Last reviewed: September 29, 2026

Not clearly. Each approach has its own trade-offs, and neither has been shown to be better overall.

An anterior hip replacement reaches the hip through the front. A posterior one reaches it through the back. The new joint is the same either way.

Surgery through the front is often done on a special table that holds the leg by a boot at the foot, with live X-rays taken during the operation. Surgery through the back is usually done with the patient lying on their side on a standard table.

Trials comparing the two found less pain and a faster start in the first weeks when the hip was replaced through the front. Walking distance and hip muscle strength were slightly better in the first months. By a year, pain and function come out about the same.

Dislocation, the ball slipping out of the socket, has been less common after surgery through the front in several large studies, though pooled trials found no clear difference. People who have had a fusion in the lower back are more likely to dislocate, and in that group, dislocations were fewer with surgery through the front.

Other complications differ. Surgery through the front more often leaves a numb patch on the outer thigh and more often causes minor wound problems. Weakness from nerve injury is rare with either approach, but it tends to affect different nerves. Surgery through the front more often affects the nerve that straightens the knee. Surgery through the back more often affects the nerve that lifts the foot. Only about half of those injuries recover fully. Ankle injuries from the leg-holding table have been described but are rare.

Thigh bone fractures happen at about the same rate with either approach, but after surgery through the front they tend to appear in the first weeks, often without a fall. Extra bone forming around the new hip was less common after surgery through the front in one large study, though the severe kind was not.

The socket is more often placed in the target position through the front. Whether leg lengths come out more even is unclear.

For durability, overall repeat surgery rates look similar. Some registries found more loosening of the thigh-bone part after surgery through the front. Comparisons beyond about ten years do not exist yet.

Surgeons new to the front approach have more complications, which fall as they gain experience.

According to the American Academy of Orthopaedic Surgeons, there is no preferred approach, and each has specific risks and benefits.

In general:

  • Ask your surgeon which approach they use most often, and how often they do it.
  • Mention any lower back fusion or stiff lower back before surgery.
  • New weakness in the thigh, trouble lifting the leg, or a foot that drags needs to be seen promptly.
  • New thigh or groin pain in the first weeks, even without a fall, is worth reporting.
  • Drainage, redness or a wound that reopens needs to be seen promptly.

Drafted with AI assistance from published sources, reviewed and edited by Babak Sheikh, MD.

Sources:

  • American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Hip: Evidence-Based Clinical Practice Guideline. 2023. https://www.aaos.org/globalassets/quality-and-practice-resources/osteoarthritis-of-the-hip/oah-cpg.pdf
  • Miller LE, et al. Does Surgical Approach Affect Outcomes in Total Hip Arthroplasty Through 90 Days of Follow-Up? A Systematic Review With Meta-Analysis. J Arthroplasty. 2018. https://doi.org/10.1016/j.arth.2017.11.011
  • Ramadanov N, et al. A Meta-Analysis on RCTs of Direct Anterior and Conventional Approaches in Total Hip Arthroplasty. Sci Rep. 2021. https://doi.org/10.1038/s41598-021-00405-4
  • Yan L, et al. Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty: A Systematic Review and Network Meta-analysis. JAMA Netw Open. 2023. https://doi.org/10.1001/jamanetworkopen.2022.53942
  • Christensen JC, et al. Comparing Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty on Physical Function Recovery: A Prospective Cohort Study. J Orthop Res. 2025. https://doi.org/10.1002/jor.70065
  • Huerfano E, et al. Use of Surgical Approach Is Not Associated With Instability After Primary Total Hip Arthroplasty: A Meta-analysis Comparing Direct Anterior and Posterolateral Approaches. J Am Acad Orthop Surg. 2021. https://doi.org/10.5435/JAAOS-D-20-00861
  • Haynes JA, et al. Direct Anterior Approach for Primary Total Hip Arthroplasty Lowers the Risk of Dislocation Compared to the Posterior Approach: A Single Institution Experience. J Arthroplasty. 2022. https://doi.org/10.1016/j.arth.2021.11.011
  • Huebschmann NA, et al. Does Surgical Approach Affect Dislocation Rate After Total Hip Arthroplasty in Patients Who Have Prior Lumbar Spinal Fusion? A Retrospective Analysis of 16,223 Cases. J Arthroplasty. 2024. https://doi.org/10.1016/j.arth.2024.03.068
  • Wang H, et al. A Comparison of the Clinical Efficacy of Total Hip Arthroplasty via Direct Anterior Approach and Posterior Approach: A Meta-Analysis. Medicine (Baltimore). 2024. https://doi.org/10.1097/MD.0000000000039237
  • Guarin Perez SF, et al. Comparison of the Type, Impact, and Resolution of Complications Following Direct Anterior Versus Posterior Approach Total Hip Arthroplasty: A Multicenter Propensity-Weighted Analysis. JB JS Open Access. 2026. https://doi.org/10.2106/JBJS.OA.26.00172
  • Slaven SE, et al. Motor Nerve Palsy After Direct Anterior Versus Posterior Total Hip Arthroplasty: Incidence, Risk Factors, and Recovery. J Arthroplasty. 2023. https://doi.org/10.1016/j.arth.2023.03.086
  • Goldberg TD, et al. Direct Anterior Approach Total Hip Arthroplasty With an Orthopedic Traction Table. Oper Orthop Traumatol. 2021. https://doi.org/10.1007/s00064-021-00722-x
  • Lygrisse KA, et al. Is Surgical Approach for Primary Total Hip Arthroplasty Associated With Timing, Incidence, and Characteristics of Periprosthetic Femur Fractures? J Arthroplasty. 2021. https://doi.org/10.1016/j.arth.2021.04.026
  • Wilke BK, et al. Is Heterotopic Ossification Associated With Surgical Approach in Total Hip Arthroplasty? J Am Acad Orthop Surg. 2023. https://doi.org/10.5435/JAAOS-D-22-00639
  • Lu Y, et al. Comparison of Leg Length Discrepancy After Total Hip Arthroplasty: Direct Anterior and Posterior Lateral Approach. PLoS One. 2025. https://doi.org/10.1371/journal.pone.0318953
  • Hoskins W, et al. Early Rate of Revision of Total Hip Arthroplasty Related to Surgical Approach: An Analysis of 122,345 Primary Total Hip Arthroplasties. J Bone Joint Surg Am. 2020. https://doi.org/10.2106/JBJS.19.01289
  • Charney M, et al. A Comparison of Risk of Dislocation and Cause-Specific Revision Between Direct Anterior and Posterior Approach Following Elective Cementless Total Hip Arthroplasty. J Arthroplasty. 2020. https://doi.org/10.1016/j.arth.2020.01.033
  • Mjaaland KE, et al. Implant Survival After Minimally Invasive Anterior or Anterolateral Vs. Conventional Posterior or Direct Lateral Approach: An Analysis of 21,860 Total Hip Arthroplasties From the Norwegian Arthroplasty Register. J Bone Joint Surg Am. 2017. https://doi.org/10.2106/JBJS.16.00494
  • Wilson JM, et al. Outcomes Following Direct Anterior Approach Total Hip Arthroplasty: A Contemporary Multicenter Study. J Bone Joint Surg Am. 2025. https://doi.org/10.2106/JBJS.24.00132
  • Nairn L, et al. The Learning Curve for the Direct Anterior Total Hip Arthroplasty: A Systematic Review. Int Orthop. 2021. https://doi.org/10.1007/s00264-021-04986-7

This is general information about what published research shows. It is not medical advice and it is not about your situation. Reading it does not create a doctor-patient relationship with me. I am a retired orthopedic surgeon and I do not see patients. Talk with your own doctor before changing anything about your care. If something feels suddenly or seriously wrong, get medical care promptly rather than waiting.

This page is provided as is. I make no guarantee that it is accurate, complete or current, and medical evidence changes. Use of it is at your own risk.

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