Surgical Approach by the Jo...

What are the differences between the posterior and anterior surgical approaches?

Recovery is quicker with the posterior approach because no important muscle groups are sectioned. The posterior approach is also well-suited for patients who are large, well muscled or who require special techniques to implant the hip resurfacing socket.
To improve stability and reduce the incidence of dislocation after THR, some surgeons changed from the posterior to the anterior approach. Even a hip resurfacing procedure technically can be performed in most individuals using an anterior approach but this requires removal of 33% to 50% of the abductor muscles. Even though the muscle group is reattached, the muscles are strong and, therefore, the reattachment may pull loose even if activities are restricted for a prolonged period. Further, the data that indicates improved stability in THR with the anterior approach involved patients in whom the ball size utilized was very small (ie., between 22mm and 28mm). It is now possible, due to the newer, more wear resistant bearing technology, to use much larger balls and, hence, there is no advantage with the anterior approach. Wear data now available supports the use of larger ball sizes from 36 mm up to 54mm with Metal on Metal technology and up to 40 mm with new cross-linked polyethylene. The largest ball size available for ceramic on ceramic bearings is 36 mm because a two part socket is required and ceramic material must be relatively thick to minimize the risk of fracture.

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