There are several different ways of performing a total hip replacement. By far the most common surgical technique involves a posterior incision ranging anywhere from 3-1/2 to 6 inches over the posterolateral corner of the buttock. This is utilized in approximately 70% of cases performed in the United States. There is very little muscle damage utilizing this approach, and is associated with excellent outcomes from multiple authors.

The next most common approach is a direct lateral which involves some detachment of muscle and therefore does require some protection during the first four weeks of healing after surgery. This is utilized in approximately 25% of cases in the United States, and again excellent results have been documented with this approach, though there is a slightly higher incidence of limping associated with the lateral approach.

The least common, but recently revisited anterior approach, is utilized in approximately 5% of cases in the U.S. It carries the advantage of the most direct approach to the hip joint and does not require any division of muscle. It is technically more demanding and may require a special table to perform. The potential advantage of this approach is a lower dislocation rate than the posterior approach and we are currently enrolling patients in a prospective randomized study to evaluate the differences between the anterior and posterior approach in patients undergoing total hip replacement.