We recently completed our prospective randomized study evaluating the differences between anterior approach and posterolateral approach total hip replacement. There was a statistically significant difference in the amount of postoperative pain, return to work, and function between the two groups. The anterior approach hip recovered faster, got back to work sooner, and had an earlier return of function when compared to the patients in the posterolateral group. At one year, the differences between the two groups seemed to be minimal, supporting the fact that total hip replacement is an excellent operation with very gratifying, long-term results. While there were certain exclusion criteria in the study, such as morbid obesity and age over 75, these groups were otherwise very well matched and similar to the general total hip replacement population. Evaluating these two approaches and having done them both for many years, it is clear that certain patients are better suited for one approach versus the other. Certainly, individuals who have a large “beer belly” or pannus of adipose tissue are less desirable for an anterior approach as it interferes with the exposure and can potentially complicate healing. Certain bone conditions also will favor a posterior approach as there are more options for implant selection. For motivated, more-fit individuals, the anterior approach offers some advantages.
— William P. Barrett, MD