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:

1. easier to perform

2. less chance for dislocation

3. no difference in posterior approach at six months to one year or in long-term studies

4. increased range of motion from not having to repair the capsule

5. 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.