The posterior approach is a very versatile approach. It allows the surgeon to visualize any aspect of the hip and perform any type of reconstruction around the hip. In many patients, only a standard hip replacement is necessary, and in these cases often an anterior approach can be used with the same success rate as a posterior approach; however, whenever complex deformities or problems are encountered, the posterior approach usually is the preferred treatment option.
A further advantage of the posterior approach is that both cemented as well as uncemented fixation is possible, that means the surgeon can during the procedure switch from an uncemented to a cemented fixation without changing his exposure or implant preparation.
An additional benefit of a posterior approach is that should in the future a further revision be needed, any of these revisions can be performed through a posterior approach, and therefore all surgeries can be performed through the same approach which decreases the risk of dislocation following revision procedures.
The main downside of the posterior approach is that compared to an anterior approach often the first four weeks the rehabilitation is a little slower. Some patients with a posterior approach will have a similar progress in their early rehabilitation as patients with an anterior approach; however, in general, in my experience, the first two to three weeks the rehabilitation is a little bit slower. Having said this, at about four weeks, patients after a posterior approach usually reach a similar activity level as patients with an anterior approach. Patients with a posterior approach will have to observe hip precautions, that means they have to sit on a high chair, have to use a toilet seat elevation, and usually are recommended to use a pillow between the legs at night. We often also limit driving a car for some of our patients who undergo a posterior approach and will not allow them to drive within the first four weeks after surgery.
Any type of implant can be used through a posterior approach. There is no limit in regard to type of implant or type of fixation through a posterior approach.
Well usually after you undergo medical clearance you are admitted to the hospital the day of your surgery. You will then undergo a spinal anesthesia, a regional anesthesia that allows us to control your pain during surgery and has less risks than general anesthesia. The surgery itself takes about 30 to 60 minutes and after the surgery you initially will be transferred to a postoperative recovery room where your vital signs and the weaning of the anesthesia is monitored by an anesthesiologist. You are then transferred to the floor where the day of your surgery physical therapy and rehabilitation will start. Usually within two days you are able to leave the hospital. Dr. Boettner in general recommends that you go home after surgery where he will provide you with a therapist that will check on you during the week to make sure that you achieve adequate physical therapy. By the time you leave the hospital, you should be able to walk 100 feet with either a cane or walker and you should be able to walk a flight of stairs. By the time of discharge, your incision should be dry.
The main complications with a posterior approach are the risk of dislocation. In Dr. Boettner’s practice, the risk of dislocation has been about 1%. Recently Dr. Boettner reevaluated about 800 of his patients who underwent surgery between 2011 and 2013. Of those patients, eight patients (1%) suffered a postoperative dislocation. Further complications of a posterior approach can include things like intraoperative fracture, deep implant infection, blood loss requiring blood transfusion, leg length discrepancy, wound drainage, implant loosening over time secondary to wear of the components or loss of fixation. Medical complications like deep venous thrombosis are possible and you will be placed on a blood thinner (usually aspirin). More serious complications like a pulmonary emboli, heart attack and stroke, etc. as well as bleeding complications are relatively rare. Our preoperative clearance program reduces the risk of serious complications significantly, and almost all of our patients today will avoid major medical complications because of our thorough preoperative medical work up.
By the time you go home you should be able to move inside your house and go for short walks. We do close the incisions with resorbable stitches covered by surgical glue and therefore you should be able to shower right after you get home. Do NOT bath or swim. During the day, you will be required to do a basic set of exercises. Dr. Boettner also recommends that you increase your walk distance every day and come off the cane once you are comfortable to walk without a limp. By one week you should be off all narcotic pain medication. You can return to work when you are comfortable and start driving after 4 weeks after you saw Dr. Boettner in the office for follow up.
Four weeks after a posterior approach you will usually be able to walk without assisting devices. Your walking distance will vary between 5 and 25 blocks. You should be able to reach your shoes and socks after your four-week appointment. You also should be able to drive a car after four weeks. Most patients will return to work between two and six weeks after posterior approach total hip replacement surgery. Please be aware that your postoperative function will often depend on your preoperative function. If you are very disabled, or only able to walk with assisting devices prior to surgery, or if your walking distance is less than one block, postoperative rehabilitation can be slower and it might take you longer to reach independence from assisting devices.
In general, Dr. Boettner does approximately 600 joint replacements per year of which about 50% are total hip replacement surgeries. Dr. Boettner has performed more than 2500 posterior approach total hip replacement surgeries. Most of his posterior hip replacements are performed through a minimal invasive approach with incisions measuring between 3 inches and 4 inches