Being in need of hip replacement surgery can be a concerning time. During your consultation with your orthopaedic surgeon who will be performing your hip surgery, you may hear talk of “anterior” and “posterior” hip replacement surgery. What do these terms mean?
In simple terms, these two types of surgery accomplish the same thing, just with different technical approaches to the operation. In this article, we will discuss:
- The similarities between posterior and anterior hip surgery
- Key differences between the two procedures
- Risks associated with different types of hip replacement surgery
What are the similarities between anterior and posterior hip surgery?
The overall aim of both types of hip replacement surgery are the same – giving you a new hip joint which will give you back mobility and take away arthritic pain. The key difference between the two approaches to hip surgery are how the actual procedure is performed by the surgeon.
During hip surgery, whether anterior or posterior, your ball and socket joint will be cut away and replaced with either a mix of metal, ceramic, or plastic components. Whichever type of hip surgery your orthopaedic surgeon performs will not limit which type of prosthetic joint can be fitted.
Recovery times will be different depending on the surgical approach your surgeon selected, but ultimately you will return to mobility after rehabilitation with either procedure. Having a hip replacement will, on average, increase your Harris Hip Score from 43.6 up to 91 out of 100. You might hear your surgeon and care team talk about this – it is a way to measure how well your hip functions before and after surgery.
What makes anterior and posterior hip surgery different?
The overall difference between anterior and posterior hip surgery is where on your body the surgeon cuts your skin and changes your hip joint. This might seem like a rather small difference, but it changes lots of things about the surgery as well as what happens next.
Let’s go through some of the most important differences for you.
1. Incision location
During an anterior hip replacement surgery, the incision in your skin is made from the front of the pelvic bone and goes down towards the thigh. This is where your scar will be after the surgery too. To be able to perform this surgical approach, you will be lying on your back – although you will not notice because of the anaesthetic.
During posterior hip replacement surgery, the orthopaedic surgeon will make a curved incision across the side and back of your hip. When this happens, you will be lying on your side.
2. Surgical procedure
During anterior hip surgery, your muscles and soft tissue will not be cut, but rather will be ‘pulled’ by clamps out of the way. This can help reduce post-operative pain and reduce healing time, but also makes things slightly more complicated for your surgeon because they have less visibility to see and access your joint. Anterior hip surgery in Sydney is performed by expert orthopaedic surgeons only for this reason as it is considered a more challenging operation than posterior hip surgery – but there are clearly benefits to anterior hip surgery for the patient. Prof Lawrence Kohan in Sydney Australia specialises in anterior hip surgery and has performed the operation over 1,000 times.
This video illustrates an anterior hip surgery works:
Better access to view the joint is gained through a posterior approach to hip surgery, but this does mean that muscles like the gluteus maximus and the external rotators in the hip are cut during the procedure. Indeed, the posterior approach might offer better visibility of the joint and thus take less time to complete, but it results in significantly more soft tissue damage.
3. Post-operative limitations
There are things that you must and must not do after your hip replacement surgery, and this differs between procedures. This table is a useful guide to how you can move about after either operation.
|Anterior hip replacement||Posterior hip replacement|
|Walking||As soon as possible, sometimes the same day as surgery||As soon as possible, but not usually the same day as surgery|
|Crossing legs||No restrictions||Avoid for 6-8 weeks|
|Bending over||No restrictions||Avoid for 6-8 weeks|
|Sleeping on your side||No restrictions||Avoid for 6-8 weeks|
|Running||You should not run after your hip has been replaced||You should not run after your hip has been replaced|
Be sure to listen to the advice from your surgeon and aftercare team about exactly what you can and cannot do after your operation.
4. Discharge time
You will normally be able to leave hospital a little sooner when you have an anterior hip replacement, sometimes as quickly as the next day! Two to three days is more normal so that everyone can be confident that you are going to be safe at home after your hip replacement.
With posterior hip replacement surgery, because more muscles and tissue have been cut and moved about it can take a little more time to get out of hospital. Expect to be discharged after around three to five days.
What are the risks of anterior and posterior hip replacement surgery?
As with any medical procedure, there are going to be risks involved. Your surgeon and anaesthetist will go through everything you need to know in terms of the surgery and any problems that could arise from you being put under a general anaesthetic.
There seems to be a higher risk of infection with an anterior procedure compared to posterior hip replacement. Around 1.22% of anterior hip replacements suffer from infection, whilst that number is 0.63% for posterior procedures.
When it comes to recover time and pain, you are more likely to forget that you even had hip replacement surgery if you have the anterior hip procedure. From a quality of life perspective, this is a positive to consider.
Should I choose anterior or posterior hip surgery?
Every patient should be given as much as choice as possible when it comes to any treatment they receive. There are a number of factors to consider when it comes to which type of hip replacement surgery you should get, such as:
- How active you need to be after your surgery
- Whether you are obese or muscular – this makes anterior procedures more difficult
- How experienced your surgeon is – more than 1,000 procedures is a good guide
Take advice from medical professionals after you have equipped yourself with the research.
Both anterior and posterior hip replacement surgery will relieve you of the pain and discomfort you will be experiencing in your hip joint. The difference between the two is how easy it will be for your surgeon to complete and how quickly you will be back on your feet.
If you have concerns or would really prefer one procedure above the other, have a frank conversation with your orthopaedic surgeon. If they do not feel comfortable performing an anterior procedure, you can ask to be referred to a different surgeon.
Remember, the anterior option is more modern and new so you may find it harder to find a surgeon who can perform it – your long term outcome will be roughly the same, no matter which type of hip surgery you end up going with.