Disclaimer: This information is an educational resource only and should not be used to make a decision on the type of total hip replacement you should have. All decisions must be made in conjunction with your surgeon or a licensed healthcare provider.
The Antero-lateral aPPROACH
In the conventional-antero-lateral approach the hip abductor (gluteus medius and minimis) muscles/tendons are detached and split. This approach also cuts through the tendons of gluteus maximus and tensor fascia lata muscles.
THE Posterior APPROACH
In the conventional-posterior approach the gluteus minimis muscle is cut off the capsule. The posterior approach also cuts through the tendons of gluteus maximus, tensor fascia lata, piriformis, gemelli and obturator muscles.
The Direct Anterior Approach
The direct anterior approach incision is only 7-10cm in length, whereas antero-lateral or posterior approach incisions are usually between 15 - 30cm in length.
With the direct anterior approach there is no detachment, splitting or denervation of muscle. No muscles or tendons are cut as they are simply retracted to create a gap. The tensor fascia lata muscle is retracted laterally whilst the rectus femoris muscle is retracted medially. There is no gluteal (buttock) muscle injury with this approach.
The gluteal muscles provide the main hip power and stability and as they are entirely intact with the direct anterior approach a faster recovery is expected.
The direct anterior approach enters between the nerve supply to the muscles so the muscle fibres retain their full ability to function after the operation.
Other approaches permanently damage either muscle fibres and/or the nerves which supply them so there may be a permanent loss of nerve function and/or partial muscle wasting.
Remember that ALL approaches if performed correctly will result in a successful pain free outcome that should last at least 20-30 years using modern day implants.
Front of a healthy hip
The hip is a ball and socket joint. In ha healthy hip, the bones are covered with smooth cartilage that enables the femoral head and acetabulum to glide painlessly against each other.
OF A TOTAL HIP REPLACEMENT
(Left) the individual components of a total hip replacement. (Center) The components merged into an implant. (right) The implant as it fits into the hip.