Which Method of Hip Replacement is the Best?
If you’ve been researching hip replacement surgery, you’ve probably seen claims that the anterior approach is more modern, less invasive and offers a quicker recovery. These messages are often repeated in marketing rather than supported by long-term scientific evidence. In reality, the anterior approach has been around for many decades, and previously fell out of favour due its multiple limitations. The anterior approach offers only modest early advantages while exposing patients to a higher potential risk of complications – particularly during the first year after surgery.
Dr David Sime, one of Melbourne's leading hip replacement surgeons, does not offer anterior hip replacement surgery because the long-term outcomes are identical, the short-term benefits are limited, and evidence shows additional complication risks that simply aren’t justified. Dr Sime routinely utilises the posterior approach because it has been proven over decades to be the safest and most predictable approach to hip replacement, providing the best long term results. Additionally, it is suitable for virtually every patient and every body type.
Quick Answer
Key differences:
Posterior: Most common worldwide, shorter surgery time, comprehensive joint visualisation, suitable for all body types.
Anterior: Marginally faster early walking unaided, no movement restrictions, longer surgery time, technical challenges, not suitable for all patients.
Understanding Anterior vs Posterior Hip Replacement
Anterior vs posterior approaches both replace the same hip joint with the same implants. However, the approach you choose directly affects complication risk.
The Posterior Approach
The posterior approach to hip replacement has been the global standard for decades and remains the most commonly performed technique worldwide. Your surgeon makes an incision at the side of your hip while you are lying on your side.
This approach involves splitting the gluteus maximus muscle and some smaller rotator muscles, which are then carefully repaired at the end of surgery. Modern refinements to the technique now preserve most of the posterior muscles, leading to faster recovery with no long-term movement restrictions.
Why it's still most common:
Provides excellent visualisation of the hip joint and femur
Shorter surgery time (60-70 minutes on average)
Suitable for patients of all body types and bone anatomy variations
Better access if complications arise during surgery
Shorter learning curve for surgeons
Decades of refinement and proven reliability
Why We Don’t Perform The Anterior Approach
Is anterior hip replacement better? Well, marketing often frames anterior as “minimally invasive” or “faster recovery,” but real-world evidence doesn’t actually support those claims..
Small early benefit that disappears
Yes – some early studies show patients may walk unaided slightly sooner. But by six months, studies show no functional difference at all.
So the only proven benefit is short-term and temporary.
Higher complication risk
Large, high-quality studies have reported:
More early complications
A higher risk of infection
Higher revision surgery rates
This includes a major international registry study of more than 30,000 hip replacements showing increased serious complications linked to anterior surgery, especially in the first 12 months.
The Technical Challenges Nobody Talks About
The anterior approach isn't just "minimally invasive" – it's technically more challenging to perform well.
Limited Surgical Visualisation
The front of your hip provides a very restricted view of the joint. This makes it harder for surgeons to position implants precisely, assess bone quality and handle unexpected complications during surgery.
Studies show this limited visualisation can only be overcome with intraoperative X-rays, and even then, some findings (like a short femoral neck or deep socket) may only become apparent after the X-ray is taken. Due to the difficulty in exposure, it is more likely for surgeons to mistakenly use components that don't properly fit the patient's anatomy, leading to earlier failure and higher rates of revision.
For example, a systematic review published in the International Orthopaedics journal found the anterior approach has a substantial learning curve, with mean complication rates of 20.8% in early surgical groups, only decreasing to 7.6% in amongst experienced surgeons. The operative time plateaued after approximately 100 cases.
Longer Surgery Time
Anterior procedures typically take 30 – 40 minutes longer, meaning:
Longer time under anaesthetic
Increased surgical stress
An increased risk of medical complications
Not Suitable for Everyone
The anterior approach isn't appropriate for all patients.
Anterior hip replacement is often not suitable if you are:
Overweight
Very muscular
Have complex hip arthritis
Have had previous hip surgery
Have difficult anatomy
So, which type of hip surgery is best? Posterior – the one that can be safely and effectively performed in every one of those situations.
Why Surgeon Experience Matters
Posterior surgery is much more reproducible, which means surgeons can perform the operation more safely – and with predictable outcomes.
We believe choosing a safe, stable, proven surgical method is more important than choosing a technique associated with unsubstantiated marketing-driven claims of “fast recovery.”
Posterior surgery now preserves muscles and achieves the same long-term results as anterior – without added surgical challenges or increased complication rates.
We only perform posterior approach hip replacement because it consistently delivers safer, reliable outcomes for every patient.
By only using the posterior approach vs the anterior, experienced surgeons like Dr David Sime achieve:
Lower complication rates
More precise implant positioning
Better ability to handle unexpected issues
Shorter surgery times
More predictable outcomes
Decades of Proven Reliability
If you’re asking yourself, “Which method of hip replacement is the best?”, there's a reason the posterior approach remains the most common technique worldwide – it works consistently well for nearly all patients.
Modern refinements have addressed earlier concerns about dislocation risk. Today's posterior techniques preserve muscle attachments and eliminate the need for long-term movement restrictions. Most surgeons no longer require the hip precautions (no bending past 90 degrees, no crossing legs) that were standard 10-15 years ago.
The approach offers:
Excellent visualisation for precise implant placement
Ability to handle complex anatomy or unexpected findings
Suitability for all body types
Proven track record with millions of successful procedures
Shorter learning curve, meaning more surgeons perform it well
If you do experience post-surgery buttock pain, it's typically related to normal muscle healing rather than the surgical approach itself.
What to Ask Your Surgeon
When discussing which type of hip surgery is best for you, ask these questions:
How many hip replacements do you perform annually? (Look for 50+ per year)
What's your experience with your preferred approach? (Hundreds of cases is ideal)
What are your complication rates? (Should be under 2% for experienced surgeons)
Why do you prefer this approach for my specific situation?
What's your revision rate? (How often do implants need replacing)
An experienced hip specialist in Melbourne or an orthopaedic surgeon for hip replacement will answer these questions confidently and help you understand why they've chosen their preferred technique.
Questions about implant durability? Modern implants should last 20-30 years or longer, regardless of which surgical approach is used.
Anterior vs Posterior: Which is Better?
The posterior approach offers:
Proven long-term success
Lower complication rates
Suitability for all patients
Safer visualisation
Less technical risk
More predictable outcomes
The anterior approach offers:
A small early advantage that disappears quickly
Higher complication rates are reported globally
Limited visualisation
More technical challenges
Longer surgery time
Greater risk for certain body types
For those reasons, we do not recommend or perform anterior hip replacement.
But don't choose a surgeon based on their marketing claims about recovery duration or clinic superiority. Choose based on their experience, outcomes and ability to match the right technique to your specific anatomy and needs.
FAQs – Which Method of Hip Replacement Is the Best?
Is anterior hip replacement better than posterior?
No. It shows temporary early benefits but more complications. The anterior approach has technical challenges, a steep learning curve and isn't suitable for all patients.
Posterior remains the safest and most reliable approach with the best long-term results.
Which type of hip surgery is best for me?
The most appropriate surgical approach depends on your anatomy, body type, any previous operations and, most importantly, your surgeon’s experience with the method they use. The posterior approach is suitable for virtually all patients and remains the safest, most reliable option for a wide range of hip conditions. In contrast, the anterior approach is often not suitable if you are significantly overweight, very muscular or have complex hip anatomy, as these factors increase complication risk.
An experienced hip specialist can explain why the posterior approach is recommended in your specific situation.
What are the main differences between an anterior vs a posterior hip replacement?
Anterior hip replacement uses a front incision and works between muscles, which can offer a small early walking advantage but comes with restricted visualisation and a longer operation time of 90–100 minutes.
Posterior hip replacement is performed through the back or side of the hip, allowing clear, safe visual access to the joint and typically takes only 60–70 minutes. This improved visibility and efficiency are key reasons posterior remains the more predictable and lower-risk technique.
Does the surgical approach affect how long my hip replacement lasts?
Not necessarily. Implant lifespan is determined by implant quality, accurate positioning during surgery, your activity levels and your body weight, not whether the surgeon uses an anterior or posterior approach. Since both techniques use the same implants, modern hip replacements should generally last 15–20+ years. There is a higher likelihood that surgeons using the anterior approach may use under sized or poorly positioned components due to the lack of adequate surgical exposure. This increases the risk of fracture or early component loosening, which will reduce the longevity of your hip replacement, which is why the posterior approach is preferred by Dr Sime.
