DAA hip replacement accesses the joint from the front while preserving major muscle attachments.
This page provides general information for patients of Dr Borshch, an orthopaedic surgeon consulting in Hamilton, Brisbane, who are being assessed for or considering Direct Anterior Approach (DAA) hip replacement surgery.
I use the Direct Anterior Approach for most suitable primary hip replacements, but not every patient or hip is best treated through this approach.
Your individual treatment should therefore follow advice from your surgeon and treating team.
What is Direct Anterior Approach Hip Replacement?
DAA is a way of performing a total hip replacement through the front of the hip.
A total hip replacement, also called total hip arthroplasty (THA), replaces the damaged ball and socket of the hip with artificial joint surfaces.
There are several established ways for an orthopaedic surgeon to reach the hip joint. These include anterior, lateral and posterior approaches.
The Direct Anterior Approach (DAA) reaches the hip through an incision at the front of the joint.
Rather than routinely detaching the major muscles around the hip, the surgeon works through an anatomical interval between muscles to reach the joint. For this reason, DAA is sometimes described as an intermuscular or muscle-sparing approach.
The hip replacement itself is not fundamentally different. It still generally consists of:
- a metal socket inserted into the pelvis
- a durable plastic or ceramic liner
- a metal stem inserted into the femur
- a ceramic or metal ball attached to the stem
The difference is primarily how the surgeon reaches the hip to perform the replacement.
Why is the Direct Anterior Approach Used for Hip Replacement
DAA may aid early recovery, but long-term results are similar to other established approaches.
The main reason for hip replacement is usually advanced hip arthritis causing significant pain, stiffness and loss of function despite appropriate non-operative treatment.
The Direct Anterior Approach is one way of performing that operation.
A potential advantage of DAA is that the hip can be accessed without routinely detaching the major muscles and tendons behind or beside the joint. This may reduce some of the soft-tissue disruption associated with surgery and can contribute to earlier functional recovery in some patients.
A systematic review and meta-analysis of randomised controlled trials comparing DAA with posterior hip replacement found less early pain and better early functional scores with the anterior approach. However, there was no significant difference in later functional outcomes, overall complications or radiographic outcomes.
A larger meta-analysis of 24 studies and 2,010 patients similarly found better early functional outcomes and a slightly shorter hospital stay with DAA compared with posterior surgery, but no significant differences in several major complications.
This distinction is important.
DAA may provide advantages during early recovery, but current evidence does not demonstrate that it produces a better hip replacement in the long term.
A randomised trial with an average 7.5 years of follow-up found that small early functional differences between anterior and mini-posterior hip replacement did not translate into meaningful differences in longer-term clinical outcomes.
The surgical approach is therefore only one part of a successful hip replacement.
How is Direct Anterior Hip Replacement Surgery Performed?
The hip is replaced through an interval between muscles at the front of the joint.
Anaesthetic
A spinal or general anaesthetic may be used, together with additional methods of pain relief around the hip.
Accessing the hip
An incision is made at the front of the hip.
The surgeon carefully works between the muscles to reach the capsule surrounding the hip joint.
This provides access to the arthritic ball and socket without routinely detaching the major muscle groups surrounding the hip.
Removing the damaged hip joint
The damaged femoral head is removed.
The natural hip socket is then prepared to accept the new acetabular component.
Replacing the hip socket
A metal shell is inserted into the pelvis, usually using a press-fit technique.
A highly durable plastic or ceramic liner is placed inside the shell to create the new socket.
Replacing the femoral head
The femur is carefully prepared and a metal stem is inserted into the thigh bone.
A ceramic or metal ball is attached to the stem and placed into the new socket.
The hip is checked for:
- stability
- movement
- implant position
- appropriate leg length
- muscle tension
Closing the incision
The deeper tissues are closed with absorbable sutures.
I generally close the skin with a fine absorbable suture underneath the skin and use a glued mesh over the incision to support the skin during healing.
Is the Direct Anterior Approach Suitable for Everyone?
I use DAA for most primary hip replacements, but another approach may suit some patients better.
I try to use the Direct Anterior Approach for most patients undergoing primary total hip replacement when I believe it is appropriate.
However, the objective is not to perform every hip replacement through the same incision. The objective is to perform the most appropriate reconstruction for the individual hip.
Factors that can influence the choice of approach include:
- unusual hip or femoral anatomy
- severe deformity
- previous surgery and scars
- retained plates, screws or other metalwork
- significant bone loss
- some fractures around the hip
- complex or revision hip replacement
- the type of specialised implant required
- body shape and soft-tissue distribution
Wound healing is also relevant when selecting an approach. A systematic review examining surgical approach and infection risk in patients with obesity found that obesity increased infection risk after hip replacement generally, with some evidence of additional wound and infection risk in patients with higher BMI undergoing DAA.
Diabetes and obesity have also been associated with wound-healing problems specifically after anterior hip replacement.
If I believe another approach provides better access or a more appropriate way to reconstruct the hip, I will recommend that approach instead.
How Should I Prepare for DAA Hip Replacement in Brisbane?
Optimising your health, strength and home can make early recovery easier.
Health preparation
Before surgery:
- stop smoking or vaping if possible
- optimise diabetes and blood sugar control
- improve general fitness and weight where appropriate
- maintain good nutrition
- provide a complete list of medications and supplements
- tell us about blood-thinning medications
- tell us about previous blood clots, heart or lung conditions and sleep apnoea
- tell us about previous operations or injuries around the hip
Prehabilitation
Maintaining general fitness and strengthening the muscles around the hips and legs can help prepare you for recovery.
You do not need to make an arthritic hip pain-free before surgery. The aim is to arrive at surgery as mobile, strong and medically healthy as reasonably possible.
Preparing your home
Arrange help with shopping, meals and transport during early recovery. Remove loose rugs and other trip hazards and make sure frequently used items are easy to reach.
Because Brisbane has a warm and humid climate, particularly during summer, consider making sure you have access to a cool, comfortable and preferably air-conditioned environment during early recovery. Apart from making recovery more comfortable, published research has found an association between warmer weather and higher rates of surgical-site infection.
Keeping yourself comfortable and your surgical dressing clean and dry is therefore particularly important during Brisbane's warmer months.
What Should I Expect After Direct Anterior Hip Replacement?
Walking starts early, while strength and endurance continue improving for months.
In hospital
One of the priorities following hip replacement is early mobilisation.
You can expect:
- several different forms of pain relief
- standing and walking with physiotherapy
- exercises to restore strength and movement
- measures to reduce blood-clot risk
- a frame or crutches initially where required
Some suitable patients may leave hospital the following day, while others benefit from a longer stay.
First 2 weeks
Walking generally begins immediately and progresses according to comfort, strength and confidence.
Swelling and bruising around the hip and thigh are common.
Physiotherapy focuses on safe walking and simple strengthening exercises. The incision should be kept clean and dry while it heals.
2–6 weeks
Walking aids can progressively be reduced as strength and confidence improve.
Do not rush to stop using a walking aid if this causes a significant limp.
Driving should resume only when you can safely control the vehicle, perform an emergency stop and are no longer affected by medication that impairs driving.
6 weeks–3 months
Most patients notice substantial improvement in everyday activities.
Strength and endurance continue to improve.
The early recovery differences reported between surgical approaches become less apparent over time. The randomised-trial meta-analysis comparing anterior and posterior approaches found no significant difference in functional outcomes at later follow-up.
3–12 months
Strength, balance, endurance and confidence can continue improving for many months.
The long-term objective is not simply to have an “anterior hip replacement”, but a stable, comfortable and well-functioning hip replacement.
What Are the Long-Term Outcomes After DAA Hip Replacement?
Long-term success depends more on the hip replacement than on the location of the incision.
Total hip replacement generally provides substantial improvement in pain and function for appropriately selected patients with advanced hip arthritis.
The available evidence suggests that the main potential advantages of DAA occur during the early recovery period, rather than producing substantially different long-term outcomes.
A 2025 systematic review and meta-analysis involving more than 44,000 patients found similar rates of revision, dislocation and fracture between direct anterior and posterior approaches, with no significant difference in Harris Hip Scores.
How long does the hip replacement last?
The longevity of a hip replacement is influenced by implant fixation, bearing surfaces, implant position, patient factors and activity rather than simply the surgical approach.
A major systematic review and meta-analysis of long-term hip replacement survival estimated from national registry data that approximately 58% of total hip replacements remained unrevised at 25 years.
These are population estimates and cannot predict how long an individual hip replacement will last.
What Are the Specific Risks of the Direct Anterior Approach?
DAA has some approach-specific risks, particularly skin numbness and wound concerns.
Every surgical approach has advantages and disadvantages.
Numbness or altered sensation
A sensory nerve called the lateral femoral cutaneous nerve passes near the anterior surgical approach.
Irritation or injury to this nerve can produce:
- numbness
- tingling
- burning sensations
- altered sensation over the outer thigh
This generally affects sensation rather than muscle strength.
A meta-analysis of randomised studies comparing anterior and posterolateral hip replacement found lateral femoral cutaneous nerve symptoms were more common with DAA.
Symptoms may improve over time, although an area of altered sensation can persist in some patients.
Wound problems
The anterior incision is located near the hip crease, so wound care is particularly important.
Obesity, diabetes and soft-tissue distribution can increase wound-healing risk. A systematic review of wound complications after DAA hip replacement identified obesity among the most frequently reported risk factors.
Fracture
Fracture of the femur can occur during any hip replacement. The technical demands of preparing the femur through an anterior approach can influence this risk, particularly during a surgeon's learning curve or in difficult anatomy.
The choice of approach should therefore consider patient anatomy as well as surgeon experience.
Warning Signs After Anterior Hip Replacement
Worsening wounds, severe pain, leg swelling or sudden loss of function require assessment.
Contact our office, your GP or seek medical attention if you develop:
Possible infection
- increasing redness or warmth around the incision
- worsening pain after initially improving
- persistent wound leakage or pus
- fever or feeling significantly unwell
Possible blood clot
Seek medical attention for new calf pain or significant one-sided leg swelling.
Sudden shortness of breath, chest pain or coughing blood requires emergency assessment.
Wound problems
Persistent leakage, opening of the incision or increasing redness should be assessed.
Keeping the anterior incision clean and dry, particularly within the hip crease, is important during early healing.
Hip dislocation
Dislocation can occur after any hip replacement.
Sudden severe hip pain, inability to move the leg or a leg appearing shortened or abnormally rotated requires urgent assessment.
Nerve symptoms
Some altered sensation around the outer thigh can occur following DAA.
Please let us know if numbness, burning pain or other nerve symptoms are severe or worsening.
Nerve or circulation problems
Increasing muscle weakness, extensive new numbness, a cold or pale foot, or severe escalating pain requires urgent assessment.
Direct Anterior Approach Hip Replacement
Dr Alexey Borshch is a specialist orthopaedic surgeon in Brisbane with a particular clinical focus on surgery of the hip, knee and lower limb.
His practice as a Brisbane Orthopaedic Surgeon focuses on the assessment and treatment of hip arthritis and hip injuries, mainly performing hip replacement and revision hip replacement surgery.
Dr. Borshch completed his medical degree at the University of Queensland before undertaking specialist orthopaedic training in Queensland. He completed the Australian Orthopaedic Association training program and the Royal Australasian College of Surgeons Fellowship Examination in Orthopaedic Surgery. He obtained specialist registration in Orthopaedic Surgery in 2022 and is a Fellow of the Australian Orthopaedic Association.
He offers consultations in Hamilton, Brisbane, and conducts private orthopaedic surgery at Brisbane Private Hospital.