There are three basic approaches to a total hip replacement. The most commonly used approach in the United States is a posterior lateral approach where a skin incision is made over the posterior part of the hip. The second most commonly used approach is a direct lateral, which utilizes a lateral incision over the hip and takes down a portion of the muscles to gain exposure. The third approach is an anterior approach, which has been used for several decades, but has become more popular recently because of several potential advantages. Each approach has its pluses and minuses.
With a posterior approach it is the most commonly used and offers a fairly direct approach to the hip joint without having to divide any significant muscles. The gluteus maximus muscle is split in line with its fibers, short rotator muscles are detached, and the capsule is opened. The disadvantage of the posterior approach is a higher rate of dislocation after surgery. With the advent of larger heads for total hip replacement this potential complication has decreased.
The direct lateral approach decreases the risk of dislocation, however, it does require taking down a portion of the large abductor muscles, which have to be protected during the first six weeks after surgery. A disadvantage of this approach is a longer limp after surgery, due to the muscle detachment.
The anterior approach does not divide any muscles, but goes between different muscle planes and offers the most direct approach to the hip joint. The advantage of this is a potentially quicker recovery and a lower dislocation rate because the posterior structures of the hip are not removed. The disadvantage of this approach is that it is the least commonly used and may require use of a special table to enhance visualization and it requires different implants than are used through a posterior approach.
We have been using the anterior approach for total hip replacement at Valley Medical Center since 2008. As part of our ongoing commitment to excellence, we conduct clinical research studies to test new and different surgical techniques and implants.