Many of my total hip patients want to know the difference between a traditional hip approach and a direct anterior hip approach. Below are examples of how the surgical steps of an anterior approach hip replacement differ from the steps of the posterior approach, which is the most commonly utilized approach to hip replacement in the US.
Location of incision
During anterior hip replacement the incision is made at the front of the hip. This incision starts at the front of the pelvic bone (iliac crest) and extends down toward the top of the thigh. During posterior(back) approach to hip replacement, the surgeon makes a curved incision on the side of the hip, just behind the greater trochanter, the prominent bone that sticks out at the side from the top of the femur (thigh bone).
During anterior hip replacement the surgeon works between the muscles, with minimal or no muscle cutting. Utilizing this interval between the muscles is called the Hueter approach, after a German surgeon who first described this method of entering the hip joint. It is a truly “internervous” approach, meaning the surgeon is working in between muscles supplied by different nerves, so it’s a natural separation that allows ready access to the hip joint.
Traditional surgical approach requires surgeons to cut muscles and other soft tissue at the back of the hip to access the hip joint. First, the surgeon cuts the fascia lata, a wide piece of fibrous soft tissue at the top of the outer thigh, and the large gluteus maximus muscle that attaches to it. Next, the surgeon must cut the external rotators of the hip, which are small, short muscles that connect the top of the femur to the pelvis. These muscles provide hip stability, preventing the femur from dislocating out the back of the hip socket (posterior dislocation). These muscles are repaired and reattached at the end of the surgery.
Recovery following surgery
Research supports quicker return to mobility and walking with the direct anterior muscle sparing approach along with a decreased risk of dislocation and limp. The long-term differences between the approaches has not shown to be significant.
Technical ease of surgery
A surgeon tends to have a limited view of the hip joint during anterior hip replacement surgery, making the surgery technically challenging, especially for less experienced surgeons. Make sure that your hip surgeon has many years of experience with the approach that they plan to use.
A surgeon tends to have a good view of the hip joint and comfortable access to the hip joint during posterior hip replacement.
All hip replacements require the opening of the hip capsule and shaping the bones in order to implant prosthetic hip joint components.
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