Anterior v. Posterior & scars

Hi, friends!

I am 40 years old & healthy weight.  I have an upcoming THR surgery scheduled for 12/19/17.  I was told initially that my surgery would be anterior approach; I found out today that my surgeon only does posterior approach.

I’d ever so much appreciate your feedback about the following:

1) Among runners, is there a preferred approach, anterior or posterior?

2) Is it true that both approaches have about the same outcome?

3) How bad/long/sunken are the posterior scars?  From where to where exactly are the anterior scars?  Is there a specific place on this site or other sites where I can review pics of scars and compare?

The doc today was quite irritated and dismissive about any of my questions related to anterior THR.  “I don’t do that, so I’m not going to answer that.”  I managed to arrange a consult with the one doctor at Mayo Clinic who performs anterior THRs before my surgery day so I can call off the posterior surgery if needed.  This, of course, would be quite stressful as I’ve arranged my life to recover from surgery over the holidays.

I’m not sure why I fear the posterior scar as much as I do.  I have an ACL scar that has never bothered me at all.  Given that I am female and curvy, I just don’t want a surgery that would noticeably deform my figure, and I have some concerns about the butt muscle being “split.”

4) Is a split glut muscle a big deal, or not a big deal?

5) The doc said today that the anterior scar is much uglier than the posterior scar.  Is that true?

All feedback/advice is much appreciated!  Please and thank you.

Kelly

 

21 thoughts on “Anterior v. Posterior & scars

  1. I have had each procedure. I changed doctors to get the anterior procedure—WORTH the switch. My recovery time was about a third and the recovery pain was not even comparable! Scars are about the same my posterior scar is faded a lot but it is 2 years older. I would highly recommend the anterior.

    1. Thank you, Wynn! How long is your anterior scar, and where is it (upper thigh or over pelvis?) Just wondering how visible/noticeable it is…

  2. Hi Kelly, I recently (5 weeks ago) had the anterior THR. I was back on my feet and in the gym for a light workout within a week. I was back to work at my desk job in 9 days. I’ve was on the Stair Master after 2 weeks and I recently got back on my Zero Runner without any problem. Last week I got the all clear from my doctor for unlimited activity. I’m scheduled for my first 5K on the Saturday after Thanksgiving. That’s in less in than 2 months. I’m actually thinking about running it. Did I mention that I’m 65? I can’t speak to the posterior approach but I can say that I have been totally satisfied with the anterior. My scar is about the same location and length as the pocket on my slacks. It isn’t pretty but it is uniform and even. I think that has a lot to do with the surgeon. Given my experience, I would suggest you reschedule. Good Luck!! – Kelly

  3. Hi,

    Well, if I was in your situation I would be a little more concerned about the dismissive behavior of your Dr. In my opinion its always better to have a Dr. with a good attitude. In regards to the difference in the procedures/scaring- I had a posterior done because I also had to have some reconstruction, my joint was jammed in the socket with very limited mobility so anterior was NOT an option for me. My scar is exactly 8 inches long and not very wide. I consider it pretty nice looking in comparison to the other scars I had from my childhood surgery, back when they used staples instead of whatever magic glue they use today. I do have a minor “blip” on the outer edge of my buttock but its really small – I notice it but I don’t think others would think anything of it. I think it may go away eventually because I see it less now. ( I am considered a somewhat curvy and am also 40 (had the surgery two years ago)

    Honestly, I wouldn’t worry too much about the scar. Its a part of your life history, and as mentioned earlier… in comparison to the staples they used in the 80’s (which made my scars look like a Caterpillars with 16 sets of legs) an 8 inch thin line on your back side is not too bad.

    I hope that helped — good luck 🙂

    1. Also, as far as recovery time, It took me four months to get off my cane but as mentioned earlier I had some reconstruction done and extra ligaments cut to lengthen my leg. Most people are out and about very quickly with the anterior approach. If you can, reschedule it – you may be happier with the outcome.

    2. My current doctor has an excellent reputation, but I would appreciate a physician with a better bedside manner. Happy to know that I will have a choice. I was told this afternoon that if I choose anterior, doc #2 will try his best to schedule me by the end of the year 🙂 Thank you so much for your comments!

  4. The “irritable” manner of your doc is concerning. I can only speak to the anterior approach, but in terms of the greater precision offered by this harder-to-learn technique. You’re on your back, and everything is fully visible straight on, as opposed to “over the side” with posterior. Getting all of the angles of the new joint correct, in relation to the rest of the hip structure, within small tolerances, is critical – my doc actually wrote this up as a little “white paper” to explain it in language patients could understand. Everything else is secondary to getting those critical angles correct.

    THAT SAID … no muscles are cut with the anterior approach – just moved aside. You’re left with sore quads but they’re not cut. The incision, at least for me, is just about 4″. I’m 15 months post surgery and the scar is almost gone; it’s on the upper thigh. Not visible when you wear anything but the tinest briefs. I’m proud of that scar. It’s scary to get surgery. Not everyone is a candidate for anterior THR – usually very overweight or very muscular people are not candidates because it’s too hard to get to the joint from the front.

    Recovery time can vary depending on your age, physical condition, etc. etc. but I was 50 when I got surgery, spent 1 night in hospital, and walked the next day. Started PT almost immediately, and walked a little each day, first with a walker, then crutch, then cane, then nothing, Now I’m running 40 miles a week.

    Best of luck and hope this helped! –Carolyn

    1. Carolyn. Do you mind sharing the type of hip you got? I have been running marathons and ultras and recently found out I have hip dysplasia and due to arthritis I will need a hip replacement soon.

  5. I had the anterior approach in July– I was pleasantly surprised at how quickly I have recovered. They had me up & walking (with a walker) the same day as my surgery.

    The scar is not big at all- maybe 4 inches & is healing & fading nicely. It looked pretty terrible right after the surgery, but now when I look at it, I can’t believe how well it has healed. Hard to believe they were able to do all they did with such a small incision.

    I have heard the posterior approach is a much longer recovery time with more pain. I am grateful I had the anterior approach, and so happy with my results.

  6. I have two four inch scars from two resurfacings. They are on the side of my butt/legs, so posterior, approximately where very fit people naturally cave in. So now I permanently cave in, even when I am not so fit. The scars show, but are not prominent and I am not self conscious. And I can run again, as much as I want, so who cares about scars.

    Anterior or posterior doesn’t matter so much for your running career. Pick a doctor who has done hundreds of these surgeries and had good results. That matters more than approach. Either one can dislocate. Some report anterior is initially easier, but with either one you have to let soft tissue heal and let bone and prothesis grow together. Anterior has the risk of femoral nerve damage.

    I am another person who didn’t like your doc’s reaction to your questions. His shortness with you concerns me.

  7. Hi Kelly. I’vehadbs oth my hips done by the posterior approach & can honestly say that given the choice I’d go the same route. My scars are approximately 6 inches long & can hardly see them. My recovery was very quick. Operation on the Monday, physio that afternoon & home the next day. Absolutely no pain at all after the op & I was never on any painkillers. I’d be a bit concerned with your specialists attitude. Some drs do posterior & others anterior. I think it’s their preferences & how they were taught. Don’t worry about you’re scars but remember to always do your exercises every day.

  8. Hi Kelly
    I think the doctor is the most important choice.
    I had posterior (aged 49) and was home in 3 days- no pain killers and no walking aides. 4 years on i do everything pain free. Running has been no problem. Scar is about 5 inches but never notice it as it is so light. If I do I think of it as a badge of honor!
    Best wishes with your choice and recovery. Make sure you feel comfortable with whatever or whoever you choose.

  9. Hi Kelly,
    I had the same experience. I assumed my doctor was going to do the anterior approach and found out close to the surgery that he uses the posterior. I panicked. He explained to me that he was trained in both approaches but found he had more success with the posterior. He said the rate of infection was smaller with the posterior and that it allowed him more procession in the surgery with less chances for mistakes. He said that although the initial recovery was quicker with the anterior the full recovery period was really the same for both. My scar is about 6 inches. The very bottom may extend a little past a bathing suit but I don’t think its very noticeable. I was walking the day after surgery slowly with a walker. I took pain meds for about 10 days. Overall I am very happy with the experience and I love the new hip. Good luck!!!

  10. Hi Kelly,

    I hope you got what you needed from this post (and more). Looks like the biggest concern was how dismissive your doctor was. I want to give you a couple of links from scar pics on this site.

    I believe this is posterior: http://hiprunner.com/wp-content/uploads/INCISION-CLOSE-UP-e1422569081812.jpg
    Anterior: http://hiprunner.com/wp-content/uploads/scar6wks1.jpg
    Posterior: http://hiprunner.com/wp-content/uploads/3day-THR-Scar.jpg
    This one is a 2 year progression (mine) anterior: http://hiprunner.com/wp-content/uploads/2YearsHealing.jpg

    Just remember, some of those pics are from early on. The scars fade. Hopefully the 2 year progression will show that for you. I hope these enlighten you.

    Good Luck!

  11. Thank you all for your comments and photos. Very helpful! My consultation with doc #2 is 12/12/17, so I’ll keep you posted 🙂

  12. Kelly: I got Posterior done. I went to see my surgeon because he supposed to do Anterior and I heard Anterior recovered faster. He actually can do both but told me right away that I was not a candidate for Anterior due to 3 reasons. He said there is no difference in term of recovery. I recovered very fast, almost no pain after surgery (I had to take narcotic pain med before surgery), I only took two Tylenol after surgery. I walked with walker to the bathroom the same day of surgery, walked around the hospital ward with PT next day, and I barely used walker at all when I got home. Now I am 14 days post surgery, I walked in the park 1.5 mile per day, with 28-20 min/ mile, driving, shopping… the scar is about 6 in long and fresh and ugly, but it will get better, and I really do not care, as long as I can be physically active. Good luck!

  13. I am 55 and have had both hips replaced by anterior method. First was at 50 and second was one year ago at 55. Because they separate the ligaments and muscles in a natural way to access the joint (rather than cutting through the tissue) anterior approach has faster return to normal activity and little pain. The scars are about 4 inches long and have faded a lot… I wear them proudly as they show my courage and dedication to keeping myself healthy.

  14. Hi Kelly, I had both hips done together, anterior method, over 3 years ago when I was 56. Although the first 2 weeks weren’t a cake walk, I was driving within 10 days and off all walking aids by 3 weeks. Recovery sped along, with the help of a good physio to make sure my gait was aligned and strength regained and I’ve never had a moment’s issue since. The scars are about 3.5″ long and do go down the front of my thighs a bit so would show in a bikini (those days are over for me) but have faded a lot. But hey – a small price to pay, and people are blown away to find out I had both hips replaced – especially when they meet me hiking in the Himalayas or Andes! The biggest downside is going through airport security. I travel overseas a lot, and have become very accustomed to being patted down as the hardware always sets off the security devices. Ah well, this is nothing compared to spending the rest of my life in a wheelchair!

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