There are a few options when it comes to hip replacement approaches. The approach is the location the surgeon places the incision to gain access to the hip joint. Traditionally, surgeons have used the so-called ‘posterior’ approach. From the patient perspective, there is a hockey-stick shaped incision over the buttock. Surgeons typically restrict bending the hip up and crossing legs when the posterior approach is used, as this may increase the risk of the hip dislocating out of the back of the socket. If you know someone who had to sleep with a foam wedge in between their legs after surgery, that means it was a posterior approach.
There are a few anterior approaches, but the most commonly used is the so-called ‘Smith-Peterson’. This describes the specific muscles that the surgeon goes between. The posterior approach detaches (and then later re-attaches) muscles from the hip that provide stability to the hip joint. The anterior approach aims to improve stability and function by going in between the front muscles and thus preserving the muscles in the back of the joint.
Because the muscles in the back of the hip are preserved, most of who use the anterior approach allow our patients to flex and cross the legs without restriction after surgery. This certainly makes the recovery more convenient when it comes to getting in and out of bed, toilet, kitchen, etc.
The anterior approach has gained momentum in the last 20 years as we have learned that there may be earlier return to function and mobility as well as lower dislocation rates. There have been recent advances in the approach and equipment used that makes the surgery more feasible and reproducible.
It is also easier to create more equivalent lengths of the legs using the anterior approach. This is due to having the surgery performed in a supine (flat on your back) position which levels the pelvis; this allows live xray imaging to more accurately position the implants and the leg in real time during surgery. One of the downsides is that there can be a patch of numb skin on the outer thigh next to the incision. Just like any hip replacement surgery, there is always a risk of infection, continued pain, and blood clots.
I was trained in both posterior and anterior approaches, and I now routinely use the anterior approach due to the advantages I have seen with my patients in the early recovery phase. I find it helpful guiding implant placement with real time xray imaging to improve accuracy.