By the way, doctor: Is anterior hip replacement better?
Q. I have a severely arthritic hip. It's pretty clear that I'm a candidate for hip replacement. When I looked on the Internet, there were a lot of Web sites promoting "anterior hip replacement." What is it, and is it any better than the traditional approach?
A. Traditionally, orthopedic surgeons have approached the hip joint from the side and back when doing total replacement surgery. The incision used in this posterolateral approach, as it is called, is about six to nine inches long and is made along the side of the hip and the upper thigh. Anterior means front, and the incision for the anterior approach is made in the upper part of the front of the thigh.
The anterior approach does have a few advantages. There are a lot of claims about anterior hip replacement being less invasive or "tissue sparing." I think that's overstating it — the anterior approach is not less invasive. But there is a natural opening beside the sartorius muscle in the front of the thigh, so the anterior approach means the surgeon can gain access to the hip joint by separating muscle tissue rather than cutting through it. The posterolateral approach involves cutting through some muscle tissue, but the muscles affected (called the short external hip rotators) aren't important for common day-to-day movements, like walking. Besides, depending on the case, the surgeon can repair the hip rotators.