Comparative Analysis of Hip Abductor Strength Following Anterolateral Versus Posterior Approaches in Total Hip Replacement: A Prospective Study

Background Total hip replacement (THR) is a highly successful procedure for end-stage hip disorders; however, persistent postoperative functional limitations continue to be reported, particularly due to weakness of the hip abductor musculature, which plays a critical role in pelvic stability and gait mechanics. Surgical approach may influence abductor integrity and postoperative recovery. This study prospectively evaluated hip abductor muscle strength recovery following THR and compared outcomes between the anterolateral and posterior approaches. Methodology A prospective, observational study was conducted among 50 THR patients at a tertiary care center over 12 months. Patients were allocated to anterolateral (n = 25) or posterior (n = 25) approaches based on surgeon preference. Baseline demographic, clinical, and radiological profiles were comparable between groups. Hip abductor strength was assessed using Manual Muscle Testing (MMT) at 48 hours, 6 weeks, and 3 months postoperatively. A standardized rehabilitation protocol was implemented for all patients starting 48 hours after surgery. Data were analyzed using SPSS version 27.0 (IBM Corp., Armonk, NY, USA), and a p-value <0.05 was considered statistically significant. Results Abductor strength improved significantly from 48 hours to 3 months in the entire cohort (p = 0.001). At all follow-up intervals, the posterior approach demonstrated significantly higher mean abductor strength than the anterolateral approach (48 hours: 2.60 ± 0.70 vs. 2.04 ± 0.35; 6 weeks: 3.52 ± 0.58 vs. 2.72 ± 0.54; 3 months: 4.48 ± 0.58 vs. 3.52 ± 0.51; p = 0.001 for all). Baseline clinical examination parameters showed no statistically significant differences between groups, suggesting comparability at entry. These findings indicate that early postoperative functional abductor recovery is more favorable with the posterior approach. Conclusions The posterior surgical approach was associated with superior early hip abductor muscle strength recovery when compared to the anterolateral approach following THR. While these results have important implications for functional rehabilitation and approach selection, interpretation should be made cautiously due to non-randomized allocation and modest sample size. Future studies with larger cohorts, longer follow-up, and objective quantitative strength assessment (e.g., dynamometer measurement) are warranted to validate these findings and guide evidence-informed approach selection in THR.