All About Anterior Hip Replacement

The main difference between anterior hip replacement and traditional hip replacement is the location of the surgical incision. The location of the incision determines which muscles will be cut or pushed aside during surgery.

• Anterior hip replacement involves an incision at the font of the hip (the word anterior means “front”).
• More traditional hip replacements use incisions at either the side of the hip (lateral incision) or the back of the hip (posterior incision).

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Compared to a traditional hip replacement, an anterior hip replacement:

• Involves less damage to muscles and other soft tissues
• Is a more technically challenging surgery

Despite the fact that the anterior approach is considered more challenging for surgeons, it is becoming more popular. Estimates suggest between 20% and 35% of hip replacements surgeons use the anterior approach.¹Survey performed at the American Association of Hip and Knee Surgeons 2016 Annual Meeting, Washington, DC, USA. As cited in Tatka J, Fagotti L, Matta J. Anterior approach total hip replacement (THA) with a specialized orthopedic table. Annals of Joint. Vol 3 No 5, May 2018. doi: 10.21037/aoj.2018.04.07^,2Shofoluwe AI, Naveen NB, Inabathula A, Ziemba-Davis M, Meneghini RM, Callaghan JJ, Warth LC. Internet Promotion of Direct Anterior Approach Total Hip Arthroplasty by Members of the American Association of Hip and Knee Surgeons. J Arthroplasty. 2018 Jan;33(1):167-170.e1. doi: 10.1016/j.arth.2017.08.015. Epub 2017 Aug 23. PubMed PMID: 29066111.

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Why Some Surgeons Prefer Anterior Hip Replacement

In recent years, some surgeons have expressed a preference for the anterior approach over more traditional surgical approaches because patients seem to have:

• Less postoperative pain³Goebel S, Steinert AF, Schillinger J, et al. Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop. 2012;36(3):491–498. doi:10.1007/s00264-011-1280-0^,4Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty. 2015;30:419–434. As cited in Galakatos GR. Direct Anterior Total Hip Arthroplasty. Mo Med. 2018;115(6):537–541.
• An easier and faster recovery during the initial 2 to 6 weeks after surgery⁵Aggarwal VK, Iorio R, Zuckerman JD, and Long WM. Surgical Approaches for Primary Total Hip Arthroplasty from Charnley to Now: The Quest for the Best Approach. JBJS Reviews. January 2020; 8 (1): e0058. DOI 10.2106/JBJS.RVW.19.00058

Whether or not anterior hip replacement offers better long-term results compared to other surgical approaches is the subject of ongoing research.

Surgeons Should Have Special Expertise and Training

The anterior approach can be challenging for a surgeon, and it is preferable for a surgeon to have undergone extensive training before he or she performs anterior hip replacement.

A surgeon’s first 20 to 30 anterior hip replacement surgeries typically have a higher complication rate than the surgeries that follow.⁶Müller DA, Zingg PO, Dora C. Anterior minimally invasive approach for total hip replacement: five-year survivorship and learning curve. Hip Int. 2014 May 22;24(3):277-83. doi: 10.5301/hipint.5000108. Epub 2014 Feb 3. PubMed PMID: 24500832.^,7Yi C, Agudelo JF, Dayton MR, Morgan SJ. Early complications of anterior supine intermuscular total hip arthroplasty. Orthopedics. 2013 Mar;36(3):e276-81. doi: 10.3928/01477447-20130222-14. PubMed PMID: 23464946. Some experts suggest it may take as many as 100 surgeries before complication rates plateau. Patients are advised to seek out surgeons who are experienced with an anterior approach.

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Anterior Hip Replacement Is Considered Minimally Invasive

People generally think of a minimally invasive surgery as one that requires a smaller incision(s). Anterior hip replacement surgery typically uses a standard-size incision but is often referred to as minimally invasive.

The reason anterior hip replacement is considered less invasive is because it involves little to no muscle cutting. Over time, experts have learned that it is not the length of the incision that affects recovery. Instead, what matters is the amount of damage to muscles and other soft tissues during surgery. Less muscle cutting is associated with a faster, less painful recovery.