Surgical Approaches for Primary Total Hip Arthroplasty from Charnley to Now The Quest for the Best Approach

Total hip arthroplasty is one of the most successful surgical interventions of the last century, yet questions remain as to the best surgical approach to use in order to achieve an optimal result. The main approaches to access the hip joint, which will be reviewed in this article, have a long history in the orthopaedic literature. The evidence behind the advantages and disadvantages of each approach also will be reviewed. In general, it can be said that the anterior approach affords the best early recovery as measured in the first 2 to 4 weeks after surgery. Lateral approaches have the lowest rates of dislocation. The posterior approach has the lowest rates of overall complications, and concerns regarding dislocation have been mitigated with the use of larger-diameter prosthetic femoral heads and advanced soft-tissue repair techniques. In the end, the selection of approach for total hip arthroplasty should be based on surgeon experience and familiarity with the approach. The pros and cons of each approach seem to equalize by 6 weeks postoperatively. Overall, the reproducibility of the operation is a testament to its continued success.