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

Well, garret, I am a kamikaze skier, so I had to cross skiing off my list. That's OK, because I head south as soon as the weather turns cold. But I do come home for the holidays, and manage to go sledding with my little grandsons.
But we had an uncle who made his doctor change out his pacemaker so he could ski when he was 80.
Sue

I met with a “potential surgeon today and I can see now I didn’t ask enough questions. He told me he only did posterior hip replacements - @ 800 each year!
I didn’t think to ask about a possible shortened leg, or what muscles he would be cutting into, staples? None of these even occurred to me. I DID learn that, at least in my state, they prefer me to go home rather than to a rehab facility because so many at rehab facilities are there for other health reasons and going home helps prevent infections that might occur. I will see if a friend can help me the first several nights. I have a second floor bedroom with a shower so I may need to prepare a bed downstairs with no shower only a sink and toilet.

I would not go to a surgeon who still uses posterior approach. But I went the other way and went all the way to Superpath which is an improvement to Anterior. I used the surgeon who invented the approach (Jimmy Chow) and who has done more than 4,000 of them. I was operated on the AM and home by mid afternoon and after the anesthesia wore off essentially no meaningful pain.

If there is a good, experienced surgeon in your area who does Superpath, I would suggest going that way. But there might not be as it is still fairly new and doctors tend to want to stick with what they know. While I would prefer Superpath to Direct Anterior, I would prefer a surgeon who does direct anterior if the Superpath surgeon has not done a lot of them.

I don't want to post steal but consider a surgeon using the Superpath approach. Most studies call it an improvement and the best approach (note that studies show that posterior, anterior and superpath all have about the same ultimate results but vary in terms of pain, return to action, etc.).

I completely agree with the comments about finding a doctor who has done many, many such procedures. My surgeon uses the Superpath approach and has done more than 4,000 such operations. I asked him about whether I am a good candidate for Superpath and he said he has not had a bad candidate as of yet. Folks actually come to Arizona for his services so he has an existing protocol for out of state patients.

While results are generally positive on a THR, it is still a very complex operation and you want someone whose muscle memory and actual memory is built on experience.

While THRs tend to be successful, they are still complex operations. Most surgeons tend to specialize in one approach (posterior, direct anterior, superpath). IMO it is much more important to have a superb surgeon who has done her preferred approach hundreds if not thousands of times than the method.

Of course, if you can find one who has done thousands of such operations and uses the method you prefer, that is the way to go.

But do not expect to ask a doctor who uses one approach to do you with one of the others. If she agreed, I would change surgeons anyway as I would not trust a surgeon who claims to do both or all three of the methods.

I had compression fractures of 3 vertebrae and was bed ridden for 5 weeks.I’m told that the anterior approach is better as less muscles are involved and recovery is quick.I’m in rather bad shape due to ADT meds for prostate cancer.I’m in Canada so I really don’t have much choice but I’ll wait for the anterior approach if it’s best for my situation.Thanks for your help.

Hello @starman - I moved your discussion to the Joint Replacements support group and combined it with an existing discussion titled, "Anterior vs. posterior hip replacement (THR): How do you decide?" - https://connect.mayoclinic.org/discussion/hip-replacement-thr/.

I did this so you could read through some of the previous members' experiences weighing the two approaches as well. Members @hipuser82, @sueinmn, @cat082011, @stephdoug123, and @garret have shared their hip replacement experiences and may be able to chime in as well.

@starman - if you don't mind sharing, does your prostate cancer complicate your surgery schedule or is your hip replacement surgery imminent?

I’ve been to the orthopedic surgeon twice now. I have been waiting over a year for this surgery. The doctor refused me first time because she said I looked like I was managing well without a cane,walker or crutches. Next time she told me that my prostate cancer was a problem if I had metastasis to my hip. I was getting cortisone injections and my bones were fine without any metastasis. I asked for the anterior approach and this got her upset. I will see her yet again this time I will request a referral to another surgeon.

I’m a physician (anesthesiologist). I think an experienced joint replacement surgeon likely does something like several hundred hip replacements annually. (The best orthopedic hospital in the US and perhaps world, Hospital For Special Surgery in NYC, claims a surgeon there performs around 1000 joint replacements annually). It’s good to important to find someone who did a joint replacement fellowship and it’s good if possible to find someone who did fellowship and orthopedic residency at a leading program (Hospital for Special Surgery, Mayo, etc.—look at US News & World Report for rankings). Beyond that, look for lots of favorable on line reviews. It sounds like it would be helpful for you to go to someone with a specialty in complex joint replacement. If you live in a remote area without such surgeons and can afford to travel for such a surgeon, do so. Best wishes!

I have an anterior hip replacement scheduled in 4 days. Surgeon called me today saying that he is reviewing his plan and there may be a risk for fracture due to being too small. The smallest stem may be too big. So I’m now given the option for posterior to avoid risk of fracture but increases risk of dislocation (and would be higher for me since I own a yoga studio and teach yoga, Pilates and barre). I was originally a great candidate for anterior approach. I’m fit and active. Now I have to choose either risk of fracture during surgery with anterior approach or increased risk of dislocation with posterior approach. I don’t know which way to go.