Anterior hip replacement: what patients should know

Medically reviewed by: Frank Buttacavoli, MD

Painful conditions in your hip, like arthritis or a traumatic injury, can be debilitating and impact your daily life. Your doctor may recommend a total hip replacement if other pain-relief methods don’t work for you. In recent years, the direct anterior approach hip replacement has become an increasingly popular option. Find out why. 

What is anterior hip replacement? 

A direct anterior approach hip replacement is a minimally invasive procedure. The anterior approach is when your surgeon makes a small incision in the front of your hip. They then remove and replace your full hip joint with a new implant. The implant can be made of metal, plastic or ceramic. 

Making the incision in the front avoids cutting through muscle as the surgeon works between muscles. This helps you heal faster during the early part of recovery than approaches that cut through muscle. The anterior approach also means you’re likely to have less pain than other hip replacement approaches. 

Approaches to hip replacement surgeries

Anterior hip replacement is one of four approaches to hip replacement surgery. You may need surgery when chronic conditions like arthritis cause bone-on-bone pain. Your doctor may recommend it if hip pain keeps you up at night or prevents you from doing everyday activities.

Total hip replacement surgery methods:

• Anterior: Innovative surgery is performed from the front of the hip. 
• Posterior: Traditional surgery is performed from the back of the hip.
• Lateral: Traditional surgery is performed through the side of the joint.
• Combination: Blends more than one technique. 

What’s the difference between an anterior and posterior hip replacement?

A posterior approach hip replacement: 

• Requires cutting through muscle and tendons at the side and back of your hip
• Involves reattaching muscles cut during surgery
• Recovery may take longer in the early stages compared with muscle-sparing approaches

An anterior approach hip replacement: 

• Uses an approximately 8–10 cm incision in the front of the hip
• Allows your surgeon to work between your muscles rather than through them to replace your hip joint
• Preserves surrounding muscle tissue
• Requires specialized training and experience due to a more limited surgical view
• May provide a shorter healing and recovery time for some patients

Though the posterior approach has an initial recovery period as your muscles heal, your long-term recovery is similar for both approaches after one year.

What is the benefit of anterior hip replacement?

This advanced anterior surgical approach has many benefits, such as:

• Faster healing of the surgical site
• Fewer post-operative precautions and restrictions
• Less bleeding
• Less pain after surgery because major muscles aren’t cut
• Less rehabilitation
• Low risk of implant dislocation
• Shorter hospital stays

What are the disadvantages of anterior hip replacements?

Despite its popularity, there are some drawbacks to anterior hip replacement surgery, including:

• May not be the best option for people who are very muscular or who have a large abdominal overhang (pannus)
• Requires specialized training and experience to perform the surgery
• The incision location near the groin may increase the risk of wound healing concerns in some patients

Even though hip dislocation after a hip replacement is uncommon — about 2% within a year of surgery — it remains a complication. Researchers found that anterior hip replacement has a lower dislocation rate than posterior and lateral approach hip replacements. 

A possible complication of all hip replacement surgeries, not just anterior, is damage to a major sensory nerve. This nerve runs down the front of your pelvis and past your hip, supplying sensation to your thigh. There is a chance of numbness in your anterior thigh after anterior hip replacement surgery.

Who should get an anterior hip replacement?

Orthopaedic surgeons decide whether to recommend anterior hip replacement on a case-by-case basis. They tailor their advice to your specific situation. However, anterior hip replacement surgery can dramatically improve the quality of life for people who have:

• Avascular necrosis (bone weakness and joint collapse) 
• Fracture
• Hip dysplasia
• Osteoarthritis
• Rheumatoid arthritis

What is the recovery time of an anterior hip replacement?

Patients who have an anterior hip replacement are usually standing the same day or the next day and walking with a walker or crutches. Your doctor may prescribe physical therapy to help you gain strength and balance safely. Recovery times are different person to person, but generally: 

• Day 1: It’s possible to be discharged the same day as the surgery or within 24 hours of surgery. You begin taking small steps with a walker.
• Weeks 1–2: You can walk short distances with a walker or cane. 
• Weeks 3–6: You may walk longer distances with a cane, drive and go to work.
• Week 6 and beyond: You can resume low-impact activities like swimming and biking.

How long does a hip replacement last?

How long a hip replacement lasts depends on a person’s age, weight and activity level, as well as the surgeon’s technique and experience. In general, hip replacements can last 15–30 years or longer. One study published in the medical journal The Lancet found that all hip replacement approaches can last 25 years in 58% of patients. This means some patients will never need another hip replacement.

When is it time to talk to your doctor about having hip replacement surgery? 

It may be time to talk to your doctor if you have:

• Nagging pain in your groin or thigh
• Pain even after taking over-the-counter medications
• Pain that keeps you up at night 
• Pain that prevents you from doing certain activities
• Problems when bending at the hip
• Trouble putting on your shoes or socks

How do I know if anterior hip replacement surgery is right for me?

You should always talk to your doctor about which option may be right for you. There’s no single perfect surgery — all come with pros and cons. Your doctor considers factors such as your body type, medical history, anatomy and complexity of the surgery.

Does insurance cover an anterior hip replacement?

Most insurance plans, including Medicare, Medicaid and private insurers, cover anterior hip replacements if medically necessary. Because insurance plans vary, it’s important that you contact your insurer before moving ahead with surgery.

Contact us

If your hip pain is slowing you down or you want to learn more about anterior hip replacements, call us at 210-450-9300 to schedule an appointment today.