Ask the Doctor - Two Approaches for Hip Replacement Surgery

Ask the Doctor at Saint John’s:
Two Approaches for Hip Replacement Surgery

     Q.  What is the difference between anterior and posterior hip replacement surgery?

     A. By Robert Klenck, M.D., board-certified orthopedic surgeon at the Hip and Pelvis Institute at Saint John’s Health Center.

     The most obvious difference is where the surgeon makes the incision. The actual hip reconstruction -- replacing the hip joint with new components -- is the same in both operations.

     The posterior approach is the most commonly practiced surgical approach for total hip replacement. It involves the surgeon making a six-to-eight inch large and deep incision in the buttocks, behind the hip joint. The buttocks muscle is split apart in order to reach the hip joint. Because the posterior hip capsule and musculature is so important with regards to hip stability , patients are cautioned to limit their hip movement after posterior approach  hip surgery, in order to give the soft tissues adequate time to heal and decrease the chance of joint dislocation.

     With the anterior approach to the procedure, the surgeon makes a three-to-four inch incision in the front of the hip, much closer to the joint. The cut is not as long or deep as the posterior incision. The surgeon actually is able to work through a natural space between the muscles in order to reach the hip joint. This approach is made possible by the use of a high-tech operating table that places the leg and pelvis in a stable position, yet allows the surgeon to rotate and place traction on the operative leg. This provides better access to and better visibility of the joint, allowing the surgeon to more precisely implant the new joint components, which along with the intact posterior soft tissue structures, markedly reduces the chance of dislocation after surgery.  Typically, patients have no limitations to hip movements or to the activities that they may perform after anterior approach hip replacement surgery.

     I have performed the operation both ways, and at the Hip and Pelvis Institute at Saint John’s Health Center, we prefer the anterior approach. It’s a winning situation in every respect. The biggest advantage is the preservation of muscles around the hip. If patients have surgery in the morning, they are often able to get up and walk around for first time that same afternoon and may even leave the hospital on the next day. Because the incision is smaller, there’s not as much surgical trauma, which means patients experience less pain, less scarring and recover faster.

     The anterior approach to hip replacement, though not as commonly performed as the posterior approach, is a proven technique that can help people who need a new hip joint.

     Robert Klenck, M.D., is a board-certified orthopedic surgeon at the Hip and Pelvis Institute at Saint John’s Health Center. For more information about Dr. Klenck and other Saint John’s services, please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.

     Want to learn about a variety of health and lifestyle issues? Watch “Coffee Break,” a weekly, live television show broadcast Wednesdays at
2–3 p.m. on Santa Monica City TV Channel 16 and LA City Channel 36.

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