Anterior vs. posterior hip replacement (THR): How do you decide?

This will me my second THR. I had the first one eight years ago. I have one surgeon ready to do anterior approach Feb. 12. Another surgeon ready to do posterior. Both have outstanding credential and did Ortho fellowships in nationally recognized hospitals. I'm in Atlanta so I have many good surgeons to choose from. It appears to me that it's a matter of the age of the Doctor. The older Docs were trained in posterior approach the younger ones can do both but prefer anterior unless there are complicating factors. I told my regular doctor (internal medicine) I have a choice and he said why would you want the posterior approach?

I have had both hips replaced in the year 2018. My doctor did the anterior approach. He said the reason he does the anterior approach is because there is a chance of cutting the tendon which can happen more often with the posterior approach. This is precisely what happened to my sister who is now having numerous problems which I feel could have been avoided had she had the anterior approach. I did much research prior and am very satisfied and happy with my decision and the doctor I used. My recovery time was far easier and faster. I wish you the best.

I'll try to give you a long term perspective. For reasons I don't need to address, I have had 2 total hip replacements and 3 revisions, over a period of 6 years. The last was in 2012, and I am doing fine, active and the only pain is from arthritis and a little bursitis.
In 2006 I had both total hips, 3 months apart. My original doc did both anterior and posterior, but would only consider posterior because the hips appeared to be badly eroded on xray and were pretty well frozen in the joints (I was only 55 and of very average weight - he said he expected someone over 85 based on the pics)
Healing time was about 2-3 weeks longer than for my cousin who had surgery at the same time. I was walking with crutches the day of surgery, and with barely a cane after 3-4 weeks, and dancing at 6 weeks.
At 5 years both implants failed and required revision, which the second surgeon did 6 weeks apart, posterior. He would not consider anterior (which he also does) because he said my small stature left "no room for even minor inaccuracy" which according to him is the biggest down side of the anterior approach where the doctor cannot see the joint as well. Those revisions, and a subsequent one were all done within an 8 week period -don't ever do that! The recovery time from 3 major surgeries with anesthesia and blood loss in that short time took a year. A relative my age and size talked her doc into an anterior incision at that time, her initial recovery was about a month shorter than mine. However her joint never aligned right and she still walks with a cane and pain.
Fast forward to 2020 - I barely remember the recovery time, but my hips were positioned exactly right, the scars don't look any worse than my friends' and everything works.
Also, at the times of my surgeries, each doc had done well over 1500 hip replacement surgeries, so I had confidence in their skill.
Here is another strong recommendation : Ask for at least a few a physical therapy sessions, especially if you have had a frozen joint or have been limping for a long time. At a minimum you need gait training to get you walking in such a way as to minimize stress on back and knees. Some strength and flexibility work is helpful as well. And do the recommended exercises as instructed. I am sure that was partly responsible for my success.

I have had two hip operations. One was ten years ago. I recovered well from it. I do not know what kind. It looks like a lateral or side one. I had a bad back and a second hip problem. I did the back first since the sciatic nerve was being destroy. They said the operation was risky. It came out ok. However, my hip became so bad, I needed hip replacement.. I had a posterior......my sister had had 2 anterior and swore by them. So I went to a well know doctor. I had horrible bone Spurs, bone on bone and bad arthritis. He only did posterior. He wanted to do a spinal but I refused having had surgery on the spine low. So I was put out. My problem was because I had had bad back surgery while doing the hip, he disturbed my sciatic nerve which was part of the back surgery. I was in terrible pain for weeks and he gave me steroid. Throughout the pain, the hip starting working well. What I found was that the latest incision was almost 50 percent longer and wider than first scar hip. He admitted he had to really move the nerve aside. My question is, if I had had an anterior hip replacement would he have had to bother this nerve?

@nmcwill Welcome to Mayo Clinic Connect, a place to give and get support.

It sounds like you have dealt with a lot of pain and you have had quite a few surgeries.

You are wanting to connect with members that can help you answer a question related to anterior hip replacement and the nerve that gave you trouble.

Members like @sueinmn @mamm @edmcrae have discussed this topic and may be able to help or direct you.

Below I have linked another somewhat related past discussion.
- Pain below and at my Anterior hip replacement scar https://connect.mayoclinic.org/discussion/anterior-hip-replacement/

If you haven't already done so, you may wish to scroll through and read past comments in both discussions.

I think it makes sense that you want to know if that particular nerve would be touched during surgery. It's a huge decision. I assume you will ask your current surgeon soon, right? I'm wondering if you get a second or third opinion regarding your surgery and how that may intercat with your past nerve issue?

I don't know the precise answer to the question about moving the nerve aside. But I can tell you that my Orthopedic surgeon, who does both anterior and posterior THR surgeries told me the posterior approach is the best one for any complicated surgeries because it exposes the field better so the doctor can see precisely what he is doing. Also, remember that our nerves will respond to any kind of trauma or perceived trauma, and yours was already more sensitive due to the previous surgery, so it may well have become inflamed by any approach.
I hope you are doing better now. Did the steroid injection resolve the pain?
SSue

I chose anterior - quicker initial recovery, no muscles are cut (just moved to the side), no physical therapy required (but available), and no restrictions afterward.

I have been to see two doctors who have diagnosed advanced arthritis in my left hip and both recommended hip replacement surgery. I would like to hear from anyone about what the recovery time is like and how to prepare for the surgery. Both doctors have indicated they would do the anterior approach so that recovery time is shorter. I would love to hear how long it was before you went back to normal activities after the surgery. I have a sit down job so how long did it take to get back to work?

Hi @cat082011 you will see that I moved your post to a like conversation about hip replacement. It is my hope that @breick, @sueinmn, and @happybug can help you with the questions about recovery time and preparing for the surgery itself.

Do you have an opportunity to stand at work if your work station is altered?

Yes, I have a standing desk at my workplace and I work 30 hours a week. I do not have a standing desk at work. Thanks.