From the Guidelines
Total hip replacement surgery can be categorized into several types, including traditional posterior approach, anterior approach, lateral approach, and minimally invasive techniques, with the choice between these options depending on the patient's age, bone quality, anatomy, surgeon expertise, and specific medical needs. The main types of total hip replacement surgeries available today include:
- Traditional posterior approach: the most common method, where the surgeon accesses the hip joint from the back, offering good visibility but requiring more muscle cutting 1
- Anterior approach: accesses the hip from the front, potentially allowing faster recovery as it works between muscle planes rather than cutting through them 1
- Lateral approach: enters from the side and may have a lower dislocation risk but can temporarily affect the hip abductor muscles 1
- Minimally invasive techniques: use smaller incisions (3-6 inches versus 8-10 inches in traditional surgery) and specialized instruments to reduce tissue damage 1 Additionally, hip replacements vary by fixation method:
- Cemented prostheses: use bone cement for immediate stability
- Cementless implants: have textured surfaces allowing bone to grow into them
- Hybrid replacements: combine both approaches 1 The choice between these options should be based on the patient's individual needs and the surgeon's expertise, as there is no conclusive evidence to support one approach over another in terms of postoperative pain 1. The most recent and highest quality study suggests that the surgical technique should depend on surgeon and patient preference 1.
From the Research
Types of Total Hip Replacement Surgery
- Total hip arthroplasty (THA) can be performed using various surgical approaches, including:
- Posterior approach
- Direct lateral approach
- Direct anterior approach
- Anterolateral approach (also known as the Watson Jones approach)
- Two-incision approach
- Direct superior approach 2
- Robotic-assisted total hip arthroplasty (rTHA) is a relatively new approach that uses robotic systems to improve surgical precision and outcomes 3
- Total hip replacement can be performed using different types of implants and bearing surfaces, including highly cross-linked polyethylene, which has been shown to improve implant longevity 4
- Computer-assisted navigation and robotic technology can be used to improve the accuracy of implant positioning and reduce the risk of complications such as dislocation and leg length discrepancy 4
- Minimally invasive surgical approaches can be used to reduce tissue damage and improve recovery times 4
Surgical Approaches
- Each surgical approach has its own unique advantages and disadvantages, and the choice of approach depends on the individual patient's needs and the surgeon's experience and preference 2
- The posterior approach, direct lateral approach, and direct anterior approach are the most common approaches used for THA, but other approaches such as the anterolateral approach and two-incision approach can also be used 2
- Robotic-assisted THA has been shown to improve accuracy and reduce complications, but it is still a relatively new technology and more research is needed to fully evaluate its benefits and limitations 3
Implant Options
- Different types of implants and bearing surfaces can be used for THA, including metal-on-metal, ceramic-on-ceramic, and metal-on-polyethylene 5
- Highly cross-linked polyethylene has been shown to improve implant longevity and reduce wear rates 4
- The choice of implant and bearing surface depends on the individual patient's needs and the surgeon's experience and preference 5