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3 Approaches to Hip Replacement Surgery

Total hip replacement has become a commonly performed procedure because it dramatically reduces pain and quickly improves one’s quality of life. Dr. Nicholas Alexander of Mahwah Valley Orthopedic Associates has performed thousands of total hip replacements and helped thousands of patients return to an active life after a hip replacement.

In the past, traditional hip replacement procedures used a large open incision and cut many muscles to access the hip joint. Today’s procedures are more advanced—much smaller incisions are used, muscles are split or divided, rather than cut and thus less surgical trauma occurs and pain, bleeding and healing times have been dramatically reduced. A posterior, lateral or anterior approach may be used to perform hip replacement surgery.


Posterior approach. The most commonly performed approach is the posterior approach which makes an incision near the buttocks. The incision is typically 4-5 inches, depending on the patient’s body habitus. Muscles are split to gain access to the hip joint; however, the important hip abductor muscles are preserved. The posterior approach is used to perform the majority of procedures in the United States.

  • Lateral approach. A lateral approach makes an incision on the side of the hip. The hip adductors are elevated but not cut. This approach typically requires a larger incision and does result in weakness of the hip abductors for a period of approximately 6 weeks. The approach is the second most common in the United States.
  • Anterior approach. The anterior approach is not new. It is a previously used approach that has been resurrected and refined. This is also called the Direct Anterior Approach (DAA) and the incision goes between muscle groups, rather than splitting muscles. The incision may be the same or larger than traditional Posterior or Lateral Approaches, depending on the surgeon’s level of expertise and the patient’s body habitus. The purported advantage of anterior hip replacement, is that, since muscles are not even split, that the rehabilitation time during the first 6 weeks will be quicker. By 6 weeks it is
    difficult tot discern patients who underwent surgery from the posterior or anterior approaches.

Total Hip Replacement

Whichever approach is used, after the hip joint is exposed, hip replacement procedure steps are similar:

1. Arthritic hip bone and cartilage are removed
2. Precise bone cuts are made using Computer Guided Navigation or Robotic Technology
3. Trial implants are placed in the bones
4. The patient’s hip is taken through a range of motion and carefully checked to ensure proper implant size, stability, limb length, and positioning.
5. Most hip replacements are performed without the use of bone cement, however in osteoporotic bone, or in older patients with poor bone quality, methyl methacrylate cement may be used to secure the implants.
6. After the actual implants are inserted, stability and limb lengths are again assessed, using the computer as an adjunct to confirm implant placement.
7. The incision is carefully closed in layers, and sterilely dressed

In some instances, this can be done as a same day surgery, or require an overnight stay in the hospital before going home. Typically, by 48 hours, 75-80% of patients are sent home, and a physical therapist and nurse will visit the patient at home. Recuperation is typically in the range of 8 to 12 weeks.

Making an Appointment

Total hip replacement relieves hip pain and stiffness due to osteoarthritis and dramatically improves one’s quality of life.
If you are experiencing hip pain and are interested in the procedure. please contact our office and make an appointment with Dr. Nicholas Alexander at our convenient locations in Mahwah or Clifton, NJ. Our goal is to get you back to an active and pain-free life!

Scheduling An Appointment

Dr. Nicholas Alexander is Board Certified and Fellowship Trained and an expert in treating osteoarthritis of the knee. Please do not delay a diagnosis. Contact our office today to make an appointment!

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