Q&A Topic: Posterior vs. Anterior Hip Replacement

Jeffrey Geller, MD

Q. What inspires you about what you do?

A. I love doing hip replacements because it’s a very predictable surgery with excellent outcomes. It restores people’s quality of life. Patients come in with horrible pain; we fix their hips and give them their lives back. It’s truly a life altering intervention.

Q. What are key differences between posterior and anterior surgeries?

A. Hip replacement as a surgical solution has been around for decades. The tried and true posterior approach is still very good. For many years, it was the gold standard. Traditionally, approaches from the front—the anterior—were more difficult. However, with continued effort and an innovative technique, we’ve improved the anterior process. Today, it’s far more routinely done. Research has shown that recovery with the newer anterior technique is faster and easier. The ultimate outcomes for both types are similar after 6-12 months, but there’s an earlier return to function with anterior. In other words, patients resume work and daily activities faster.

Q. Which approach is best — how do you select the right one?

A. The choice depends on the individual surgeon: for self-evident reasons, the surgeon needs to feel comfortable with the strategy. This surgery is utilitarian, versatile, pretty straightforward and not hugely challenging from a technical standpoint. Among doctors who do hip replacement routinely, anterior is increasingly in vogue. However, those who don’t specialize may still prefer the traditional posterior method. There aren’t many major medical centers around New York that do anterior. At NewYork-Presbyterian/Columbia University Medical Center, three members of our team focus on that almost exclusively. We also perform the anterior approach at NewYork-Presbyterian Lawrence Hospital, now fully staffed with orthopedic specialists from Columbia.

From a purely technical perspective, anterior is more difficult than posterior. Research has shown that a surgeon needs to do between 50-100 surgeries to become really proficient. I’ve been doing this work to some degree since I went into practice 12-13 years ago. I train residents, fellows and other surgeons nationally. It’s a lot of work to hone these skills, but I find it endlessly fascinating.

Q. Why do people need this surgery, and what can they do to stay fit?

A. Our typical patients range from former athletes to elderly people whose joints have just worn out. We don’t know conclusively what leads to arthritis and what prevents it. Overdoing it with running, especially with improper form, could be a risk factor. It’s possible that hip arthritis develops from a mild anatomical abnormality that worsens over time. Everybody’s different. Find and do what works for you to stay fit. Cross training seems like a wise strategy—a mixture of safe strength training, yoga and other activities.

Q. What does the future of hip replacement surgery look like?

A. We’ve made amazing strides in pain management, overall technique and recovery. We often send patients home the same day or the next day. We’re always trying to make the process easier and minimally invasive. On the horizon, robotics will further transform this field. Some centers, including ours at NewYork-Presbyterian Lawrence Hospital, already use robotic assistance in replacement surgery.  It will require continued commitment to research and education to make the process even better in the future, and this is part of our academic mission, right here in Westchester.

ColumbiaDoctors Orthopedics
NewYork-Presbyterian Lawrence Hospital
One Pondfield Road, 1st Floor
Bronxville, NY 10708
914-750-4650
nyp.org/lawrence-ortho