The Advantage of the Anterior Approach for Hip Replacement

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by Robert Mayle, M.D.

The purpose of a hip replacement is to relieve pain and restore function. There are many different ways for your surgeon to access your hip joint (anterior, anterolateral, posterior). Many people argue that the anterior approach is superior to the posterior approach, because it is muscle sparing. I believe the anterior approach is superior to the posterior approach, because it allows the surgeon to effectively utilize fluoroscopy (live X-ray) during the procedure. The use of fluoroscopy allows the surgical team to recreate a patient’s anatomy, chose the ideal size of the components (cup, stem), and to place the components in the optimal position. By effectively recreating the anatomy, the hip will feel more natural as the muscle tension and leg length will be restored to their normal position. Choosing the correct cup size will minimize complications of muscles rubbing on the cup which can lead to chronic hip flexor pain. Choosing the ideal femoral stem will help prevent complications that can occur from over or under sizing of the stem, like fracture of the femur or settling of the component which can lead to a shorter leg. Placement of the cup in the ideal orientation will allow the replacement to last longer, as it will prevent rapid wear of the liner. As well, a properly oriented cup will aid in preventing dislocation of the hip.

While there are many advantages to the anterior approach to hip replacement, I believe the use of intra-operative fluoroscopy to assist the surgical team recreate a patient’s anatomy and to place the optimally sized components in the optimal orientation to be the main advantage.

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