Perspective on Anterior Versus Minimally Invasive Posterior Approach
As new approaches to hip surgery are constantly developing, patients have even more to consider. And, while choosing a highly trained, experienced orthopedic surgeon is crucial -- it is also important to understand the potential risks and benefits of the procedure you are having, says Doylestown Health Orthopedic Institute surgeon Thomas H. Vikoren, MD, explaining why he and his colleague Charles Burrows, MD, both fellowship-trained orthopedic surgeons, currently prefer the minimally invasive or mini-posterior approach for total hip replacement over the anterior approach.
What's the Difference Between the Posterior and Anterior approaches?
"Generally speaking, the more commonly used posterior approach, involves approaching the surgery from the back of the hip. The anterior approach, used less frequently, involves making the incision in front, and going between two muscles," says Dr. Vikoren.
Low Complication Rate
"What I like best about the mini-posterior approach is the very low complication rate. While the potential benefits and drawbacks of the newer, anterior approach are still being evaluated, two large studies have recently raised what I feel are serious concerns about its safety."
"A recent study in the Journal of Arthroplasty, March, 2017 issue, "The Direct Anterior Approach is Associated with Early Revision Total Hip Arthroplasty," found that, among a group of patients with failed hip replacements, a disproportionately high number were patients who had an anterior approach," notes Dr. Vikoren.
"The Journal of Bone & Joint Surgery (JBJS), in its Jan. 18, 2017, issue, published a peer reviewed study, "Direct Anterior Approach: Risk Factor for Early Femoral Failure of Cementless Total Hip Arthroplasty," that looked at a group of people who experienced early failure with their hip replacement and found that again, more failed surgeries had been done with the anterior approach," says Dr. Vikoren.
"We consider not just the speed of recovery, but the possibility of complications, such as fracture of the bone, nerve damage or wound healing problems. These safety concerns are being raised in the top scholarly journals for joint replacement surgeons; that's saying a lot," he says.
Better View of Anatomy
"Anterior hip replacement goes between two different muscles, eliminating the need to cut muscle; however, the visualization of the anatomy of the patient is not as good, a high number of people have numbness on the front of their thigh and wound healing issues are much more common," says Dr. Vikoren. "With the posterior approach, visualization of the entire anatomy is excellent and we use techniques to minimize any muscle damage. This is what allows us to get people walking so soon."
Track Record of Excellent Outcomes with Rapid Recoveries
"One suggested benefit of the anterior approach is a recovery with fewer bending restrictions; however, these two large studies suggested no reduction in hip dislocation complications so I'd be cautious in recommending anterior approach patients don't need temporary hip bending restrictions. At Doylestown Health Orthopedic Institute, we have our patients walking within hours after their hip replacement surgery," says Dr. Vikoren, adding. "Not only do our patients walk on the day of surgery, half or more of them also do stairs with the mini-posterior approach, and Same-Day patients go home within hours after surgery."
About Same-Day Joint Replacement for Rapid Recovery
At Doylestown Health's Orthopedic Institute, qualified patients can participate in our Same-day surgery program for joint replacements. Same-Day Joint Replacement allows pre-selected patients to receive a multidisciplinary approach that utilizes preoperative preparation combined with advanced surgical techniques and multimodal pain control.
Same-Day patients benefit from:
- No hospital stay
- Recovery in the comfort of their home
Find an Orthopedic Specialist
About Clark Outpatient Rehabilitation Center
The Clark Outpatient Rehabilitation Center offers physical, occupational, and speech therapies as well as hand therapy, lymphedema therapy, and pelvic floor rehabilitation, and programming for neurological impairments with ample space. Its location within steps of Doylestown Hospital—and convenient parking—on the health system’s flagship campus is in careful consideration of facilitating patient access to these popular and critical services.