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The choice of approach to use for resurfacing has received much attention and I believe extra
"hype." In multiple studies now published, there are no reported clinical differences in the short term and up to ten years of follow-up between anterior and posterior approaches. I believe that any approach can be used and the surgeon should use what they feel most comfortable.
Short-term differences that patients may report with either approach have to do with other factors in my opinion. I use the antero-lateral approach because it affords me easy exposure, lower dislocation risk, less chance to disrupt the blood supply of the femoral head
- among other reasons. However, I have no problem with posterior approaches and am currently working on an even more minimally invasive anterior approach.
Again, I would repeat that a recent prospective randomized study showed no
differences in all three approaches.
In summary, the reasons I use the anterolateral
approach are as follows:
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easier to perform
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less chance for dislocation
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no difference in posterior approach at six
months to one year or in long-term studies
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increased range of motion from not having to
repair the capsule
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multiple studies showing decreased effect on
femoral head blood supply
Presently, I’m performing an anterior approach
which does not go through any muscles.
I don't preserve the capsule as the anteriorlateral approach that I use doesn't lead to dislocations. If you preserve the capsule it can grow larger and lead to stiffness and decrease range-of motion. For posterior approaches where there is a higher dislocation rate many surgeons repair the capsule to keep hip stiffer.
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