Anterior or Posterior

Hi kim28696, I'm here in Hampton, VA. I had. Anterior because its less invasive and the recovery time is much better. I am 6 months post op my left hip and 3 months post op my right hip. Recovery is long and painful but well worth it. My quality of life is so much better and I can walk again pain free. Which ever your procedure surgeon does do you will be relieved. Listen to your body and be kind and patient with your recovery process. Blessings! Teresa

Hello Kim,

I get your dilemma, haven't had the surgery yet myself and this issue has had me confounded as well.  I have come to the decision that it is the choice of surgeon that is the most important one.  The surgeons I've researched and had the most confidence in were ones that had the most confidence in the surgical approach they used, also by and large they would say the different approaches are less important because in the hands of the right surgeon all approaches had their pros and cons.  I know that doesn't answer your question directly but it's the viewpoint I have been working from after all the research and reading.  I have spoken with people who have both types done successfully as well as those who have had difficulties from both approaches.  Such a crap shoot.  Do either of these doctors give you more confidence than the other and have you researched their experience?  I've read one medical opinion that 300 surgeries is the minimum before real proficiency.  Most of the surgeons I have looked at have done 1000 plus, many thousands in some cases.  A good surgeon will tell you that information a well as how many needed revision or had complications.  The best of them will be transparent and as far as I'm concerned if their attitude is condescending, arrogant or defensive I'd talk to someone else.  It's our body and we have the right to protect it and only trust it to someone trustworthy.  May I ask where about you're located?  Your speech sounds like the US.  Have you researched the Superpath approach and are their any surgeons in your area that specialize in this?  Might be worth investigating.

Best, Jimbone

HI Kim,

?I'm due to have my hip replaced in 2 weeks. I went to the surgeon with my mind set on the anterior approach. He said that many surgeons who have done the anterior approach have now reverted back to the posterior approach. He said that initially ( the first week or 2) the anterior approach does have a quicker recovery time but at 6 weeks they're pretty similar. He also said that nerve damage is more common with the anterior approach and this can cause a lot of pain down the thigh. The posterior approach also enables him to have a better view of the hip. 

?I did get a second opinion and the consensus was much the same so I have now opted for a posterior approach.

?I'm sure other surgeons have different views. This is just my experience.

?Good luck with your decision.

Kirrilly

 As mentioned before I feel you should go with whatever surgeon you’re more confident in. I finally went into my doctors office June 2017 after living in pain for so long and was told I need a bilateral total hip replacement as soon as possible. I had both hips done at once at the end of August with the posterior approach. You sound like you’re in the same boat as far as pain so either way you’re not going to go backwards. I was walking without the walker or cane two weeks after the procedure. I don’t know if it was due to the posterior approach but the biggest challenge I faced was scooting into the middle of the bed. I had no strength to lift my pelvis up by pushing my thighs down on the mattress and shifting left or right. This only lasted a few weeks so it’s not important enough to base your decision on. What is your activity level and approximate age at this time? I’m sure your surgeons are taking that into consideration

Find a GREAT DOCTOR....even if you have to wait! Talk to people and get recommendations! I had both hips done at the same time ....Anterior approach....it took the Dr. One hour to do both hips! I was walking in the recovery room and went home in 2 days.....I am now 16 weeks post op.....teaching DANCE CLASSES 5 hours a day 6 sometimes 7 days a week......Yes... I am stiff in the morning and have a bit of thigh pain....the legs are still numb anywhere near the incisions but I have no more arthritis pain and that was debilitating! I have heard that doctors are trained to do anterior or posterior.....not many do both.....the posterior doctors don't want to take the time to learn the anterior surgery and this is a newer procedure ......I read a lot and talked to a lot of friends who have had the surgery....I definitely DIDN'T Want my hamstring cut as I am a dancer....and anterior was quicker getting back to dance.

Wishes to you for a fast recovery!

I agree with Mollie, the older surgeons don’t want to get retrained to learn anterior method.  Also, your hospital needs to have the latest surgery equipment, including the Hanna surgery table.  But all of the best surgeons here in My area (So. California) use the anterior method.  I️ had my LHR at 7:30 am, I️ was walking at 3:30 pm and sent home the same day.  Was walking 3 miles at 4 weeks.  I️ am back to playing tennis 3 or 4 times a week at 5 1/2 months.  I️ don’t have any lingering nerve or muscle pain.  But I️ have followed the PT program and still continue w my PT exercises at the gym.

Hi, Kim, I strongly agree that the best approach is that of the surgeon you are most comfortable with. And, of course his level of experience. I have also heard 300 as a minimum number.

I had the anterior approach for my THR. in January of 2017. I picked my surgeon because a couple of friends had used him and he does a lot of anterior. Although I should have known better, I never questioned that the newer anterior approach wss better. (I live in Phoenix, in the US, and we do have at least one surgeon doing SuperPath, but his waiting list is at least 18 months.)

Well now I am regretting both choices, of doctor and approach. I am still in a great deal of pain and dysfunction almost 10 months post-op. The surgeon won't even deal with me at this point; he did his job, it looks fine, and so it is not his problem if I am still in pain.

I also have heard now from a couple of healthcare professionals that anterior is not all it is cracked up to be. Initial recovery is easier (to which I say, hah! It is the worst surgery I have ever had in my life, and the worst aftermath), but long term it seems to have more problems.

I would certainly say my experience is not typical, and I dont want to tell you to avoid the anterior approach. It is great for many people. But It also has its problems. I just think it pays to research a little more and go with the surgeon you trust and can talk to.

Hi Kim

My advice is go with the surgeon that has the most experience in whatever approach they are most familiar with.

It seems to me that there are pros and cons with both approaches and the outcome is dependent on a number of factors, with the patient -  age and level of fitness, any underlying or pre-existing conditions and for the surgeon - competence, experience and number of successful operations.

My surgeon only does posterior, but he does a lot - 3 times the national average with very few that require corrective surgery.  His bedside manner is not good but I was more concerned about his success rates than anything else and I have been pleased with the results.

Good luck with whatever approach you choose and do let us know how you get on.

 

I was determined to do the anterior approach & found a great surgeon in Bangkok (Iive in Thailand ) who specializes in this approach. All went well for 2 -3 weeks but now I am struggling with moderate nerve damage. My knee, shin & calf are numb & feel heavy & wooden. Had extensive nerve testing on Monday which revealed moderate nerve damage to the saphenous nerve. Luckily even though it feels really weird it does not affect the muscles. So I have to push forward with exercise, physio & acupuncture & have to adapt to this new normal. It can take up yet 6 months to resolve. I am trying to be just discouraged & not depressed by this news. So for me, I couldn't recommend the anterior approach. Others have had great results with it however

If I had to do it again wouldn't choose anterior method. However that said, one can have issues with other approaches also. Wish you all the best. Maureen

I had posterior and it has been great. I did daily exercise (Pilates, yoga, aqua and gym within the limitation of my arthritis) for 5 months prior to my op which did help a lot post op. I was able to kneel on the floor (and get back up) at 2 weeks. The Physio said I was fit to drive at 4 weeks but I waited until 5 weeks as I wanted it in writing from the surgeon. I was back at the gym at 5 weeks and have started Pilates today which is 6 weeks. I have minimal scarring and feel great. My world is opening back up at last. I chose the surgeon I wanted based on his experience as reported in the national joint register. Best of luck with your decision.

Ann

I'm recovering from bilateral anterior THR.  My original surgeon would not do my surgery because, as an older surgeon, he was only experienced in the posterior method and he felt that my active schedule was not a good fit for posterior approach.  He recommended me to a younger surgeon who was experienced in the anterior approach.  I am now 6 weeks post op and I have not had a single problem or set back and I've had almost no pain.  Based on my experience and recovery, I would personally recommend the anterior approach.

I had a lateral posterior as I had heard that the anterior approach can cause nerve damage. Also there are supposed to be less complaints about the posterior approach which is very tried and tested. I think if you go for an anterior go for a surgeon who does them all the time and has done lots of them. I found out after four weeks I had no restrictions and could have touched my toes after the op if I had wanted too, having been terribly careful! I had no heavy leg and the wound was like a scratch from a thorn. In fact I felt as if I still had my old hip.

Agree with others as far as having a great Surgeon. My Doc has been doing the posterior approach for over 40 years. No problems.  Good luck 

Hi Kim, I can only speak about my experience with anterior approach. I had surgery in June and so I am almost 5 months post op. I chose anterior approach based on my research regarding faster recovery time due to the fact that I had to be back at work after 4 weeks. I chose a very reputable surgeon for the area I live in and went for it. I know that the Anterior approach has less restrictions too. I was told I had no restrictions after surgery and the possibility of dislocation was almost none. The only instructions I was give after surgery was to do the home exercises and walking was my therapy. The only lasting problem I have is the numbness to my thigh which is slowly going away, and the occasional nerve pains that shoot into my knee and sometimes into my foot if I am on it for too long. I was told the nerve damage is not permanent and should slowly subside too, hopefully.  Nerve damage is more common with the Anterior approach I found out! Anyways good luck to you which ever way you decide 

I had one  surgeon say that posterior was best. Out of the three other opinions I received from other surgeons they all said interior is by far the best. The posterior proponent surgeon will probably say the recovery time is the same. But the “time”  is the only thing that is the same. The risk of dislocation early in recovery is higher in the posterior procedure patient. Anterior surgery is, in my opinion, the only way to go unless there is a medically necessary need for the posterior. The recovery is more comfortable. I come to that conclusion after talking to other posterior  surgical patients and comparing results. As you see I got multiple medical opinions before deciding and did a lot of study on the internet. That’s my 2 cents worth. Good luck with your decision. It certainly isn’t an easy one to make.