Such advances include cementless femoral components and improvements in the bearing surfaces used for the femoral head and acetabular liners. Some surfaces for implants are now 3D printed, which also improves their durability. Others are designed
to increase the ability for bone to grow on implants, making their fixation more secure for better longevity. “The implants have porous metal around them,” he says. “They are structured in a way that mimics, or is similar
to, the nature of cancellous bone, which increases the likelihood the implants will achieve biologic integration with the bone.”
• Posterior pros. Although Dr. Behery performs nearly all (around 90%) of his hip replacement procedures using the anterior approach, he does end up utilizing the posterior approach to great success for other cases. “It
depends a lot on the patient’s anatomy,” he says. “I use that as a guide to determine what approach to use to address the pathology of their hip. Overall, I select my approach based on what I think is best for the patient.”
A prime example of when the anterior approach isn’t appropriate is when patients have had previous hip surgeries. “When people have had prior posterior surgery or have an unusual femoral anatomy, I’ll perform a posterior surgery,”
says Dr. Behery.
Another reason not to overlook the posterior approach: It has a proven history. Traditionally, surgeons have performed hip replacements using the posterior approach, which requires them to cut through muscle to access the joint. “The posterior
approach is more utilitarian,” says Tad Gerlinger, MD, an orthopedic surgeon specializing in hip and knee replacements at Midwest Orthopaedics at Rush. “It’s been around for some time, and there’s been some controversy
regarding dislocation rates, which is a main reason surgeons try new approaches.”
However, a high-volume surgeon using the posterior approach can still have competitive dislocation rates compared to surgeons who use a different approach, says Dr. Gerlinger, adding that many surgeons currently use the posterior approach for
hip replacement procedures.
According to Dr. Gerlinger, the posterior approach does have its advantages, especially for certain outpatient surgery centers. Not only are more surgeons familiar with this technique, it also doesn’t typically require the purchase of specialized
equipment. Most posterior hip replacement surgeries are performed on standard operating tables, which can be beneficial for facilities that are short on space or funds. In addition, most patients are better candidates for posterior hip replacement
surgery, particularly if they have multiple comorbidities. Finally, the approach gives surgeons a better view of the hip joint during the procedure, making it less challenging overall.
Regardless of the approach the surgeon takes for total hips, advances such as implants with larger femoral heads or dual-mobility heads have made the procedures much safer for patients. “The key thing to understand is that there are several
different ways to perform hip replacement surgery with successful outcomes,” says Dr. Behery. “What’s most important is the surgeon’s comfort with that technique and having the equipment available for that technique.
There’s not one single approach or technique that’s superior to others.”
Dr. Gerlinger agrees that the surgeon’s comfort and experience with using a specific approach to hip surgery is a vital part of the procedure’s success. “There’s good literature that points to high-volume surgeons having
competitive dislocation rates with any approach,” he says.
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