Anterior Hip Replacement

IS ANTERIOR HIP REPLACEMENT RIGHT FOR YOU? anterior hip joint replacement

Anterior hip replacement offers many advantages over traditional hip replacement procedures; however, it is not for everyone and, as with any surgery, has its own risks.


In traditional hip replacement procedures, surgeons replace the damaged hip cartilage and bone with a prosthesis through an incision in the back (posterior) or the side (lateral) of the hip. In both of these procedures, surrounding muscles need to be cut or detached from the bone to provide access to the joint and then repaired at the end of the procedure.  The front of the hip has fewer and smaller muscles, enabling surgeons to work between them.  Therefore, patients typically experience less post-surgical pain and don’t require as much pain medication.

Since anterior hip replacement surgery does not disrupt the surrounding muscles or soft tissues, the risk of hip dislocation, a major concern with hip joint replacement, is greatly reduced.  Patients can bend at the waist and sit with their legs crossed as soon as it is comfortable; traditional hip replacement patients must avoid those activities for 6 – 8 weeks or longer because of the risk of dislocation.

Patients who have undergone anterior hip replacement are often able to go home the day of the procedure because they tend to recover more quickly than with the other approaches. Patients are typically walking with crutches or a walker and are able to bend at the waist within a day. Patients are also able to walk unassisted a week or more earlier than patients who’ve had one of the traditional procedures.


Any successful hip replacement surgery depends on many factors beyond surgical approach. This can include the surgeon’s training and skill, the patient’s overall health and fitness, and the patient’s level of commitment to post-surgical rehabilitation. In general, people who are obese or extremely muscular are not good candidates for anterior hip replacement. This is because the excess soft tissue decreases the space in the front of the hip.

The anterior hip replacement procedure requires a high level of training and precision because surgeons are working with a restricted view of the hip joint.    With the anterior approach, the surgical area is near the lateral cutaneous femoral nerve, which extends from the front of the pelvis to provide sensation to the outer thigh. If the nerve is affected during surgery, the thigh could become numb and, in rare cases, (less than 1 %) develop a painful skin condition. Not every hip replacement surgeon has undergone the highly technical training to safely to perform the anterior procedure, so it is important investigate the qualifications of your surgeon.

Individuals considering hip replacement surgery should consult with a hip replacement specialist to understand which approach is best suited for his or her personal circumstances and lifestyle goals.

Watch a video demonstration of the procedure.

Schedule an appointment with a hip joint replacement specialist or call (203) 869-1145


Reviewed 2019

ONS Featured on Anterior Hip Replacement

ONS hip and knee replacement specialist Dr. Jonathan Berliner was featured in the Daily Voice for his expertise in anterior hip replacement, a relatively new approach to the procedure.

In the online article, titled, ONS Remains at the Forefront of Hip Replacement Surgery, John Haffey writes:

“Faster recovery and less pain are just a few of the reasons why minimally invasive anterior hip replacement surgery has seen an increase in popularity in recent years. However, this intricate procedure requires a high degree of training and expertise, and not all joint replacement surgeons are qualified to perform the operation.

During more traditional approaches to hip surgery, surgeons cut and remove the damaged cartilage and bone, and replace it with a prosthesis through an incision in the back (posterior) or the side (lateral) of the hip, explained Dr. Jonathan Berliner, a joint replacement specialist at Orthopaedic & Neurosurgery Specialists who performs the minimally-invasive surgery. During these procedures, muscles need to be cut or detached to gain access to the surgical area. However, through the anterior approach surgeons can enter through the hip’s front and repair the joint through the natural gaps between muscles. This precision helps minimize injury to the soft tissue in the area.

“Since there is less disruption to the muscles and tendons, patients tend to recover hip function and gait mechanics more quickly and with less pain,” said Berliner. The risk of hip dislocation, a concern after total hip replacement surgeries, is decreased because the muscles and soft tissue structures that normally hold the hip joint in place remain intact. Patient hospital stays are also generally shorter with the anterior approach.

Surgeons have been using an anterior approach to other hip surgeries for some time. However, anterior hip replacement has only recently gained increased attention, noted Berliner. It’s estimated that only 15 to 20 percent of hip replacement surgeries performed in the United States utilize this approach. Moreover, not all joint replacement surgeons have undergone the specialized training required to perform this technically challenging procedure, which offers a limited view of the operating site and leaves little room for error.”

The Daily Voice shares its content across Fairfield and Westchester counties.  You can read other ONS related stories that have appeared in the Daily Voice here.

Considering Joint Replacement?

If pain in your knee, hip or shoulder joint is interfering with your quality of life, it may be time to consider joint replacement.Joint replacement surgery

Join shoulder replacement surgeon Seth Miller, MD, and hip and knee replacement surgeon Frank Ennis, MD, to learn all about the advances in joint replacement procedures and what to expect from your first office visit through the recovery process.  Dr. Miller and Dr. Ennis will be joined by Greenwich Hospital staff who will outline the particulars of your hospital stay.  There will be time to have your questions answered at the conclusion of the program.

Joint Replacement Symposium

WHEN:  Wednesday, April 5, 2017

WHERE: Greenwich Hospital Noble Auditorium

TIME: 6:00 pm – 7:30 pm

SEATING IS LIMITED. Please register on line or by calling 203-863-4277.

Hip Impingement


Acute hip pain can derail even the most active athletes, and is often attributed to arthritis. However, hip impingement, also known as femoroacetabular impingement, can cause significant groin pain during everything from playing sports to daily tasks.

“The symptoms of impingement are most commonly pain the groin or front of the hip,” said Dr. Tim Greene, an orthopedic surgeon at ONS in Greenwich. “This pain generally increases with more activities. The more active you are the more pain seems to flair.”

Further, hip impingement tends to occur in active young adults, especially athletes. A painful and often unrecognized condition, impingement involves a tear in an athlete’s labrum. The problem can stem from various causes, including an imperfect shape of the ball and hip socket. This can pinch the hip labrum and cartilage causing damage with rotational movements of the hip.

“An MRI with contrast is one of our best tool at this point to diagnose injuries of the labrum cartilage,” said Greene.

However, due to the microscopic nature of some labrum tears, an arthroscopic procedure with a small camera may be needed for a complete diagnosis and repair. “We’ve developed tools that can be used inside the hip in a minimally invasive fashion, and able to treat labrum tears easily,” he said.

Prior to the minimally invasive procedures, hip impingement was treated with open surgery, resulting in a lengthy recovery time. Now, the condition can be corrected using a camera and a few small incisions. This allows for shorter recovery and a quicker return to sporting activities.

“We have learned over the course of time that you have to treat not only the symptoms that come from the labral tear but you have to treat the bony issues that cause the tear as well to reliably get an excellent outcome,” said Greene.

To learn more about hip impingement at ONS, watch Dr. Greene’s full video below or click here.


Hip Arthroscopy: A New Solution for Hip Pain


Tim Greene
ONS sports medicine specialist Dr. Tim Greene will talk about common causes of chronic hip pain including hip impingement; a painful and often unrecognized condition that involves a tear in the labrum.

Now surgeons can repair labral damage and re-contour bone using hip arthroscopy, a minimally invasive technique that uses two small incisions, a small camera and miniaturized instruments.


Noble Conference Center
Greenwich Hospital
5 Perryridge Road, Greenwich, CT
Call to register 203-863-4277, or visit


Tim Greene, MD is a fellowship-trained orthopedic surgeon who specializes in Hip Arthroscopy and Sports Medicine will discuss treatment for hip pain. Dr. Greene graduated Princeton University and earned his medical degree at the Medical College of Georgia. He performed a residency in orthopedics at Emory University and served as associate team physician to the athletic teams at Georgia Tech. He completed fellowship training at the Steadman Hawkins Clinic in Vail, Colorado.

ONS Stamford: Off to a Great Start

5 High Ridge Park, 3rd floor, Stamford, CT 06905

On the evening of June 22, 2015, Orthopedic & Neurosurgery Specialists (ONS) held a grand opening celebration of a second ONS location at 5 High Ridge Park in Stamford, CT. The event was a first look at the new facility for the public, complete with informative stations about injury prevention, exercise tips and sports medicine stations with medical models and video presentations. Throughout the evening, around 200 guests toured the office, and learned about injuries and treatments of the foot and ankle, hand and wrist, shoulder and elbow, hip and knee, spine and Platelet Rich Plasma treatment. ONS physicians were available to answer questions. ONS Physical Therapy showcased injury prevention exercises for tennis, golf and running. Local businesses participated in the evening as guests enjoyed food and beverage and displays and a drawing of exciting prizes. The ONS physicians, clinicians and staff members were pleased with the opportunity to meet and greet the Stamford community! To learn more about our new Stamford office please visit

ONS Docs Included in Castle Connolly New York Top Doctors Guide, 17th edition

14 Specialists from ONS included in New York Area Medical Guide Book top primary care and specialty care doctors in the tri-state metropolitan New York area.

Fourteen physicians from Orthopaedic and Neurosurgery Specialists (ONS) on Valley Drive are included in the latest edition of Castle Connolly Top Doctors, New York Metro Area guidebook. The resource directory, which is in its seventeenth edition, is a guide to finding the top primary care and specialty care doctors in the tri-state metropolitan New York area. It details information on over 6,400 physicians in 65 specialties. Physicians profiled in the guide were nominated by their peers and screened by a research team at Castle Connolly.

Castle Connolly Top Doctors® are nominated by their peers including physicians and hospital executives throughout the New York metropolitan region in an online survey process. Nominations are open to all board certified MDs and DOs. Nominated physicians are selected by the Castle Connolly physician-led research team based on criteria including medical education, training, hospital appointments, disciplinary histories and much more.

ONS physicians included in the 17th edition of the guide are neurosurgeons Paul Apostolides, MD; Mark Camel, MD;  Amory Fiore, MD; and Scott Simon, MD, orthopedic surgeons Michael Clain, MD; John Crowe, MD; James Cunningham, MD; Frank Ennis, MD; Steven Hindman, MD; Brian Kavanagh, MD; Seth Miller, MD; Paul Sethi, MD; and Katie Vadasdi, MD and physiatrist Jeffrey Heftler, MD.

“We congratulate our physicians who have been recognized as ‘Top Doctors’ by Castle Connolly,” said hand and wrist specialist Dr. John Crowe. “Having fourteen of our fine doctors included in this authoritative guide is a reflection of the commitment and quality of excellence of all our physicians and entire staff at ONS. The multidisciplinary nature of ONS makes it possible to provide patients with access to the most advanced care available in orthopedics, neurosurgery and physiatry.”

Survey recipients are asked to nominate those doctors who, in their judgment, are the best in their field and related fields– especially those to whom they would refer their own patients and family members.

Orthopaedic and Neurosurgery Specialists PC (ONS) is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. For more information, please visit

Dr. Tim Greene explains ITB Syndrome

Iliotibial Band Syndrome (ITBS) is a common injury in runners of all levels that is caused by friction between the iliotibial band and the outer aspect of the knee or hip.  When the knee reaches 20 to 30 degrees of flexion, the iliotibial band is closest to the outer aspect of the knee which may produce friction and pain.  This syndrome, which can be very painful, can be brought on from running downhill, uphill or at a slower pace, all of which place the knee at a lower flexion angle in the 20 to 30 degree range. Runners with anatomic variations of the leg that place it in an inwardly rotated position may predispose to this condition. Flat feet (pronation), knocked knees (valgus) and weak outer hip muscles are all associated with an inward position of the leg.

Dr. Timothy Green examining a patient experiencing pain caused by ITBS.

IMG_2560Developing outer hip or knee pain after 2-3 consecutive runs may be a sign of ITBS. An adequate period of rest is the most important course of action in alleviating these symptoms. Continuing to run through the pain will only serve to worsen the symptoms. A proper warm-up and stretching of the iliotibial band is paramount in relieving and preventing ITBS.  Continued outer hip or knee pain at baseline or with the resumption of running after a 10 day to 2 week course of rest should warrant an evaluation by a sports medicine physician.


The majority of ITBS resolves with the appropriate non-surgical management. This may include formal physical therapy, anti-inflammatory medication, or an injection of cortisone or platelets. In rare cases that fail a long course of non-surgical management, arthroscopic surgery to remove the inflamed tissue and loosen the tight iliotibial band maybe necessary.

Powerpoint presentation of talk on Therapeutic Injections Available Online

On Tuesday, June 4th, Physiatrist Dr. Jeffrey Heftler gave an informative talk at Greenwich Hospital on how some sports injuries may be effectively treated with therapeutic injections.  If you missed the talk, here is a link to his powerpoint presentation:

Dr. Jeffrey Heftler – Injection of Knee and Hip

Physiatrist Dr. Jeffrey Heftler gave a talk at Greenwich Hospital on Injection Therapy for sports injuries.
Physiatrist Dr. Jeffrey Heftler gave a talk at Greenwich Hospital on Injection Therapy for sports injuries.












Greenwich Hospital Appoints Steven Hindman, MD as Director of Orthopaedic Surgery

Orthopedic surgeon Steven Hindman, MD has bee appointed Director of Orthopedics at Greenwich Hospital.
Orthopedic surgeon Steven Hindman, MD has bee appointed Director of Orthopedics at Greenwich Hospital.

Orthopedic Surgeon Dr. Steven Hindman has been named Director of Orthopedic Surgery at Greenwich Hospital. Dr. Hindman has been on staff at Greenwich Hospital since 1987 when he began his practice with Greenwich Orthopedic Associates on Lake Avenue. In 1992, the group moved into Greenwich Office Park on Valley Drive. They later merged with Orthopaedic Associates and formed ONS (Orthopaedic and Neurosurgery Specialists).

Dr. Hindman treats the full spectrum of orthopedic conditions and injuries from ankle sprains to ACL ruptures to degenerative joint disease. He is also actively involved in injury prevention on behalf of the ONS Foundation for Clinical Research and Education, and speaks to community groups on fall prevention, skiing injuries and osteoporosis.

Dr. Hindman was born in Newtown, MA and graduated from University of Rochester, New York. He received his medical degree from Albert Einstein College of Medicine in New York in 1982 and did his residency in Orthopedic Surgery at Montefiore Hospital, Albert Einstein College of Medicine in New York from 1982 to 1987. Dr. Hindman is Board Certified by the American Board of Orthopaedic Surgery and is a former Assistant Professor of Orthopedic Surgery at Albert Einstein College of Medicine. He is included in the list of Castle Connolly New York Area Top Doctors.

Greenwich Hospital New Mini-Med Seminar series begins with talk on Joint Disease by Paul Sethi, MD

Paul Sethi, MD
Orthopaedic surgeon Paul Sethi, MD

On Wednesday, March 13 at 6:30-7:30 p.m., Greenwich Hospital will begin a new Mini-Med Seminar series. The first program, “Let’s talk about Joints: Degenerative Joint Disease (DJD); Causes, Symptoms and Treatments,” will be presented by ONS orthopaedic Surgeon Dr. Paul Sethi in Hospital’s Noble Conference Center at 5 Perryridge Road. Attendance is free. To register, call 203-863-4277 or 888-305-9253, or register online.

Also known as osteoarthritis, DJD affects over 30 percent of the US population over age 65 and is characterized by joint pain and stiffness and a progressive loss of mobility. DJD occurs when the cartilage that cushions the joint breaks down and begins to wear away. By 2030, a projected 67 million people will have been diagnosed with DJD. Understanding the latest research on the causes of the disease and the surgical and non-surgical treatment options will be the focus of this seminar. Dr. Paul Sethi, who is also President of the ONS Foundation for Clinical Research and Education, will lead this educational and interactive program.

Greenwich Hospital Mini-Med seminars offers tuition-free monthly programs that focus on basic anatomy and physiology, common disease conditions, and possible cures and treatment options. The series aims to introduce the public to the science of human health and the groundbreaking changes taking place in the field of medicine today. The audience will gain a greater awareness of significant health issues, and about the role of medical research in advancing healthcare. The seminars are presented by Greenwich Hospital staff physicians and are designed to be causal and highly informative. No science or medical background required! Ample time will be given to a question and answer period. Whether you’re a student, teacher, caregiver, healthcare provider, or someone with an interest in research and medicine, you will gain a better understanding of basic terms and medical concepts from the seminars.

NOT all Hip Pain is caused by Arthritis

Not all chronic hip pain is due to arthritis. Hip impingement can cause significant pain during sports activity as well as daily routines including getting dressed, climbing stairs, and even sitting comfortably in a chair. Hip impingement tends to occur in active young adults, and especially athletes. It’s a painful and often unrecognized condition involving a tear in the hip labrum.

Now the damage can be repaired and the bone re-contoured using a procedure known as using hip arthroscopy. With two small incisions and a small camera, the surgeon can clearly visualize the hip ball and socket, see exactly where the impingement is, and repair the problem. Because it’s minimally invasive surgery, there’s significantly less pain, minimal scarring and a shorter recover time than with open surgery.

ONS Orthopedic surgeon Tim Greene, MD is Fellowship-trained in sports medicine and hip arthroscopy.


DePuy Orthopaedics, Inc., announced a recall of the ASR™ XL Acetabular System and DePuy ASR™ Hip Resurfacing System used in hip replacement surgery due to the number of patients who required a second hip replacement procedure.

ONS physicians have never used this device in their hip replacement procedures and none of our patients should have concerns about this recall.