I started using the anterior approach to hip replacement three years ago. Initially, I was deciding whether to use the anterior approach or a traditional approach based on the patient’s body size – the conventional thinking is that the anterior approach is not appropriate for overweight or muscular body types.
As I gained more experience, I began to use the anterior approach more and more, until about a year ago, when I started to use the anterior approach for nearly everyone.
The primary reason for this change is that I have been very impressed with the speed of recovery, the improved pain described by these patients, and the overall exactness of the surgical procedure. Also, having gained experience with over 300 cases, I felt more and more able to access any hip joint using the anterior approach.
Certainly some patients are still too large for the anterior approach. In these cases, I have a long discussion with them, explaining that they will carry a higher risk of complications if they undergo any type of joint replacement. I tell them that if there is anything that can be done to reduce their weight, then it should be done first, prior to the hip replacement, regardless of the surgical approach.
My enthusiasm for the anterior approach has also been encouraged by my patients who had one hip replaced by me using the traditional approach years ago, and then came back to have the other hip done after I started to use the anterior approach. Almost all of these patients reported a significant difference between their two experiences: they preferred the anterior approach in terms of ease in the recovery after surgery, less need for pain medications, less need for assistive devices, and a quicker return to their normal activities. Therefore, I continue to use this approach for my hip replacement patients.