Anterior access hip replacement: an overview of advantages and disadvantages

By Cristiano Antonino On Jun 8, 2023

Let’s talk about hip replacement, and specifically the anterior access approach: in general, this procedure relieves pain and restores mobility in people whose joints have been damaged by trauma or degenerative diseases such as hip arthrosis

Hip replacement, the different types of surgical approaches

Orthopaedic surgeons are continuously working to improve the success of joint replacement surgery by developing, evaluating and perfecting new surgical procedures and processes.

As a result, orthopaedic surgeons today have a range of surgical approach options.

During surgery, the hip joint can be accessed through

the back of the hip – the posterior approach
the side of the hip – lateral or anterolateral approach
the front of the leg – anterior approach
a combination of the above approaches

The fact that there is more than one approach to perform a hip replacement means that there is no ‘perfect surgical approach’.

Each approach has advantages and disadvantages.

The surgical approach is carefully chosen by the surgeon based on a number of factors, including but not limited to your anatomy, body type, medical history, complexity of the procedure, and surgeon preference.

Posterior approach in hip replacement

The posterior approach, the dominant surgical method for many years, is used in most surgeries performed.

It involves accessing the hip joint through an incision made on the side of the hip.

This approach provides doctors with an excellent view of the hip structures, allowing optimal placement of all types of hip prostheses.

Over the years, doctors have refined this procedure so that it is less invasive to the body tissues by reducing the size of the incisions while maintaining safety and effectiveness.

These minimally invasive hip replacement techniques have helped reduce muscle trauma and length of hospital stay.

Anterior Approach Hip Replacement

The direct anterior approach has been used to some extent since the 1980s and has gained popularity in recent years. The incision is made in the front of the groin, rather than on the side (as in the posterior approach).

Who can undergo an anterior hip replacement?

The decision is made by the surgeon on a case-by-case basis, but some patients are not suitable for this procedure, and longer incisions may be necessary if they undergo it.

This includes people who have:

implants or metal hardware in the hip from a previous surgery
a very muscular or obese body type (BMI greater than 40)
a wide pelvis

What are the advantages of anterior hip replacement?

Frontal entry allows the hip joint to be reached by separating the muscles, rather than dividing them.

In the appropriately selected patient, anterior hip replacement is likely to be associated with less postoperative pain, especially in the first two to four weeks.

Thereafter, there is no difference in recovery between the anterior and posterior approaches.

Leg length and implant position can also be measured with the anterior approach.

Due to the different nature of the approach, there are several precautions to be followed after surgery to prevent a hip dislocation.

The re-intervention rates (the possibility of requiring revision surgery) for both approaches are similar.

The incidence of hip dislocation in some patients may be higher in the posterior approach.

Deep infection rates are similar for both approaches.

What are the disadvantages and risks of anterior hip replacement?

The disadvantages of the anterior approach are both practical and medical.

For medical experts, a special operating table or specialised retractors and instruments may be required, but this also applies to other approaches.

It has a longer surgical time.

There is a potential for radiation exposure.

Patients also run a slightly higher risk of suffering femur and ankle fractures.

There is a risk of a numb, tingling or burning sensation along the thigh, called lateral femoral-cutaneous nerve damage, which may be temporary or permanent.

Superficial wound problems are slightly more common in the anterior approach, especially in obese patients

Is anterior hip replacement painful?

All surgeries are associated with some pain but, fortunately, the anterior approach tends to be less painful than some of the other hip approaches.

What is the recovery time for anterior hip replacement?

Most patients walk with a cane on the day of surgery or the day after.

This allows rapid progress and greater independence for the patient, often enabling the patient to go home the day of surgery or the next morning.

Use of the cane is generally two to three weeks and activities progress accordingly with a return to active sport within three months.

Physical therapy is performed in person or remotely, but in some cases it is not necessary at all.

Within about three months, anterior and posterior approach patients function equally well and long-term results and longevity are similar.

How successful are anterior hip replacements?

It is important to note that the results of total hip arthroplasty are outstanding in terms of pain relief and improved function.

To date, there have been no clinical studies demonstrating the superiority of one surgical approach over another.

The possible short-term benefits of one surgical approach over another must always be balanced against the possible negative side effects unique to that approach.

Precautions with the anterior hip

Recently, improvements in surgical technique, instrumentation, and patient selection have made anterior hip replacement a viable option for patients considering total hip replacement.

Currently, when performed by an experienced surgeon on a properly selected patient, an anterior hip replacement can lead to a rapid recovery during the weeks following surgery.

Selecting the appropriate patient for anterior arthroplasty is critical to the overall success of the procedure, and your surgeon will discuss which surgical approach is best for your individual condition.

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