Daniel C. Smith, MD

The surgical approach for total hip arthroplasty continues to be a controversial topic among joint replacement surgeons. Traditional approaches, such as the posterior approach and the anterolateral approach, have been recently challenged by the direct anterior approach due to its intermuscular approach that allows for comparatively faster recovery rates. Although reports of decreased pain medicine requirements and shorter time to independent function with the direct anterior approach more easily associate this approach with the possibility of performing it at an ambulatory surgical center, direct anterior hip replacement also carries a steeper learning curve and several possible complications that are often related to femoral exposure and preparation, especially for the inexperienced surgeon. Thus, proponents of the anterolateral and posterior approaches seek to continue performing surgery via these approaches while improving function and narrowing the recovery gap for patients who undergo these approaches compared to those who undergo the direct anterior approach. It should be noted that the early pioneers of outpatient hip arthroplasty successfully used the posterior approach and may continue to do so.