Revisiting the anterior total hip approach

Revisiting the anterior total hip approach
We have recently started a program comparing the anterior approach to the posterior lateral approach for total hip arthroplasty. Both approaches have their pluses and minuses, as I have stated in previous blogs. The posterior approach is definitely the more popular and widely used approach for total hip replacement. It is a very direct approach to the hip, but does require taking down the posterior soft tissue. This has traditionally had a slightly higher dislocation rate compared to the lateral or anterior approach. With the advent of large head total hip replacement, this dislocation rate has been substantially reduced. I was a co-author on a paper at the recent American Academy of Orthopaedic Surgeons 75th annual meeting in San Francisco, California, highlighting the very low dislocation rate with large head total hip replacement. 

The anterior approach, because it keeps the posterior and lateral soft tissue in place, has a lower risk of dislocation, thereby eliminating the need for traditional postoperative total hip precautions. The anterior approach is not as commonly used and has been facilitated recently by use of a special table. Both approaches can enjoy excellent results and we will be starting a study in 2008 prospectively comparing anterior and posterior approach total hip replacement.

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  1. Neil Barnhart

    I have a severe arthritic right hip and am trying to decide on the posterior vs. anterior approach.

    My cousin had both hips replaced using the anterior approach two years ago. He was my age (74), was on crutches for two days, walker for two days and then no further support.

    I am enthused by reading about Dr.Joel Matta and his new surgery table and his 600 total hip replacements using the anterior approach. My problem is trying to locate a orthopedic surgeon with a history of many anterior approach operations. I am in Tampa, FL.

    Any suggestions?

  2. Robin Cruzen

    I am trying to locate a physician who is well versed in the anterior approach hip replacement procedure anywhere in the State of Washington. The ones I have called aren’t doing them anymore and I am becoming discouraged. Any help you can give would be appreciated.

  3. pat

    Hi – I’m seeking another anterior dr. to speak to in SF Bay Area. I had 2 anterior procedures last year at 59, AVN condition in both hips. No symptoms prior, active skier, golfer type. In shock that I had to have done. Had first one in spring 08 was a huge success, I lost my cane at 3 months, back to work. My second one in July 08, although the joint ‘feels’ great, there is something not so good w/my healing [I never could do leg lifts [on floor], and now even it’s a strain, hurts after let leg down]. It’s been 12 months [I’ve been 15 days off cane] and there is something odd about underneath the incision area & even deep down, but not the joint, its fine…Thigh up top has always felt tight [muscle or tissue wise?]. I need another anterior dr’s opinion in SF Bay area. Or if I might chat with you that would be great.

  4. Kathy

    I live in St. Petersburg, FL and need a THR. The doctor I found only does Posterior approach and I’m trying to find one who will do anterior. The two I did find doesn’t take my insurance! I am on a forum about THR and everyone is telling me to get anterior. I’m a young very, very active 60 year old (swimming, scuba, tennis, etc) and it’s getting very confusing for me. My OS, I like and he’s been done many hips, Dr. Mixa at St. Anthony’s. I’m only guessing he doesn’t do the new technique because of the hospital not having the table.
    Does anyone know of other doctors names in the St. Pete area who do anterior approach?? Thanks.

  5. Ruth Miller


    Dr. Barrett,

    In La Mesa, Ca. there is a surgeon who does lot of anterior approach hip-replacements at Grossmont Hospital. Are there any results available at this time, from a comparative study with tradition posterior approach? The hospital reported to me the rate of infection, DVT and dislocation, which are better than the national statistics. I understand that I do not need general anesthetic, unless a problem is encountered. What else should I investigate? Thank you

    Ruth Miller, RN

  6. Dr. William Barrett

    Dear Ruth,
    Thanks for your comment on my Blog. There are not a lot of peer reviewed published studies comparing anterior to posterior approach. This procedure can certainly be done under a spinal anesthetic. If you have a surgeon who does a high volume of anterior approaches and his results are comparable to those in the literature, I think that would be a reasonable option.
    William Barrett

  7. Richard A Wallden

    Am attemptingto identify a surgeon who does the anterior approach in the Madison,wisconsin area. Can you help?

  8. Natalie Davidson

    Is it possible for an 82 y.o. in good physical shape to have an anterior hip
    replacement? Is there anything that would preclude this making it necessary
    to use the other approaches with longer recovery?

    Can you recommend an MD in San Francisco area who uses the anterior

  9. Dave Fessenden

    Thank you for this blog. I am a 61 yr young male who needs T.H.R. I am looking for an surgeon experienced in the Anterior approach or the Superior approach. I am familiar with Dr. Stephen Murphy in the boston area ( where I live), but he is so busy that it is 8-9 months before the surgery can be performed. Might you have any other contacts in this area that would be available sooner? Thank You for any help. D.F.

  10. Dr. William Barrett

    Dear Dave,
    There are a few other Anterior Approach Orthopedist in the Boston area. Richard Limbird, MD at Rhode Island Hospital in Providence and Jack Irving in New Haven CT. You can Google these doctors names and it will direct you to their contact information. Best Regards,
    William Barrett, M.D.

  11. Terri Cerciello

    Hi Dr. Barrett,
    My husband is in need of a THR. Are you aware of any surgeons in the Colorado Springs area that do the anterior approach for THR’s? I am a PT here and know I’ve seen a couple over the years, but cannot remember who did them. I’ve called a few ortho ofices but have not gotton a good response yet.Is there a directory of some sort for surgeons who do this approach?
    Thanks, Terri

  12. Bruce Webb

    There are two surgeons in Centennial who trained with Dr. Matta in California years ago and have been doing the anterior approach for quite some time. They may have done the patients you encountered. Their names are Dr. Craig Loucks and Dr. Rob Greenhow.

  13. Lewis J. Bellas

    Hello Dr. Barrett

    I had my right hip totally replaced last September at Mayo in Jacksonville, FL. It was a minimal incision approach. It has taken me almost eight months to fully recover.

    Can you recommend any orthopedic surgeons in the north Florida region who can perform the anterior approach? My left hip will have to be replaced in 3-5 years.

    Many thanks,

    Lew Bellas

  14. Sue Jones

    I had AVN in both hips and had my left hip replaced March 24, 2010 by Dr. Joel Matta. I used a cane for just under two weeks, no complications, no problems during recovery and returned to California for my right hip replacement August 3, 2010. Again, used a cane for under 2 weeks. This is my third week and I’m feeling great…walking with a noticeable limp and still sore but each week is an improvement. The anterior approach is the only way to go. Find a good surgeon who has performed a lot of procedures or travel to California to Dr. Matta….it’s worth every penney.