Woman recovering hip surgery with walker

Many patients who are due to undergo hip replacement surgery do their own research into the different surgical approaches. As orthopaedic surgeons, we welcome this as it means patients are well-informed and fully engaged in their own treatment and rehabilitation, which helps to better long-term outcomes.

However, sometimes misconceptions can arise and this can lead to patients potentially making the wrong choices. This is the case currently in relation to the different surgical approaches used in hip replacement procedures.

There are three possible approaches that a surgeon can use – anterior, posterior and anterolateral. There has been a great deal of focus on the anterior approach recently with many patients requesting it in the belief that it will lead to better outcomes. But, is that the case? In this blog we look at the three different approaches and consider a recent study comparing them and assessing whether there is any difference in terms of outcomes for patients immediately after surgery and five years on.

Who is a hip replacement suitable for?

Hip replacement surgery (also called total hip arthroplasty) involves removing a patient’s damaged hip joint and replacing it with an artificial hip implant made of hard plastic, metal or ceramic. It is a routine procedure for the treatment of severe arthritis or hip fractures. A hip replacement can significantly improve a person’s mobility and quality of life, as well as reducing pain and the number of hip replacement operations has risen significantly in recent years.


What are the three surgical approaches?

Orthopaedic surgeons use three main approaches when performing hip replacements. These are:

  • The posterior approach – This is the most commonly used approach. The patient lies on her side during surgery and an incision is made just behind the hip along the buttocks. Surgery generally takes around an hour.
  • The anterior approach – In this approach the patient lies on her back during surgery on a special surgical table. The surgeon makes an incision along the upper thigh and is able to manipulate the patient’s leg during surgery. Surgery generally takes an hour and a half or slightly longer.
  • The anterolateral approach (also called the Watson Jones approach) – This is a minimally invasive approach. The surgeon makes a small incision and works in between the muscles of the hip. Because no muscles are split or detached, it generally results in fewer restrictions after surgery.

Does the anterior approach produce better outcomes?

There has been a great deal of discussion about the three approaches and some orthopaedic surgeons have come down firmly in favour of the newer anterior approach, citing faster recovery times and better function. However, a study published in the Journal of Arthroplasty earlier this year has shown that there is little difference between the three approaches. Furthermore, there is no evidence that outcomes are any better in patients operated on using an anterior approach.

The study by Nicholas Sauder et al, published in the Journal of Arthroplasty, June 2020, set out to explore whether the anterior approach produced better patient-reported outcome measures compared to the posterior approach. It looked at outcomes one and a half months after surgery and five years after surgery. The researchers compared 93 anterior patients with the same number of posterior patients from six surgical centres across the US. They concluded that there was no evidence that patients treated using an anterior approach had better patient-reported outcome measures soon after surgery. The findings were the same at or beyond one year after surgery. This led researchers to conclude that patients achieve the same outcomes regardless of surgical approach.


What questions should I ask my surgeon if I’m undergoing hip replacement surgery?

We are frequently asked by patients whether an anterior approach will lead to faster recovery times and better long-term function. This is a valid question and we point them to this research study to show that the approach used will not have any impact on how well they recover or improvements in their mobility. Factors that may influence this, however, include the patient’s general state of health and wellbeing, how well they follow rehabilitation advice and the skill and expertise of the chosen surgeon.

Other helpful questions that you could ask your orthopaedic surgeon prior to surgery are:

  • How long is my hip implant likely to last?
  • Will I be able to continue playing sport after hip replacement surgery?
  • What can I do to support my recovery?
  • How can I most effectively prepare for hip replacement surgery?

If you think you may require a hip replacement, contact us to discuss your options and to determine the best approach and timing for your surgery. You might also want to read our blog: The Benefits of Hip Replacement.


Orthopaedic consultant and surgeon | Dublin

Prof Joseph Queally hip knee and trauma specialist, will discuss the options with you and make recommendations based on your individual circumstances.

The consultation fees are clearly presented here.

Locations include:

Beacon Centre for Orthopaedics
T: + 353 1 293 7575
Beacon Court, Bracken Road, Sandyford Industrial Estate, Sandyford, Dublin 18
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Beacon Clinic Wexford
T: + 353 53 912 1918
Unit 5, Redmond Squared Medical Centre, Wexford
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