7/03/08  Dr. Lichtblau of Quebec

The anterior vs. posterior debate isn’t going to be resolved by one study of electrode blood flow. Most surgeons would agree that blood flow to the femoral head (most of which comes backwards via the femoral neck) is theoretically better preserved through an anterior approach. Much of this info comes from the work of Ganz, who did a lot of cadaver dissection to prove this. Having said that, there doesn’t seem to be any evidence whatsoever that one approach or the other leads to a higher incidence of the femoral head dying after resurfacing surgery (so called ”avascular necrosis”).

McMinn and Treacy, who have together the largest series of resurfacings in the world, both use the posterior approach, and there have not been any problems seen yet. I prefer the posterior approach because I am good at it and I can perform the surgery quite fast through this exposure. Bottom line is that your surgeon should probably use the approach he/she is most comfortable with. Hope this info is of help to you.

Ethan Lichtblau, MD, FRCS(C) Montreal, Quebec