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Total Hip: Anterior VS Posterior Approach

By November 20, 2022Sports Medicine

The Anterior Approach is not new. It was described in the 1800’s by a German Surgeon!

In the last 5 or 10 years, there has been a push towards Anterior Approach Total Hip Replacement.  It is my feeling that this was done primarily for marketing purposes.

When the first total hips were implanted, Sir John Charnley realized that to minimize wear of the plastic liner in a total hip, the ideal head diameter would be 28 mm.  This is quite small.  The smaller the head, the more likely dislocation becomes following surgery.  As materials in total hip replacement have improved, the plastic we use now is the same High Density Polyethylene, but it has been Cross-linked  to improve its wear characteristics using X-rays during the sterilization process.  Plastic components we use now have about 10 times the life of the original plastic used in a total hip in the 1980’s.  This allows for larger head diameters which are commonly 36 mm in diameter and have a very low risk of dislocation.  This is especially true after 6 to 8 weeks of healing when the hip capsule heals and then restricts abnormal motion of the hip.  These head sizes are used for both anterior and posterior approaches and provide excellent longevity.  Particulate debris is minimized using cross-linked plastic, and this also lowers late loosening of the prosthesis.

There is also little difference in rehabilitation or postoperative pain if one approach is chosen over the other.

This author has extensive experience with the posterolateral approach.  This does not damage the hip abductors and is minimally traumatic to surrounding soft tissues.  Although I have used the anterior approach on many occasions, I feel there is little or no advantage to an anterior approach.

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