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An Alternative “Approach” to Hip Replacement Surgery

Orthopaedic surgeons have several ways of reaching the hip joint during a hip replacement surgery. The traditional technique, known as the “posterior” approach, reaches the hip joint through the buttock muscles. 

Less commonly used is the “anterior” approach, which makes a small incision at the front of the hip. Only 15 percent of surgeons in the US employ the anterior approach, and few surgeons in Boston use the method.

Currently, the only surgeons in the Harvard Combined Orthopaedic Residency Program to use the anterior approach are Dr. Gregory Brick and Dr. John Edward Ready – orthopaedic surgeons in the Department of Orthopaedic Surgery at BWH. They use the anterior approach in 95 percent of their hip replacement surgeries.    

Patients Prefer the Anterior Approach   

“I have performed 3,000 hip surgeries using more traditional methods, including the posterior approach, but I use the anterior approach in almost all of my hip surgeries due to the surgical advantages, but mostly because of the benefits to patients,” says Dr. Brick.

According to Dr. Brick, the benefits to the patients include: Faster recovery, less post-operative pain, reduced length of hospital stay, and less risk of dislocation.

“Patients overwhelmingly prefer the anterior approach versus the posterior, because they usually go home the second day after surgery, and about 10-15 percent leave on the first day,” he says.

After leaving the hospital, Dr. Brick says patients are mobilized quickly. They use crutches for two weeks and then switch to a cane. After two weeks, they can also start driving and begin outpatient therapy. After six weeks, 50 percent of patients can walk without a cane.

Premier Experts in the Anterior Approach  

Since adopting the anterior approach four years ago, Dr. Brick and Dr. Ready have collectively performed over 1,500 hip surgeries using the technique, trained 12 fellows, performed live hip replacements for courses, and have recorded videos for the American Academy of Orthopaedic Surgeons for teaching purposes.

Dr. Brick performs approximately 200 hip surgeries a year using the anterior approach, but still uses the posterior approach for difficult primary replacements and revision hip surgeries. On average, hip replacement surgery time is roughly 1.5 hours, says Dr. Brick.  

Meeting the Growing Demand for the Anterior Approach

Many patients conduct extensive research before their hip replacement surgery. “Patients are more sophisticated today,” says Dr. James D. Kang, Chairman of the Department of Orthopaedic Surgery at BWH. 

“In their research, patients usually discover that the anterior approach is less painful and offers a quicker recovery. Many patients seek out Dr. Brick and Ready, because they are premier experts in the anterior approach, and their thriving practices reflect that," he adds. 

Dr. Brick says, “Only a small percentage of hips are replaced using the anterior approach, but we predict this will increase significantly in the next five years." 

- By Dustin G. 

In this video, three orthopaedic surgeons from Brigham and Women's Orthopaedic Department discuss the direct anterior approach for total hip arthroplasty.