Anyone with a painful or deteriorating hip should ask their doctor about anterior vs. posterior hip replacement. Posterior hip replacement surgery is the traditional approach, but it takes you longer to heal. Anterior hip replacement surgery is the new, less invasive procedure, but fewer physicians perform this surgery.
The first total hip replacement, or THR, occurred in 1969 in the U.S. Since then, over 200,000 operations are performed yearly. Patients undergo this operation to relieve chronic pain from arthritis. There’s wear and tear on the hip joints, which results in decreased mobility and quality of life.
The hip joint is a ball-and-socket joint. It works with the ball, or femur, and glides against the socket, or the acetabulum. The existing damaged portion of the hip is removed, and the surgeon places a metal stem down the femur and a metal cup in the socket in a THR. The doctor inserts a polyethylene and plastic liner between the ball and socket. The coating offers a weight-bearing surface that isn't metal against metal.
You’ll probably debate whether anterior vs. posterior hip replacement is best for you before committing to total hip replacement. Here are some facts about both surgeries, recovery time, and possible complications.
What is Posterior Hip Replacement?
The surgeon makes an incision in the back of the hip during posterior hip replacement surgery. This procedure is considered traditional hip replacement surgery, and it’s minimally invasive. The patient is usually put under general anesthesia.
You’ll lie on your healthy hip during surgery, and the doctor will make an incision on the posterior of your hip close to your buttocks. After the implants are in place and soft tissues rejoined, the surgeon sutures the incisions and covers them with a sterile dressing.
You’ll use an abduction pillow, which is placed between your legs to repair soft tissues. You’ll be able to walk right after surgery.
What is Anterior Hip Replacement Surgery?
An anterior hip replacement is performed from the front of your hip. These surgeries are sometimes called modified, muscle-sparing or minimally-invasive procedures. The anterior approach lets your surgeon operate using a small incision in the front instead of the larger cuts in the side or back. The advantages of anterior hip replacement are:
How to Prepare for Anterior Hip Replacement Surgery
Let your doctor know your medical history, including your family history. Be sure to have a list of all the medications, supplements and vitamins you take. Tell your medical provider if you’ve had a recent illness, like fever or if you might be pregnant.
You may need to stop taking prescription medication or over the counter drugs before surgery. You may take specific tests before surgery, like X-rays or MRIs of your hip. The doctor may also order an ECG to find out if your heart rhythm is normal.
You may need to stop eating and drinking at midnight before the day of your surgery. You might need to add a handrail to your shower and move any furniture that might cause you to trip.
Risks of Anterior and Posterior Hip Replacement
The anterior approach to hip surgery is generally safe, but there are always risks associated with any surgery. Several problems may occur after anterior hip replacement surgery, including blood clots, infection, bleeding, joint loosening, bleeding, nerve damage, and leg length changes.
The posterior method of hip surgery contains the same risks, so in that sense, there aren’t many differences between the approaches.
Length of Hospital Stay
The after-surgery care procedure for both surgeries remains similar, but the length of the hospital stay for posterior surgery is longer.
The length of the hospital stay for posterior hip replacement surgery is usually three to ten days. The patient’s health and age have a lot to do with recovery time and the length of the hospital stay.
The incision on the outer buttock may be ten to 12 inches long, and some muscles along the hip joint may need to be repaired. Recovery time lasts two to four months. For six to 21 weeks, patients who’ve had posterior hip replacement surgery can’t bend past 90 degrees turn the leg inward, cross the leg or do internal rotation.
Patients stay in the hospital for two to four days after anterior surgery. The incision along the front or side of the hip after this procedure measures four to five inches long. The muscles around the hip joint aren't cut, and there's less pain or risk of dislocation or leg length problems. Patients return to normal activities quickly.
Advantages to Anterior Hip Replacement
Anterior hip replacement accounts for only 15 to 20 percent of THR surgeries in the U.S. Anterior hip surgeries are relatively new, and although they provide excellent outcomes, most surgeons still use the traditional posterior method.
Discuss which surgery is best for you – even though anterior hip replacement works for most patients, posterior hip replacement surgery may be better for you. Below, you’ll find some of the advantages to this surgery, mentioned by doctors and patients.
The procedure won't damage major muscles since anterior surgery focuses on the front of the hip. The surgeon goes between the muscles and doesn't detach muscles from the bone or cut muscle fibers. Since no repairs are needed at the end of the surgery, the procedure takes less time than posterior surgery.
You’ll feel less pain and need less medication post-surgery because you won’t have to recover from muscles being cut.
You can get up and move around shortly after surgery. You'll be able to bend your hip and bear weight as soon as you're ready. You won't need to wait for weeks or months. You'll use a walker or crutches soon after surgery, depending on how you feel.
One study showed that anterior hip replacement patients were able to walk unaided six days earlier than posterior hip replacement patients.
Anterior hip surgery patients can sit cross-legged or bend over without worrying about hip dislocations. Posterior hip surgery patients must avoid sitting cross-legged, bending at the hip or internally rotating the hip for up to two months, depending on their medical condition and their doctor’s preference.
Less Risk of Dislocation
There’s little chance of dislocation. Anterior hip surgery keeps the new ball and socket in place better because the surgeon doesn’t cut muscles or disturb soft tissues during the procedure. This aspect makes it less likely that your hip will dislocate after surgery.
Patients who received anterior surgery completed rehab and regained mobility quickly. These patients still had to proceed with caution, but they moved better than patients who received posterior hip replacement surgery even a few days after the procedure.
There's less damage to nerves near your hip, especially the sciatic nerve if you get anterior hip replacement surgery. The sciatic nerve is located behind the hip joint, so your surgeon won't disturb it during anterior surgery.
Disadvantages of Anterior Hip Replacement Surgery
When considering anterior vs. posterior hip replacement, be aware that anterior hip replacement does have a few drawbacks, and it’s not for everyone.
Muscular and obese people may not be able to have this surgery. The extra soft tissue may make it hard for the surgeon to work on the hip joint.
Doctors need to study and master this difficult procedure before performing surgery, and this takes many months or years to perfect. The anterior incision makes it hard for the surgeon to see the hip joint, and it takes a lot of training to master the operation.
Nerve damage may occur in rare cases. The surgical area lies near the lateral cutaneous femoral nerve. This nerve runs down the front of the pelvis, to the hip, and supplies feeling to the outer thigh. (This nerve doesn't affect muscle control.)
Numbness in the thigh or irritation of the skin is called meralgia paresthetica, and it affects less than one percent of patients.
Incisions may become irritated during anterior surgery. Large patients and patients with lots of abdominal fat may experience this problem. Wounds may take longer to heal in these patients.
Did you know?
A study showed that 1.4 percent of patients who had anterior hip replacement surgery had wound healing problems, while 0.2 percent of patients who had posterior hip replacement surgery experienced wound healing problems. Most of these problems are minor and resolve themselves without medical treatment.
Mini-Posterior Hip Replacement Surgery Can Save Time
The mini-posterior approach to total hip replacement reduces the time and some of the complications of traditional hip replacement surgery for both patient and surgeon.
The doctor separates the muscle fibers but doesn't divide them, at the back or side of your hip. Therefore, your muscle function is intact, and you'll take less time to recover from the procedure. Let’s look at the pros and cons of mini-posterior hip replacement surgery.
Mini Posterior Surgery for Hip Replacement Advantages
The mini-posterior approach splits, but doesn't cut, muscles, and many surgeons believe this the most straightforward approach and the safest for the patient. You'll recover in the same amount of time as you would after anterior hip replacement surgery.
The hip socket and femur are exposed during surgery without the complicated cutting of the full posterior approach. There’s less risk of nerve injury, poor implant positioning, or femoral fracture during this procedure.
Since the femur and socket are easily exposed, no special equipment is need during the surgery.
Most medical l schools teach the posterior approach as the primary option for total hip replacement surgeries, and it remains the most common THR surgery in the world. The mini-posterior approach applies that method with a few safe tweaks for better patient comfort and faster response and recovery.
Mini-Posterior Surgery for Hip Replacement Disadvantages
You may experience hip dislocation with this method, although the rate is still low overall. Anterior hip replacement surgery has lower rates of hip dislocation, but full posterior surgery has higher dislocation rates.
The anterior approach offers the fastest recovery time, but fewer surgeons perform it. The posterior surgical procedure has the longest recovery time, but most THR surgeons can perform it.
You should consider the mini-posterior total hip replacement surgery if you can't have anterior hip replacement surgery.
Mobility after Recovery
Your doctor will recommend exercises for you to do right after surgery, after six weeks, three months, or at other points during your recovery. Ankle pumps, ankle rotations, and straight leg raises are just a few of the exercises you can do right after surgery.
You can start walking almost immediately after anterior hip replacement surgery. Swimming, riding a stationary bike, and doing heel and toe lifts are some of the most common exercises doctors recommend.
Similarities between the Surgeries
There are many similarities between anterior and posterior hip replacement. Both surgeries may occur under general or local anesthesia, depending on the patient’s condition and the doctor’s preferences.
The reasons for getting the surgery are the same, regardless of anterior vs. posterior hip replacement. Rheumatoid arthritis is the most popular reason for THR, but you may also need the operation due to a broken hip, bone tumors, or avascular necrosis (a bone that didn’t get enough blood.)
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