Explanation of the Posterior vs. Anterior Approach to Surgery Dr. V.C. Bose

***Thank You to Vicky Marlow for gathering this important information

The post approach which I employ is traditionally known as the muscle sparing approach and the anterior and anterolateral approaches which is very popular in the U.S and some parts of Europe are the muscle compromising approaches.
The muscle here refers to the Abductor group or the muscles which lift your leg sideways and is the most important muscle of the hip. The post approach spares this completely.
However some muscle have to be cut in any approach to get access to the hip and in the post approach, one cuts the short ext rotators which are flimsy , small muscles in the back of the hip. These are stitched back. These muscles are relatively unimportant as the main ext rotator is the gluteus maximus which again is undisturbed.
Increasingly surgeons the world over are realizing the importance of preserving capsule over the neck of the femur in resurfacing surgery especially in cases where there is little or no arthritis as in AVN and the blood supply comes from outside bone( extra-osseus) , in contrast to full blown arthritis where the blood supply to a large extent changes to inside bone( intra-0sseus) .
This NCP approach ( Neck Capsule Preserving ) for resurfacing surgery was developed here in Chennai. The other benefit of the NCP approach is the fact the capsule is also repaired back completely so that the surgeon can confidentently advise patients that there wont be any restrictions post-op. The repaired capsule will prevent the patient from doing any awkward movement even inadvertently.
Vijay Bose.
consultant orthopaedic surgeon
Chennai

Summary of Advantages - Posterior vs. Anterior Approach:

The posterior approach for hip resurfacing has the following
advantages now that the instrumentation has been redesigned
specifically for that approach:

1. No important muscle groups are sectioned.

2. There is no release of the abductor muscles. They are the most
important muscles stabilizing the hip during walking and other
activities.

3. The gluteus medius and minimus remain intact. The only muscle
groups that are released are the short rotators that are repaired at
the conclusion of the procedure. However, no important gait or
other disturbances results from a release even if they are not
repaired because the rotation is accomplished by other muscles. One
of the two insertions of the gluteus maximus tendon which extends
the hip may be released and if so then repaired. The other insertion
remains intact and there has been no significant physiological
damage to date.

4. The new instrumentation facilitates a smaller incision especially
in thin individuals. A longer incision is necessary in well muscled
or overweight patients. A slightly longer incision is necessary in
resurfacing than when the head and neck are amputated in
conventional THR. In hip resurfacing the surgeon must work around
the head and neck to be able to prepare the acetabulum and implant
the socket accurately. Hip resurfacing is technically more demanding
and takes slightly longer. Since hip resurfacing is an anatomical
replacement, leg length equalization is facilitated and more
precise. Leg length equalization in THR is more demanding, less
certain and requires an intra-operative X-ray.

5. The anterior approach requires removal of some of the abductor
muscles for either hip resurfacing or THR. Even though they are
repaired this reattachment may not be 100% successful.