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Cardiff Centre of Excellence for Orthopaedic Care

Clinical Excellence | Education | Research

Anterior / Posterior Approach Hip Replacements

  • The hip joint

    The hip joint forms where the top of the thigh bone (femur) meets the socket of the pelvic bone (acetabulum). The top of the femur is shaped like a ball and fits snugly in the socket formed by the acetabulum. The hip bones are covered with a layer of slick cartilage, which cushions and protects the bones while allowing smooth movement. Ligaments connect the bones of the joint to hold them in place and add strength and elasticity for movement. Muscles and tendons play an important role in keeping the joint stable and mobile.

    Anterior/Posterior Approach Minimally Invasive Hip Surgery

    The anterior/posterior approach takes advantage of a technologically advanced surgical table and special instruments.  A specialised operating table is often used to help improve access to the hip and achieve excellent alignment and positioning of the implant through the minimally invasive surgical site.

    Improved patient recovery

    The Anterior / Posterior Approach procedure requires less tissue disruption. It is combined with an ERAS programme (Enhanced Recovery After Surgery) which leads to a faster rehabilitation after surgery. Traditional hip replacement surgery, in contrast, typically requires strict precautions for six to twelve weeks

    The potential benefits of the anterior approach surgery are:

    • Potential for accelerated recovery time because key muscles are not detached during the operation.
    • Fewer restrictions during recovery. Although each patient responds differently, this procedure allows patients to move more freely. They may bend their hip and bear their full weight immediately or soon after surgery.
    • Possible reduced scarring because the technique allows for one relatively small incision. Since the incision is on the front side of the leg, you may be spared from the pain of pressure on scar tissue.
    • Potential for stability of the implant sooner after surgery, resulting in part from the fact that the key muscles and tissues are not disturbed during the operation.
    • The anterior approach requires less tissue disruption, which may lead to faster rehabilitation

     'The Anterior Approach Surgery' – muscle saving, tissue sparing

    The Anterior Approach to total hip replacement is an alternative to traditional hip replacement surgery that provides the potential for less pain, faster recovery and improved mobility. Unlike traditional hip replacement surgery, this technique allows the surgeon to work between the muscles and tissues without detaching them from either the pelvis or thighbones. The hip joint is approached between the tensor fascia lata and Sartorius/Rectus Femoris muscles.


     At pre-assessment, the details of the operation will be explained to you including the rehabilitation and how this will be different to a traditional hip replacement and your length of stay, which is considerably reduced with most patients only staying one night. If appropriate, you will be taught how to use elbow crutches and you may take those home to practice with. You will be asked to fill out a questionnaire called The Oxford Hip Score (OHS).  The OHS is a short, reproducible scoring system, completed by the patient, designed and developed to assess function and pain with patients undergoing hip replacement surgery.  This allows us to assess your improvement following your operation.

    Following your surgery you will return to the ward. Later that day if you have recovered well enough your physiotherapist or nurse will come and get you out of bed for the first time. We will start with sitting on the edge of the bed and if you manage that you will progress to standing and walking. The nursing staff will continue to encourage you to mobilise during the evening.

    The physiotherapists will mobilise you on crutches and teach you some exercises and complete the stairs. It is also important that you lie flat on your back if you are able for 30 minutes twice a day to gently stretch tight hip muscles. Later that day you should be ready for discharge. Occasionally some patients need to stay until the next day. An out-patient physiotherapy appointment will be made before you go home.

    On discharge from hospital  

    You will normally continue to use your crutches until your first out-patient physiotherapy appointment. You may at this point be weaned to one crutch or a stick. If you are not ready for this you will be reassessed at your next appointment, everybody recovers at a different pace.  Your exercises will also be progressed, the physiotherapist will begin working on strengthening your muscles as well as increasing the amount of movement you have in your hip. Physiotherapy will continue until you have fully recovered.

    Restrictions / precautions for the first 6-12 weeks post surgery 

    Not allowed:       

    • You may move your leg backwards but must not stretch the leg back further than the muscles will naturally take it.
    • No outwards rotation of the hip over 45 degrees 
    • No sitting on your bottom with your legs crossed 


    • Allowed to bend (flex) over 90 degrees
    • Normal sitting
    • Normal toilet height
    • Normal sleeping positions but with a pillow between knees in side lying

    For more information or to arrange an appointment please call our customer service advisor on 029 2054 2509. 

Who is suitable for Minimally Invasive Hip Surgery?

Any patient can benefit from less invasive surgical technique. In some cases due to the size or weight of the patient the incision may be longer than standard but the trauma to the muscles and the tissue will still be reduced with compared to traditional surgery.

Consultant Orthopaedic Surgeon Mr M Maheson 


Mr Maheson is one of a handful of surgeons offering this minimally invasive hip replacement surgery technique.

Patient Testimonials

 Patient feedback following hip surgery

 Patient information leaflet

Click here to visit the Medacta website for further information.

© Spire Healthcare Group plc (2016)