anterior vs posterior approach to hip replacement surgery

@elliott1953 Both approaches have their place. My original ortho, who did both, said I was not a candidate because I had extensive damage and am very small - both posing significant challenges for optimal placement. My second ortho, who did my revisions, concurred. He says he does 75% posterior and 25% anterior. He has stellar reviews, and is often the top ortho in our metro area reviews.
This study seems to say either one works long term, and evaluates the differences:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601379/

Thank you very much Sue and for attaching that study.

I had the anterior approach 2.5 years ago and still have tingling, numbness in the entire left leg down to the foot (the side operated on.) I was told when they do the incision for this, the nerves are cut down the front of the leg and can take forever to heal. I also have the entire back herniated, bulging and L5-S1 spondylolisthesis that no surgeon I've seen will operate on my back. I feel when they did the hip they did something to my L5-S1 because I've not had pain like this before surgery. I wish I had been given the operation of side or posterior, but he never even met with me, only a PT and business office person. I found out later he didn't have privileges at the hospital I was at, so never met with me or visited me in the 9 days I spent to the hospital. Good luck!!

When I did my research, I decided on the posterior approach as I read that they have better visibility when placing the replacement, therefore they have more choices as to which implements they can choose to use for your replacement. Anterior restricts them to using shorter implements because of the angle they have to work with going in. We have respected surgeons in Santa Fe. Many did the anterior surgery because that was most requested, but I went with a surgeon who only did posterior but had done a huge number of them, as well as knee replacements. He actually went in through the side but is considered posterior. The main difference is that you can’t bend forward past 90 degrees for 12 weeks with the posterior surgery although at 10 weeks my physical therapist said I was fine to do so and I had already accidentally bent forward to pick things up off the floor, not thinking. At 10 weeks I started walking my dog again because I could then pick up after him when he left his treasures on the ground.

So! My surgery went spectacularly well. I had so much pain before the surgery as my hip was bone on bone by the time it was done. For two years I had been made to believe that the pain in my leg from thigh to knee to calf to ankle, was due to nerve compression in my back. My hip never hurt! It was all referred pain into my leg which turns out to be more common than one thinks. Perhaps because of that, I took very little pain medication after the surgery and was just taking a little ibuprofen by the third day. (Of course they pump that area full of all kinds of numbing stuff that stays in there for awhile so that may have been partly why I wasn’t in much pain at all.) It was miraculous to me to be out of pain. The only thing is that my hip flexor was irritated (I was told it probably got irritated because it’s near where they have to retract muscles out of the way) and it took quite a few months before I could lift my leg in certain positions without some pain and weakness. It’s been a year and it is almost back to normal, but since aside from some moves in chair yoga where I notice the weakness, it doesn’t seem to affect me in general. I do have a friend who had anterior, and like someone else here mentioned, now has permanent numbness in their thigh. I have enough numb parts of my legs from my back issues, so that was another reason I didn’t want the anterior approach. I have enough numbness already.

Everyone, including my physical therapist thought I was nuts to have posterior surgery but I am very happy with the result and if my right hip goes bad, plan to have posterior surgery again hopefully with the same surgeon. Two months ago, I tried to rush down our backyard flagstone steps, stumbled and fell hard, hitting an edge of the flagstone step on my operated hip. When my husband helped me up, it hurt to walk so off we went to ER for an X-ray. My hip was not fractured, my implant was fine, whew! (My implant is long…it impressed the student X-ray tech, smile.) What I did, was to fracture my pelvis in 3 places. Fortunately they were all minor, minimally displaced fractures that healed in 9 weeks. Still. I have to remember that I’m 73 years old and I do have compromised walking ability due to my back issues. We have an iron worker putting in a continuous handrail down the two flights of steps now. We had made our home inside age friendly. Now we’re doing the same in the back yard which is in 3 tiers due to being on a slope. We plan to stay here for as long as we’re able.

Thank you for sharing your experience. It was very helpful.

Although I am (or practically) bone on bone on my left hip with moderate osteoarthritis in the other, I can still function fairly well and I don't feel I am debilitated enough yet to go under the knife (despite some pain that at times can be quite bothersome particularly during sleep) but I know it's a matter of time when surgery will be necessary whether that's in months or more.

Yours and other comments are very helpful in that it provides me (and others) with questions to ask a surgeon that you don't necessarily get out of reading the on-line literature on hip replacement surgery.

My best wishes to you.

I had anterior THR 10 days ago. Not tooting my horn here, but I found it useful to read others who posted about their experience. Checked into hospital at 10:30 AM and was released at 7pm.
pain management: One night on Oxy, followed by Tylenol (2500mg/day) and Clelbrex (100mg/ twice daily).
PT: started at home PT the next day, and formal PT on the 7th day.
Currently walking w/o assistance (half mile today around home + shopping).
Pain is mainly tightness in my thigh, especially after sitting for a while. TBH this area was tight before surgery and I stretched those muscles twice/day. Can't do that yet following surgery.
I get my dressing replaced tomorrow, and review with surgeon in two weeks.
Cheers!

The advantage of anterior approach is lower risk of dislocation and less disruption of muscle attachments. If they use imaging or robotics for placement at surgery, it is very good. They have about 15 years of experience with it and it does have a good track record for the surgeon comfortable with it.
My husband has had both - anterior for the primary and posterior for the revision 1 month later due to fracture, then twice more for wash out and explant due to infection. He says pain-wise they were similar, but most say anterior is less painful. He did have a temporary foot drop after the last surgery. However, due to excess weight, he felt the incision through the groin (anterior) did not heal well (necessitating re-closure) and likely seeded the infection that popped up at 2 months from the original. While he was fine with the anterior approach initially, in retrospect, 5 surgeries in and still waiting for another hip, he thinks that he would have gone posterior because of his belly weight.

Thank you for posting. It is useful to me as I am looking at a posterior hip surgery in a few months:)

There is a newer third method: superpath. Incidentally, according to statistics, all three methods usually produce the same ultimate results. The difference is in pain control and impacts on other body parts (e.g., muscles, tendons, etc.):
https://www.chowhipandknee.com/superpath-total-hip-replacement-hip-knee-specialist-phoenix-arizona/
My surgeon came into the prep room for my surgery with what looked like a ten page document. He said it was the Hospital's standard instruction for hip replacements (don't cross your legs, etc. etc.). He tossed it in the basket and said he had only two instructions: take my medicine and be a couch potato for five weeks because, he said, the one thing he can't do is make bones grow.

I may have been lucky but I had zero pain and the new hip feels terrific. His instructions were to take a oxy pill the first night, then continue to take it until I didn't need it and then taper it off. I took it the first night because he said to but the next morning I called and said I had no pain, could I skip the Oxy. They said of course.

The other drug they had prescribed was celebrex. I had a similar experience. The third day I called again and said I had no pain, could I stop taking the celebrex. Again, they said yes. So I had zero pain and took almost no medication and now, a year and half later, it still feels great.

There is one important downside to superpath: there are very few surgeons who have been trained in it and have used it. I was fortunate that the inventor was in my town (Phoenix) so I went directly to him. He actually does a significant business for folks who fly in for the surgery. But, having a surgeon who has done a significant number of the operations is in my mind more important then the surgical approach used. So unless you have an experienced Superpath surgeon in your town, or are willing to travel for it, I would recommend sticking with a surgeon who has successfully done many hip replacements no matter which of the methods he uses.

My husband had anterior. The incision was very small and healed quickly. It was an outpatient surgery and he was able to climb the steps into our RV that day. He had almost no pain and I had to remind him that when he took a walk he also had to be able to walk home 🙂

Before the surgery, he walked as much as possible (around 7000 steps a day) to have those muscles in the best condition possible.

He was told he needed the other hip done, but a second surgeon gave him Celebrex. It made him pain-free and he is going to wait. He would never consider posterior because of disturbing the muscles.