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

I chose the anterior approach for 2 reasons. The doctor doesn't cut through muscles (just moves them out of the way) and quicker recovery time initially. My doctor told me it would take a a full year to heal completely. I agree with that. I wasn't completely pain free until then. I also feel like I waited too long to have mine done and lost a lot of muscle. I am still trying to build up strength on that side. If you have time, try and build up your strength or start doing the hip exercises they give you.

They will have you up and walking that day. I used a walker for the first week or so, then back to my cane. Walking wasn't that difficult or painful. I just felt like I was a little unsteady and needed to be careful. The hardest things to do were to get in/out of bed, get in/out of a chair and get on/off the toilet. Also, I was extrmemely tired, so it took more out of me than I expected. I napped for the first week or two. I am pretty tolerant of pain, so I cut back on the painkillers quickly. I was able to use Tylenol during the day and something stronger only to sleep. Sometimes it was hard to find a comfortable sleeping position. I started to feel more "normal" at about 3-4 weeks. I'm retired, so I didn't have to worry about going back to work. If I had to, I could have gone back after 2 weeks.

I had bilateral hip replacements in my 50's, about 6 weeks apart. My doctor used a posterior approach because I am very small, and he needed to see the whole joint to position everything perfectly.

I was back at work 3 weeks after the first one, 3 days a week. Having the second one so quickly took a lot out of me and I was off for about 5 weeks. 3 months later I was on a week long cruise, complete with dancing and off-ship excursions. I would say it took 9 months to be completely healed. I did PT at home every day for months to get my strength back.

Sue

Did you have a more sedentary job? I have a desk job and a standup desk which I hope would be helpful. Did you have a phased in RTW or did you go back full time after 3 weeks?

I was the manager in a busy tech office, so much of my day involved moving about dealing with staff. I used crutches to ease the strain on my new hip and had a phased return- work from home weeks 2& 3 about 20 hours a week then 3 & 4 days 2 weeks each. I'm older and wiser now and would recommend giving yourself more time to heal if you can possibly manage.
I brought my cryo-cuff and iced for 20 minutes every 2 hours with legs up.
Sue

Thanks for the comment. I was wondering what it was like the first 2-3 weeks after surgery and whether patients spent a lot of time resting as this surgery seems like it would take a lot out of you. Did you have to be very careful about positioning your body? i keep reading that you should not lean too far forward and and you should keep your feet straight. Seems like getting into bed would be the toughest

No matter the approach, orthopedic surgery does take a lot out of you! Anesthesia, the assault on your body, foreign parts put in, tissue, muscle, nerves need to heal. And every person reacts differently to each surgery. Extra rest is helpful, as is a leg immobilizer block to keep everything aligned as you sleep.

PT should come to your room to help with how to get in and out of bed, up and down from chairs, how and whether to use crutches or a walker for a few days or weeks. Also ask them to show you the safe limits of movement for your surgery and implant.

Get yourself a variety of pillows ready to help make you as comfortable as possible. A shower bench and toilet seat riser are handy the first couple weeks.

If your surgeon doesn't suggest it, in addition to PT showing you the exercises to do at home, I recommend that you insist on an in person PT evaluation of your gait at 4-6 weeks, with additional sessions if they think it is needed. You have probably been favoring the bad hip for a long time, and need to walk properly with the new joint to prevent pain in your back, other hip, knees and feet.

Finally, ICE, Ice, ice... more often and longer than you think is needed. Keeping swelling down helps you heal faster, move better and avoid pain. And take pain meds and/or ibuprofen and Tylenol to stay ahead of the pain the first few weeks for the same reason, and so you can rest.

Good luck! People who plan for their surgery and recovery and take an active role usually do better than those who just let it happen to them.
Sue

I had anterior approach replacement on 9/20/21 and couldn’t be happier. It my quest to find a surgeon, I found that many surgeons don’t do the anterior approach, so they tell you that posterior is better. I don’t believe that’s true. There may be some physiology that would make posterior more effective for some, but I would get that advice only from a surgeon who does both procedures. The anterior approach surgery is a breeze. Although I definitely had surgical pain and significant weakness, my arthritic pain was gone IMMEDIATELY! The hardest part of the surgery are the hip precautions. With anterior you have those for about 3 weeks. With posterior - 6 weeks. Plus with posterior there is significantly more pain. I am a strong advocate for anterior. Now, all that said, even with anterior - recovery takes time. I’m at the 5 month mark now and can say it’s just been recently that I’ve felt like 100%. But I’d do it again in a heartbeat. Good luck to you. You’ll be delighted!

I couldn’t agree more with this - having just been through it. I was diligent about doing the exercises in advance. I started about 3 weeks in advance and did them 3x a day and I continued on with that (although less repetitions and sets in the first couple of days) immediately after surgery and through the PT process. I was more tired that usual for the first 2-3 weeks, but then got back to normal. I honestly didn’t need a lot of pain medicine. I took the narcotics for only 2-3 days after I got home (and then for about a week at night). The most effective pain combo was just Tylenol and the muscle relaxer - methocarbomol. Those I stayed on for a couple weeks - but again, mostly just at night. And yes on the ice. If I was sitting, I was icing and I believe that helped.

With the anterior method, there are no restrictions for life - like crossing your legs, bending forward, lifting your knee too high, etc. I took a nap every day because I was tired. I'm sure that was from the surgery because I usually don't nap. My THR was done in December, so I didn't feel like getting out anyway. If it had been summer, it might have been different. I read and watched a lot of TV from my recliner and took laps around the house with my walker. Less than 4 weeks afterward, I flew to Florida.

Thanks for the reminders Sue. I had my left hip replaced on my 66th birthday ,thus I am now approaching my 82nd and perhaps I should consider doing my right hip on my 82nd.
Your helpful reminders will allow me to recover in a quicker manner and should get me going quicker - who knows, perhaps I will be able to start cross country skiing again.
With appreciation !
garret