Direct Anterior Approach Total Hip Replacement

Traditional hip replacement surgery involves making an incision on the side of the hip (lateral approach) or the back of the hip (posterior approach). Both techniques involve detachment of muscles and tendons from the hip in order to replace the joint. Detachment of these muscles may result in increased pain after surgery, and often prolongs the time to fully recover by months or even years. Failure of these muscles to heal after surgery may increase the risk of hip dislocation (the ball and socket separating), which is the leading cause of hip replacement failure. Hip precautions after surgery (no bending greater than 90 degrees, no crossing legs, no excessive rotation) are generally required for this reason.

Direct anterior hip replacement is a minimally invasive surgical technique. This approach involves a 3 to 4 inch incision on the front of the hip that allows the joint to be replaced by moving muscles aside along their natural tissue planes, without detaching any tendons. This approach often results in quicker recovery, less pain, and more normal function after hip replacement. Because the tendons aren’t detached from the hip during direct anterior hip replacement, hip precautions are typically not necessary. This allows patients to return to normal daily activities shortly after surgery with a reduced risk of dislocation.

Possible benefits of Direct Anterior Approach (Minimally Invasive) Total Hip Replacement

Total hip arthroplasty is one of the most effective operations available in the field of orthopedic surgery. Surgery first involves removing the arthritic ball and socket using specialized instruments. A metal stem is placed within the femur and a metal socket is placed within the pelvis. A ceramic or metal ball is then placed on the stem and a dense plastic bearing is placed within the socket. The metal components are roughened and coated with a biological material which allows a patient’s own bone to grow into the metal, which allows the metal to become rigidly fixed. The artificial ball and plastic bearing are extremely smooth, which allows the hip to function and move similarly to a normal hip.

Regardless of the surgical approach, hip replacement has a success rate approaching 95% in terms of “success” (defined as an improvement of pain, function, and quality of life).

The major advantages of direct anterior hip replacement in comparison to traditional approaches include a more rapid recovery, less pain in the immediate postoperative period, more normal gait mechanics, and a more stable artificial hip without the need for hip precautions.

Regardless of the surgical approach, the most important factor in terms of technical success involves placing the hip replacement components in an optimal position.