Surgical approaches for primary total hip replacement

Excellent exposure is an essential requirement for successful hip surgery. The surgical approach selected should provide appropriate exposure of the acetabulum together with safe mobilization and exposure of the proximal femur. The approach should be versatile, allowing adequate release and exposure in the various circumstances in which primary hip arthroplasty is indicated. It should be extensile, allowing intraoperative flexibility, safe, avoiding significant risk to adjacent neurovascular structures and limit soft tissue damage and blood loss. This review article describes the common surgical approaches used for primary total hip replacement, reviewing those in common use and discussing reduced access variations on those approaches. Newer trends, such as the direct anterior approach and the direct superior approaches will be described. The strengths, limitations and clinical evidence related to each option will be discussed.