Direct Anterior Approach

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- Smaller incision

- Less pain killers required

- Not dividing muscles/tendons

- Quicker rehab, earlier return to activities including work and driving
- Can sleep on either side immediately, i.e. not on your back for 6 weeks

In traditional total hip replacement surgery (Posterior/Lateral/Hardinge approach) surgeons make an incision along the side or back of your thigh to access your hip joint. This involves cutting muscles on the side of your hip that is then repaired by the surgeon. This muscle then needs time to heal. As a result, there are various
restrictions and precautions that must be followed, eg sleeping on your back for 6 weeks, restricting your bending to put on shoes and socks.

The Direct Anterior Approach (DAA) is an alternative to the traditional approach. It leads to a quicker short term recovery. It requires a 6-10 cm incision on the front of your leg and I am able to access your hip joint by going in between the muscles. The muscles are not cut from the bone and are relatively undisturbed. This allows faster healing, helps reduce the risk of dislocation, and post-operative restrictions are not necessary. You can sleep on either side immediately. There is no restriction bending over.  

The results of hip replacement done anteriorly or via other approaches is the same, at the 12 months post surgery stage. My preference, where possible , is to perform hip replacements by the smaller incision, Direct Anterior Approach. But the decision is made on an individual basis.

However, some patients are not a candidate for an anterior approach. I will discuss that with you and recommend the most appropriate procedure. If the operation is done from the Posterior approach, this involves splitting the buttock muscle (Gluteus maximus) and then cutting the tendons of the short external rotators and then stitching them back to bone at the end of the operation. hence there tends to be a slower recovery with this posterior approach. 

Obesity, in particular abdominal obesity
Extreme muscular build
Gluteal tendons (Gluteus minimus and medius) require repair at the time of hip  replacement

Severe osteoporosis

Revision hip replacement

Bone deficiencies of the femur or acetabulum requiring significant grafting

 • Accelerated recovery time since muscles are not detached during the operation. Each patient responds differently, but in general, activity progression is faster and the need for pain medication is decreased.
• No activity restrictions after surgery.  Unless I instruct you otherwise, you may put full weight on your leg as tolerated and have no precautions to follow.
• The Australian National Joint Replacement Registry is showing an early trend to a reduced rate of dislocation and infection in DAA hip replacements. As key muscles and tissues are not disturbed during the operation.

The anterior approach is possible because of a high-tech table and special instruments. The table has padded leg supports that can be adjusted with a great deal of precision by your surgeon to help achieve excellent alignment and positioning of the implant.

Some surgeons will discredit the Direct Anterior Approach. This is ill founded. Some may not be willing to see the advantages of DAA or undertake the extra training to attain the skills of DAA after years of specialty training already.   DAA hips have been performed especially in Europe and the USA for over 50 years. It was first described in the late 1800's !

My training in DAA hips has involved visiting expert surgeons experienced in DAA hip replacements in Germany, USA and Australia.  I scrubbed in with these colleagues doing their anterior hip replacements. I also performed the surgery in cadaver laboratories, before starting to perform this surgery under the supervision of experts. Then when I was sufficiently skilled, the Australian colleagues (proctors) would scrub in with me, acting as my assistant, though I was the primary surgeon. Now having done almost 300 cases, I now support colleagues learning this technique and I scrub in to assist them as a proctor.