Surgical Approaches to Total Hip Replacement

Primary Approaches

The three main surgical approaches to total hip replacement are the posterior, direct lateral, and direct anterior approaches, all of which can be safely and successfully utilized with similar long-term outcomes, though each has distinct early postoperative characteristics 1
The posterior approach is associated with slightly higher early postoperative pain compared to the anterior approach, though the difference is clinically insignificant 1
The direct lateral approach is associated with lower postoperative pain but higher surgical complication rates compared to anterior and posterior approaches 1
The direct anterior approach results in lower pain scores on the first postoperative day compared to the posterolateral approach 1
The direct anterior approach carries a five-fold higher risk of iatrogenic nerve damage when performed as a minimally invasive technique compared to conventional approaches 1

The American Academy of Orthopaedic Surgeons states that surgical approach does not significantly affect long-term outcomes 1
All approaches show similar outcomes for morbidity and mortality when differences diminish over time 1

Surgical approach has minor impact on postoperative pain compared to the analgesic regimen employed 1
The choice of surgical approach should be based on criteria other than pain, as modern analgesic techniques can adequately control pain regardless of approach 1
The analgesic regimen should include paracetamol plus COX-2 inhibitors or NSAIDs, intravenous dexamethasone 8-10mg, and fascia iliaca block or local infiltration analgesia 1, 2

Minimally invasive approaches show clinically insignificant benefits on pain scores 1
Minimally invasive techniques carry significantly increased risks, particularly a five-fold higher rate of iatrogenic nerve damage 1
The evidence shows inconsistent results and increased risks with minimally invasive versus traditional incisions 3