Why I Use the Anterior Approach for Hip Replacement

There's more than one way into a hip. The path your surgeon takes won't change what's installed, but it can change how the first few weeks feel. Here's why I usually go in through the front.

By Dr. Luc Rubinger, MD, MBA, FRCSC · Orthopaedic surgeon, hip & knee replacement · Durham Bone and Joint Specialists, Ajax · Last reviewed November 2026

The short version

  • The anterior approach reaches the hip from the front, working between muscles instead of detaching them.

  • Many patients have less pain early on and get moving sooner, usually with fewer movement restrictions.

  • By about a year after surgery, results from the main approaches tend to even out. The difference is mostly in the early recovery.

  • It isn't the right fit for every body, and I'll tell you honestly if it isn't the right fit for yours.

What "approach" actually means

A hip replacement swaps the worn-out ball and socket of your hip for new parts. To get to the joint, I have to get past the muscles that surround it. The "approach" is simply the route I take.

The most widely used route worldwide is the posterior approach, which goes in from the back and side of the hip. It works well and has done so for decades, but it involves detaching some of the small muscles at the back of the hip and repairing them at the end of the operation.

Going in through the front

The anterior approach uses a natural gap between muscles at the front of the hip. Instead of cutting muscle off the bone, I gently move the muscles aside. Think of it as opening the curtains rather than taking them down.

You lie on your back for the operation, which lets me take X-ray images during surgery. Before you wake up, I can check the position of the new socket and confirm that your leg lengths match.

Why I choose it

  • Muscles stay attached. For many people that means less early pain and an easier time getting out of bed and walking, often on the day of surgery.

  • Fewer restrictions. Patients having hip replacement have traditionally been given a list of positions to avoid while the back of the hip heals. Because the anterior approach leaves those muscles alone, my patients typically have far fewer precautions to worry about.

  • Checked before you leave the OR. X-ray during surgery lets me confirm implant position and leg length in real time.

  • Suited to same-day surgery. For the right patient, the quicker early recovery makes going home the same day a realistic option.

The honest trade-offs

  • A patch of numbness on the thigh. A small skin nerve runs near the incision. Some numbness on the outer thigh is fairly common. It's usually small, often improves with time, and rarely affects function.

  • Body shape matters. If there's a large skin fold over the front of the hip, an incision there can be slower to heal, and a different approach may be safer.

  • Some hips need a different route. Certain revision surgeries and unusual anatomy are better handled through another approach.

  • The long run looks similar. A well-done hip replacement through any approach is a good hip replacement. The anterior approach is about how you get there, not where you end up.

Common questions

Is the anterior approach "minimally invasive"?

The incision is usually modest, but incision length matters less than people think. What really counts is what happens underneath: moving muscles aside rather than detaching them.

How soon will I walk?

Many patients are up and walking with a walker or cane on the day of surgery. Most move to a cane, then nothing, over the following weeks, guided by physiotherapy.

Will my new hip last longer?

No. How long a hip replacement lasts depends on the implant, how accurately it's positioned, and you. The approach mainly affects the early recovery.

Can I ask for the anterior approach?

Absolutely. We'll talk through your anatomy, your health and your goals, and decide together. If another approach is safer for you, I'll explain why.

Related reading

Seeing Dr. Rubinger

I see patients at Durham Bone and Joint Specialists in Ajax, with surgery at Lakeridge Health Ajax Pickering Hospital and Schroeder Ambulatory Centre. In Ontario, you'll need a referral from your family doctor or nurse practitioner. Referral and contact information · Hip replacement overview.

This article is general information to help you understand your options. It isn't medical advice for your specific situation. Whether a procedure is right for you depends on an assessment by your surgeon.