Each year, surgeons perform thousands of hip replacements in the United States - more than 300,000, according to the American Academy of Orthopaedic Surgeons (AAOS). As patients consider the benefits of surgery, learn what to expect and listen to surgeon recommendations, there is another conversation to be had: Will the surgeon use the posterior or anterior approach?
Most commonly, surgeons perform hip replacements using the posterior approach, accessing the joint through an incision in the side or buttocks. However, an alternative approach is becoming more common as surgical research continues to develop. With the newer anterior approach, a surgeon makes the incision at the front of the hip.
Arthritis-Health.com estimates that currently only 15 to 20 percent of hip replacement surgeries in the United States use the anterior approach. But the small statistic doesn't mean the anterior approach is less acceptable. On the contrary, surgeons at Franciscan Health's Center for Hip and Knee Surgery (CHKS) are quick to remind patients that the approach a surgeon uses shouldn't be the deciding factor for whom you ask to perform your surgery.
"Studies have shown successful outcomes with both surgical approaches," explains Anthony W. Feher, MD, an orthopedic surgeon for Franciscan Health's Center for Hip & Knee Surgery at Francsican Health Carmel. "The most important thing is for patients to select an experienced surgeon they're comfortable with who has the reputation and expertise required to perform these complex surgeries."
Research presented at the 2016 AAOS Annual Meeting reported that the surgical approach to hip replacement has no impact on outcomes six months after surgery. Patients undergoing both types of surgeries experienced similar results, in regard to pre- and post-surgical pain, other symptoms and daily quality of life.
Settling the Debate
While medical research overwhelming points to the success of both surgical techniques, there are still wide-ranging debates among surgeons and industry studies, often leaving patients confused on how to move forward.
Franciscan Health's joint replacement surgeons at the Center for Hip & Knee Surgery, who are widely known for performing Indiana's largest volume of joint replacements per year, squash those debates by focusing on surgical training and expertise to produce the best surgical outcomes - regardless of the approach.
"We have surgeons who prefer the posterior approach and those who prefer the anterior approach, mainly based on how they were trained," said Timothy J. Williams, MD, JD, a total joint repalacement surgeon with Franciscan Health's Center for Hip & Knee Surgery at Franciscan Health Mooresville. "Regardless, most of our patients are able to go home within 24 hours after hip surgery. This quick recovery has nothing to do with the approach, but everything to do with patient education, managing expectations, pain control, cutting-edge anesthesia techniques and physical therapy."
Because of the sheer volume of patients CHKS surgeons treat, the surgeons experience a large variety and quantity of surgical experience. As a result, patients in their joint replacement program notice that, in comparison with other joint replacement programs, they have:
- Less post-operative pain with less need for medications
- Less risk for fractures in elderly patients
- Less risk for nerve damage that could cause numbness or burning sensations along the thigh
- Faster discharge-to-home rates
- Smaller incision(s) in both surgical approaches
- Less blood loss
So, Which Approach is Right for You?
Dr. Williams urges patients to focus their deciding factors on the surgeon's surgical volume, not the approach.
"I cannot emphasize enough the importance of choosing an experienced surgeon," Dr. Williams said. "The learning curve for these procedures is steep, and complication rates will be higher for inexperienced surgeons. I'd recommend patients choose a fellowship-trained surgeon who has done at least 300 or more overall joint replacements a year. If the surgeon you choose recommends the anterior approach, be sure he or she has completed at least 100 similar surgeries."
Dr. Feher stresses the importance of having a thorough conversation with your surgeon.
"I always encourage my patients to ask questions," Dr. Feher said. "Talk to your surgeon about his or her preferred surgical approach, the outcomes other patients have experienced and the risks and benefits to expect. Getting this information early on will help you manage your expectations and pave the way for a smooth recovery."