During the week one that I rotated with orthopedic surgery, I had to the opportunity to scrub into a total hip replacement. Before scrubbing in, one of the attendings, other than the one that one preforming the surgery, decided to scrub in as well. I was wondering throughout the entire surgery why he was there because he was not really doing much. I soon realized that he was there because this particular hip replacement was a learning experience for this orthopedist. It was so surprising to me because I thought attendings were supposed to know everything. However, the surgeon that performed the hip replacement explained that traditionally, the hip replacement had a posterior approach. Now, there are many studies that prove the anterior approach to total hip replacement is overall very beneficial to the patient.
I decided to focus on a study that was done by one surgeon, so the stigma of bias could be avoided. In this study, one surgeon preforms 150 consecutive total hip replacements. The first fifty were a posterior approach, the middle 50 was a learning window for the surgeon for the anterior approach and the last 50 were full anterior approach. The pain scale for all the patients that had an anterior approach were all higher than those patients that had a posterior approach done. The time it took to preform an anterior approach versus a posterior approach was not significant. It was found that the anterior approach has a significant reduced hospital stay, of 2.7 days were the posterior group had a hospital stay of 3.9. At the six week mark, patients that had an anterior approach were much less likely to be narcotics, as well as assistive devices when compared to those patients that had a posterior approach. From this result, one can assume that the pain scale of those that had an anterior approach done was also significantly less than those who had a posterior approach.
Overall, the clinical bottom line, for not only this study but many other articles approaching this subject is that anterior hip replacement is superior to posterior hip replacement. Anterior hip replacement has shown overall better prognosis and less pain at the six-week mark.
Posterior versus Anterior Hip replacement
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