-established surgical approaches to the hip.  Two surgical approaches for total hip that have gained recent notoriety are the direct anterior approach and the minimally invasive or mini-posterior approach.

The direct anterior approach involves splitting the fibers between the two main muscles located at the front of the hip and working through the natural interval between the muscles.

Advantages of the Anterior Approach

  1. Because the anterior approach avoids cutting through muscle, it is hoped it will lead to a quicker recovery.  This has not yet been show to be true or false through scientific study.   Most agree that any short term benefits are not apparent after the initial healing period.
  2. Some feel the approach is more minimally invasive than other approaches, but honestly, the definition of minimally invasive is not clear or agreed upon.  It is not related to the length of the incision, which is about the same for both approaches.
  3. The hip dislocation rate may be lower due to the preservation of the muscles at the side and the back of the hip.
  4. The hip socket is exposure is straight forward.

Disadvantages of the Anterior Approach

  1. Nerve injury is possible, which decreases sensation to the outside of the thigh.
  2. There is an increased risk of complication on side of the hip where the femur is located due to increased difficulty in exposing and visualizing the femur.
  3. It is difficult for the surgeon to see enough of the femur to fix a fracture if it were to occur.  With some femoral fractures, it would be necessary to abandon the approach and expose the femur through a different approach using a new incision.

In my next post, I will list the advantages and one main disadvantage of the mini-posterior approach.  In the meantime, feel free to join the discussion by leaving a comment or question below.

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3 replies
  1. marion cerrato
    marion cerrato says:

    Dear Dr. Leone: I am going to have posterior hip replacement surgery in January. I am a belly dancer and also do weightlifting. As a belly dancer I use my hips quite a bit, but the whole body is used. My doctor said I wont be able to squat or deadlift after the surgery. He also told me I had the option of having anterior. So he gave me the names of two other surgeons. I am 77 yrs. old, but if I can ‘t dance, I will be very unhappy. He also said quicker recovery with anterior has not been proven. I am very active and don’t feel my age. I am having a problem making a decision. I really like my doctor who does posterior. Thank you, Marion Cerrato

    • holycrossleonecenter
      holycrossleonecenter says:

      Dear Ms. Cerrato,

      Consistently, my best results have been with a mini posterior approach. The anterior approach has the initial advantage of being more stable posteriorly. That said, once the soft tissues around the new prosthetic hip heal, whether the hip was implanted though an anterior or posterior approach, it is stable. Also, with modern prosthetics, an excellent soft tissue closure and optimal component positioning, the risk of dislocation with either approach is very small.

      Although this healing process is progressive, I advise patients to avoid certain positions for the first several months. Most of my patients return to whatever activities that they want to after that period, although I still advise against repetitive running for exercise (some of my patients still do) or extreme limb position like one occasionally sees with yoga (unfortunately some still do this as well). Returning to belly dancing after the recommended healing time sounds fine.

      I wish you the best.

      Dr. William A. Leone

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