Total Hip Replacement Surgical Approach

Procedure Overview

What Does “Surgical Approach” Mean?

In total hip replacement surgery, the term surgical approach refers to the pathway the surgeon uses to access the hip joint.
This determines where the incision is made and how muscles are handled during surgery.
Importantly:

The same artificial hip components are used regardless of approach
The goals of surgery are the same: pain relief, improved mobility, and better quality of life
Long-term outcomes are excellent with both approaches when performed well

Surgical Approaches Covered on This Page

The two most commonly used approaches in Dr Grammatopoulos’ practice are the:

Anterior approach
Posterior approach

Which approach is recommended for you will be based on what is safest and most appropriate for your anatomy and medical factors.

Clinical Outcomes & Patient Safety

Key Benefits

Less muscle disruption during surgery Often fewer formal movement restrictions after surgery Some patients experience faster early mobility and recovery Low risk of hip dislocation Recovery Expectations Early walking and physiotherapy begin soon after surgery Many patients are allowed to move more freely early on, but activity progression is still guided Long-term outcomes and implant durability are excellent and comparable to other approaches

Risks & Considerations

Not suitable for all patients, depending on anatomy, body shape, or bone structure Technically more demanding and highly dependent on surgeon experience Temporary numbness or tingling on the front or side of the thigh may occur due to irritation of a superficial nerve

Incision Details

Location and Size of the Incision

The location and length of the incision differ between the posterior and anterior approaches. Incision size can vary depending on patient anatomy, surgical complexity, and surgeon preference. A smaller incision does not necessarily mean a better or safer operation.

Posterior Approach Incision
Located at the side/back of the hip, slightly toward the outer side of the buttock
Typically curves gently along the natural contours of the hip
Average length is usually 8-15 cm, but this can vary
Positioned to allow good access to the hip joint and safe implant placement

Anterior Approach Incision

Located at the front of the hip, near the groin and upper thigh
Usually in a horizontal, ”bikini”, incision
Average length is often 8–12 cm, but this also varies
Positioned between natural muscle planes

Important Points for Patients

Incision length is influenced by safety and visibility, not cosmetic preference alone
All incisions are closed carefully to promote good healing
Scars typically fade over time, though appearance varies between individuals

Surgical Approaches

Which Approach Is Best?

There is no single best approach for all patients. Research shows that:

Long-term results are similar for posterior and anterior approaches
Surgeon experience and implant positioning are more important than the approach itself
Individual anatomy, medical conditions, and safety considerations matter most

Your surgeon will explain which approach is recommended for you and what it means for your recovery.

Anterior Approach Preferred

Description

The incision is made at the front of the hip
The surgeon works between natural muscle planes, often without cutting major muscles
Specialized operating tables or equipment may be used

Potential Advantages

Less muscle disruption during surgery
Often fewer formal movement restrictions after surgery
Some patients experience faster early mobility and recovery
Low risk of hip dislocation

Clinical Considerations:

Not suitable for all patients, depending on anatomy, body shape, or bone structure
Technically more demanding and highly dependent on surgeon experience
Temporary numbness or tingling on the front or side of the thigh may occur due to irritation of a superficial nerve

Recovery Expectations:

Early walking and physiotherapy begin soon after surgery
Many patients are allowed to move more freely early on, but activity progression is still guided
Long-term outcomes and implant durability are excellent and comparable to other approaches

Posterior Approach Preferred

Description

The incision is made at the back of the hip
The surgeon works through muscles at the back of the hip, which are carefully separated and repaired at the end of surgery
This is the most widely used approach worldwide and is very well studied

Potential Advantages

Excellent visualization of the hip joint, allowing accurate implant positioning
Suitable for a wide range of patients and body types
Long track record with decades of supporting evidence
Reliable and reproducible technique

Clinical Considerations:

Slightly higher risk of hip dislocation in the early recovery period
Temporary movement precautions may be recommended, such as:
Avoiding deep bending at the hip
Avoiding twisting the leg inward
These precautions are usually short-term and guided by your care team

Recovery Expectations

Walking typically begins the day of or the day after surgery
Physiotherapy focuses on strength, balance, and safe movement
Long-term recovery and implant longevity are excellent and comparable to other approaches

What This Means For You

You may wish to ask your surgeon:

Which approach do you recommend for me and why?
Will I have any movement precautions?
How might this affect my recovery and return to activities?

Comparison: Posterior Approach vs Anterior Approach

Feature	Posterior Approach	Anterior Approach
Incision location	Back of the hip	Front of the hip
Typical incision length	~8–15 cm	~8–12 cm
Muscle handling	Muscles separated and repaired	Muscles moved aside
Muscle handling	Often recommended	Often fewer
Early dislocation risk	Slightly higher	Low
Patient suitability	Most patients	Selected patients
Long-term outcomes	Excellent	Excellent

Preparing for Surgery

Medical Preparation

Attending a preoperative assessment clinic to review your overall health. This may require blood tests, X-rays, and heart tests.
Reviewing medications with your healthcare provider, as some may need to be stopped before surgery.
Managing existing conditions (such as diabetes, anemia, high blood pressure, or heart disease) as well as possible
Treating existing infections (including dental, skin, or urinary infections) before surgery

Lifestyle Preparation

Stop smoking, ideally several weeks before surgery, as smoking can delay healing and increase risk of complications
Maintain a healthy diet rich in protein, vitamins, and minerals to support healing
If advised, try to lose excess weight to reduce stress on the new joint
Begin preoperative exercises ("prehabilitation") to strengthen hip and leg muscles and improve flexibility

Plan Ahead

Arrange time off work and discuss return-to-work plans with your healthcare provider
Organize help at home for the first few weeks after surgery
Plan transportation to and from the hospital on the day of surgery and for follow-up appointments. You will not be able to drive initially.
Prepare questions and concerns to discuss with your surgical team