If Anterior Hip Replacement Is So Much Better, Why Isn’t Everyone Doing It?

by James Loging, MDLeave a Comment

I get asked this question a lot. And sometimes I wonder “why not?” too, since there are so many benefits to anterior hip replacement. After all, we each have a tendency to go with the crowd and do what is popular, thinking that is the best way.

When it comes to offering a new therapy, many factors that go into the decision-making process. But if you examine the requirements below, it is understandable why more physicians don’t offer anterior hip replacement as an option.

Anterior hip replacement takes a lot of training

As a resident surgeon, most training facilities historically have offered training only on posterior approach since it is the most commonly used and technically easiest to perform. Thus when surgeons go into practice on their own, they continue to perform posterior approach. Since they have no experience in performing anterior approach, they don’t offer it. This is changing somewhat, as some training programs do offer some training on anterior approach hip replacement. However these programs are still scarce, especially when compared to traditional hip replacement training.

It can be very costly to learn

For surgeons already out in private practice, there is definitely a cost component to this decision. They would have to make the effort to take time away from their practice to travel and train how to do anterior hip replacement. This decision to take this time away from the practice and make the effort to learn to perform a new surgery proficiently is something I call “The Doctor’s Dilemma.” It is illustrated by the graphic below:


Anterior Hip Replacement – The Doctor’s Dilemma (click for larger version)

If a surgeon doesn’t receive enough training to feel comfortable with the anterior approach, they will usually quit performing it.

The anterior approach is technically difficult

Another reason more surgeons don’t offer this approach is that it is definitely more difficult and technically harder to perform than other hip approaches. Because it’s so much harder, surgeons starting out usually find that performing anterior hip replacement has a huge learning curve. Unfortunately, a large learning curve usually means more complications early on. This higher complication rate early on usually will discourage surgeons and cause them to stop performing anterior hip replacement.

There is additional investment for the hospital

Most surgeons performing anterior hip replacement use a special operating table to perform the surgery. This special table makes performing the surgery easier but is very expensive and as a result not owned by many hospitals.

As you can see, there are several reasons many physicians don’t offer anterior hip replacement surgery. Most surgeons have what they deem to be a suitable alternative in the traditional approach. Why deal with all of these obstacles if you don’t have to? Using that line of thinking, its easy to understand why most surgeons don’t learn the anterior approach.

But that doesn’t mean there isn’t a better way. Anterior hip replacement has makes a huge difference for all types of patients in recovery after surgery. You need to be aware there are several options when it comes to hip replacement surgery. Research doctors who perform it and ask for it. Don’t settle for longer recovery times and more pain when you can get back to your active lifestyle quicker.

Dr. James Loging is a is a board certified orthopedic surgeon and the first physician to perform anterior hip replacement surgery in South Carolina. To learn more about Dr. Loging or anterior hip replacement, visit DrLoging.com. The content of this page should not be used as a substitute for medical consultation, diagnosis or treatment. 

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