Total hip replacement: Does the surgical approach matter?

Total hip replacement: Does the surgical approach matter?
Dr. Silverman

Each day in the office, I see patients suffering with hip pain. Some have symptoms so severe that they begin to lose their mobility, independence, and quality of life. Hip replacement is often the best treatment for these patients. After the decision has been made to proceed with hip replacement surgery, my first question is, “Where do we begin?”

The hip joint is a deep structure encapsulated by muscles and ligaments as well as important nerves and blood vessels to the leg. Hip replacement surgery can be done by accessing the joint from the front (anterior approach), the side (lateral approach) or the back (posterior approach). When the hip is accessed via the posterior or lateral approaches, important muscles need to be removed from the bone and repaired at the end of the surgery. The difference with the anterior approach is that there is no need to detach and repair muscles. The anterior approach is a more elegant approach to the hip which exploits a working space (inter-nervous plane) between muscles. Therefore, no muscle repair is necessary after the hip replacement.

The anterior approach is not a new technique. It was described by both Dr. Carl Hueter and Dr. Marius Smith-Peterson in the late 1800s and early 1900s. It was popularized for its utility for hip replacement in the 1980s. Until recently, most hip replacements were performed through either the posterior or lateral approaches to the hip.

Orthopedics has seen a rapid growth in popularity of the anterior approach over that last 10 years. The enthusiasm has been fueled by a desire to improve outcomes and speed recovery for total hip replacements.

The benefits of the anterior approach have been studied extensively. Research has shown a potential benefit in the first one to two months after surgery in pain control and functional recovery.

Additionally, the anterior approach eliminates the need for certain restrictions and limitations which are necessary with other techniques. Focused on safe and rapid recovery, our team at The Center for Orthopaedic Innovations has seen excellent results with the anterior approach. We also utilize nerve blocks, non-narcotic pain medications and aggressive physical therapy.

For these reasons, I prefer to begin each hip replacement with the anterior surgical approach.

One thing is clear, a well-positioned total hip replacement can offer many years of pain relief and functional improvements for patients with arthritis. Each patient is unique and the choice of surgical approach requires an in depth discussion between patient and surgeon.

Dr. Edward Silverman specializes in hip and knee replacements, complex and revision hip arthroplasty as well as fractures involving total joint implants. He is accepting new patients at his office located at 3659 S. Miami Ave., Suite 4008, Miami, FL 33133.

Visit his website at or call his office (305) 285-5025 for more details and to schedule an appointment.

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