Anterior Hip Replacment - What Would Kramer Do?

Anterior Hip Replacement: Why Kramer from Seinfeld Would Never Have One

by James Loging, MDLeave a Comment

If you had a TV in the 1990s, chances are you tuned in to see the show Seinfeld. I enjoyed watching the predicaments that Jerry, Elaine, George, and Kramer would find themselves in and, most of the time, find their way out of. Those guys were in the prime of their lives then, but 20+ years later, Father Time may have caught up with them. After living on the edge with crazy dance moves, time in the dojo, and other hijinks, there’s a chance at least one of them would have developed hip pain warranting a hip replacement.

There are several conditions that can cause the need for a hip replacement. When a person suffers from arthritis or avascular necrosis and has constant and severe hip pain, it is time to consider hip replacement surgery. Most people needing hip replacement surgery don’t realize that there are several options available for how this hip can be replaced. And most surgeons wont discuss the options because they only usually offer one option. It seems some people put more research into buying a car or TV than they do when deciding about hip replacement surgery.

What you need to understand is that there are essentially 3 different ways to replace a hip. These different ways, also called approaches, differ in the direction the surgeon uses to reach the hip. Using help from our Seinfeld friends, let’s take a look at the different ways to replace a hip.

Posterior Approach (Elaine)

The most common method and technically the easiest to perform is the posterior approach. This means the surgeon comes from the back of the hip and has to cut numerous muscles away from the hip in order to perform the hip replacement surgery. While it is the most commonly taught method in training surgeons and easiest to perform, it has the highest complication rate, is the hardest for patients to get over, and has the longest recovery time.

In a cast of characters that all have their quirks, Elaine is probably be the most conventional. And with the posterior approach to hip replacement having been around the longest, I could see Elaine choosing this method.

Lateral Approach (George)

A second approach is the lateral approach where the surgeon comes from the side of the hip. Unfortunately this approach still has to cut muscle away from the hip to gain access. Lateral approach is less commonly performed and also has a longer recovery time and more post-operative pain.

George always presented himself as just a normal guy, but as we got to know him, I felt he always wanted to do things just a little bit different. For this reason, I think George would choose a lateral approach.

Anterior Approach (Jerry)

Last but not least is the anterior approach, where  the surgeon comes from the front of the hip. Advantages of anterior hip replacement include:

  • No muscles cut. By not cutting muscle, this leads to a much quicker recovery for patients compared with the posterior and lateral approaches.
  • Quicker recovery. And when I say quicker, usually it’s about half that of the other two approaches.
  • Use of live x-ray. Live x-ray can be used only during anterior hip replacement. This is important because it allows…
  • More accurate component placement. More accurate component placement usually leads to longer life of the implants and also make more accurate restoration of leg lengths.
  • Less dislocation risk
  • Less blood loss
  • Less post-operative pain.

Jerry always struck me as a guy who may say something funny or off the wall, but after hearing his explanation of things, it usually made total sense. The anterior approach may be the newest procedure, but when weighing the benefits it can provide, it makes the most sense for patients.

When considering hip replacement, people need to understand that they have options with regard to how their hip is replaced. Not all hip replacement surgeries are the same and the recovery is different between them all. Anterior approach hip replacement surgery and can definitely get patients back to their active lifestyles quicker. It is the only true minimally invasive surgery, which is why it’s been my choice for hip replacement for more than a decade.

So what about Kramer? What kind of hip replacement would he have? Well, based on his history, I think Kramer would find some magical way to the improve his condition that no one has ever thought of in an effort to avoid hip replacement. Besides, he would have a hard time getting into my operating room because of his dangerous dessert habits!

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 The content of this page should not be used as a substitute for medical consultation, diagnosis or treatment. 

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