@beachbabe

There are essentially three approaches. The oldest is the traditional approach of a posterior entry. The newer less invasive method was the anterior entry. The third, and most recent method, is various versions of the super capsular approach such as the Superpath led by my surgeon...Jimmy Chow:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9318286/
Another approach variant of the super capsulary method is the STAR method (Superior Transverse Anatomic Reconstruction):
https://pmc.ncbi.nlm.nih.gov/articles/PMC10125016/
Dr. Chow did my left hip and I had no pain using the Superpath method. But, then again, he also replaced my right knee six months ago and again I had no pain. So maybe the answer is to have Dr. Chow as the surgeon, no matter what method is used.

I am a big believer in the view that finding that extraordinary surgeon is the key to a successful joint replacement.

@beachbabe Not @kildaren here, but my posterior hip replacements were done because I am small and had extensive bone erosion in both hips. The surgeon chose the posterior (really lateral) approach because the longer incision and position provided a much better field of view for him. Several years later, my (different) revision surgeon chose to do the same for the same reason - I had chromium/cobalt metallosis with significant tissue damage and the wider field was needed to "clean things up." All surgeries went flawlessly aside from the metal complications.
I saw my surgeon this week for a recheck, and he says the hips look great - 20 years from the original operation and 15 since revision. He said he still does about 60% anterior and 40% posterior, depending on the patient; he is one of the top hip and knee guys in our metro area,

@beachbabe I have friends who have had successful anterior surgeries and my physical therapist was aghast that I had chosen posterior. But I also know a person whose anterior replacement got dislocated although that can happen regardless of anterior/posterior, but I also know two people who had nerve damage from anterior placements. Since I have nerve issues in my legs from my spinal issues, I didn’t want the possibility of more nerve damage, no matter how rare it might be.

In the end, two articles influenced me the most, as well as knowing that my surgeon would have more choices as to the length of the implement that goes into the hip if I had the posterior approach. My surgeon went in through the side of my hip, not through the buttock muscle. The scar is only a few inches long and much faded now, plus not where anyone is going to see it anyway. Reading these two articles made me decide to go with a doctor who did posterior hip replacement. Of course I also found out all I could about him and made sure thathe had a good reputation. My doctor was board certified and had done over 10,000 joint replacements.

The articles: https://kingandparsons.com/2019/08/19/reasons-not-direct-anterior-total-hip-replacement-surgery-portsmouth/
https://holycrossleonecenter.com/anterior-approach-2
Again, I know people who have had completely good experiences with the anterior approach. I’m the outlier by deciding on posterior, but I had a great experience with the posterior approach and three years later am so happy that I had my hip replaced. It is a miracle surgery in my opinion.