Hip replacement approaches: which is best for me?

Consultant orthopaedic hip and knee surgeon Mr Stephen Veitch discusses the various surgical approaches for hip replacement, explaining the advantages and disadvantages of each approach

What are the different surgical approaches to a hip replacement?

The most common surgical approaches to the hip are lateral, posterior and anterior.

Lateral approach

The traditional approach for many years was and still is the lateral approach. It works by detaching part of the hip abductor muscle (gluteus medius). It is extremely safe and maintains good stability of the hip.

However, after this type of surgery, some patients have experienced a persistent limp and certain studies have reported that the long-term functional outcome is not as successful as with the posterior or anterior approach.

Anterior approach

The anterior approach is popular choice for patients in the USA, as well as in some European countries. It is the choice of many patients because it does not require any muscle splitting, which results in faster recovery.

Despite its benefits, it can significantly more challenging for surgeons and is unsuitable for complex cases consisting of significant bone loss or revision.

The posterior approach

The posterior approach is often the preferred choice of hip surgeons in the UK as it is safe and permits good vision, ensuring that implants are well positioned.

Furthermore, it has outstanding long-term functional outcome scores, similar to that of the anterior approach. It doesn’t involve detachment of the abductor muscles, meaning that it is unlikely that patients will be left with a limp following surgery. Thanks to modern implants, soft tissue repair and optimisation of implant positioning, the dislocation rate is significantly lower than it was in the past.

How long does a hip replacement procedure take?

The procedure normally lasts one hour, while some more time may be required to for the anaesthetic and to position patients.

What are the restrictions following surgery?

After undergoing hip replacement surgery, it is important to perform physical instructions or exercises, as recommended by your surgeon. Patients will be advised on how to move safely from sitting to standing, such as when they’re getting in and out of bed. In this situation, patients should walk with a frame and after a period of time, they can use two crutches instead.

However, for the majority of patients, there is a low risk of dislocation. I usually do not enforce traditional hip restrictions for these patients, but I recommend that patients take things slow for the first six weeks after surgery. They should be careful when bending, to ensure that they do not damage the deep tissue. Unlike with certain other surgeries, patients are able to shower immediately.

On the other hand, for patients who are at a higher risk of dislocation, I will advise that they lie on their back while sleeping at night, use a raised toilet seat and avoid bending hip beyond 90 degrees.

Although patients can shower immediately after surgery, they should wait until 6 weeks after surgery to have a bath.

They can return to driving 4-6 weeks after surgery, begin to run and swim after 6 weeks and return to racket sports, golf or horse riding from 3 months post-surgery.

What is the usual recovery time after a hip replacement?

The wound should be completely healed 2 weeks after hip replacement surgery. During this period, most patients will take pain relief and walk with one or two sticks.

6 weeks post-surgery, most patients will still experience some stiffness, but pain relief usually isn’t necessary.

Finally, by 3 months post-surgery, the majority of patients will have already returned to their everyday activities and work, and no longer need to use walking sticks

How successful is a hip replacement? Will patients need more than one operation?

Hip replacement surgery is highly successful. The vast majority of patients are extremely satisfied with the surgery’s outcome, feeling a huge improvement in their quality of life. Normally, hip replacements do not need to be revised because the average hip replacement lasts 25 years.

If you would like to book an appointment with Mr Veitch simply visit his Top Doctors profile today.