Best approach for hip replacement

I had the anterior surgery 3 years ago and still have leg numbness and tingling in the thigh and down the leg to the foot. I know they says there's less chance of dislocation, but living with this is tiring. The nerves in the front are cut and, if they recover, it takes years. I also have L5-S1 spondylolisthesis and when my low back aches, that affects the leg as well. I'm just finishing PT for problems walking, stumbling, etc. and things are better but wish I hadn't done the anterior approach. i'm on a Mayo Clinic blog and people say the same thing and have heard this approach isn't being done as much. Good luck.

Hi Daisy. I’ll try again. Where can I find the discussion you reference re the disadvantages of anterior approach?

I'm on the bones, muscles and joints blog. I found the web site at Mayo regarding the cortisone shot quickly after the anterior approach to get ahead of the numbness and tingling. The web site is Mayo Clinic study finds nerve damage after hip surgery may be due to inflammation

Thanks Peter. I'm glad your hip replacement went so well. I've had both knees replaced, with terrific results, and I'll get my right hip replaced in June 2025.

As far as your lumbar and cervical spine - are you getting fusion, or something less intrusive? 10 years ago I had laminotomies at S1, L5, and L4 - a hole was drilled in those vertebrae to make more room for the sciatic nerve and relieve some of the pressure caused by stenosis and scoliosis. So far so good. I also maintain a very strong set of core muscles, and my surgeon tells me this is the best thing I can do for my spine (to avoid fusion).

As for anterior v posterior hip replacement, my understanding is that with a posterior incision the gluteus muscles have to be cut to get to the hip. Apparently these aren't minor cuts, and it increases post-op pain and takes longer to recover (or so I'm told).

With the anterior incision, the muscles are pulled apart to reach the hip. Someone mentioned that nerves were cut. I don't think this is ever intentional, but can happen in just about any surgery. My opinion is that anterior is better. I'll find out.

Surgeons choose a posterior incision for two reasons - 1) the surgeon simply doesn't have experience with the anterior approach, and/or 2) the patient may be carrying a lot of weight in the torso/belly and it's not viable to go the anterior route.

I have the same question.
I am scheduled to have a hip replacement in 6 months. My dr ( who did my knee,on the same side) four years ago, only performs the posterior approach. Just wondering the pros and cons of having posterior as opposed to anterior. Any experience would be appreciated!

Hi, I had Anterior Hip Replacement January 2025. I researched both options of posterior and anterior with 3 different doctors. I chose anterior because I didn’t want my gluteus muscle cut and was concerned about the dislocation possibility with the posterior and the restrictions. I did read that most people at 3 months are at the same place in recovery regardless of which procedure they have…ie, posterior or anterior.
I’m 3 month post surgery and my hip feels great. I had the Mako robotic surgery.
I am however experiencing numbness and a lot of nerve pain on the side of my leg due to having the anterior approach. I started taking Gabapentin within the first week of recovery and it seemed to help. At 2 1/2 months post recovery I tried to ween off of Gabapentin and when I got down to 1 dose (100 mg) I started having sharp electric pains in my outer thigh. I started back on Gabapentin 100mg 3x a day and it wasn’t enough now. I’m now taking 200mg 3x daily and it’s not helping. I’m hoping that the nerve pain I’m feeling is the nerves trying to reconnect to each other. Hopeful thinking at this point but if this doesn’t resolve I will seek a doctor who deals with correcting the nerve pain.
I might have to do my second hip in the future. Would I do Anterior again? No, I don’t think I would. I was worried about nerve pain and now I’m thigh deep in it. I would feel almost perfect from hip replacement if I didn’t have the nerve pain. The incision at the front of my thigh is still painful because it’s right where the leg bends from the torso, but I know that will improve. I iced my hip for 2 months because I’m a big believer in ice therapy. I didn’t have any thigh swelling and any swelling around my incision is gone.
I’m an active 64 year old female and in good shape.
Best to you in your decision for your THR.

Thank you. I asked my surgeon about nerve damage and he assured me there would be none! Now I’m not so sure. I’m 78 and not sure I have the energy for a difficult recovery. Thanks again for weighing in.

I’ve heard the posterior approach has no nerve damage pain, so I would trust your doctor on that! I will probably do posterior on my next hip, but I hope it lasts forever!

Sorry, my post was confusing. He uses anterior approach and assured me there would be no nerve damage/pain.