Anterior Approach Hip Replacement Surgery
Direct Anterior Approach Hip Replacement – Brisbane & Hamilton
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 patients having a primary total hip replacement, where it is appropriate. However, there is no single surgical approach that is best for every patient. Your anatomy, body shape, bone quality, previous surgery, hip deformity and the complexity of the replacement all need to be considered when choosing the safest and most appropriate approach.
DAA Hip Replacement Surgery
What is Direct Anterior Approach Hip Replacement?
A total hip replacement, also called total hip arthroplasty (THA), replaces the damaged surfaces of the hip joint with artificial components.
The hip is a ball-and-socket joint. During surgery:
- the damaged femoral head (ball) is removed
- a metal stem is inserted into the femur (thigh bone)
- a new ceramic or metal ball is attached to the stem
- the damaged hip socket is replaced with a metal shell
- a plastic or ceramic liner creates the new bearing surface
There are several different ways an orthopaedic surgeon can access the hip to perform this operation.
The Direct Anterior Approach (DAA) accesses the hip through an incision at the front of the hip. Rather than approaching through the muscles behind or beside the hip, the surgeon works through an anatomical interval between muscles to reach the joint.
For this reason, the Direct Anterior Approach is sometimes described as an intermuscular or muscle-sparing approach to hip replacement.
Why Use the Direct Anterior Approach for Hip Replacement?
The surgical approach is only one part of a successful hip replacement. Accurate implant positioning, appropriate implant selection, preservation of healthy tissues, stability of the new hip and good rehabilitation are also important.
One potential advantage of the Direct Anterior Approach is that the hip can be accessed without routinely detaching the major muscles or tendons around the hip.
This may assist early recovery.
A randomised controlled trial comparing Direct Anterior and posterolateral hip replacement found less early pain and better early functional recovery in the anterior group. However, by six months, functional outcomes were similar between the two approaches.
Similarly, a systematic review and meta-analysis of randomised controlled trials found better early pain and functional outcomes following the Direct Anterior Approach, but no significant difference in later functional outcomes.
Potential advantages for appropriately selected patients may therefore include:
- less disruption of major muscles and tendons
- earlier improvement in walking and function
- potentially less pain during the early recovery period
- a relatively small incision
- preservation of the muscles behind the hip that contribute to stability
However, these are potential early advantages rather than guarantees, and good long-term results can be achieved using several established approaches to hip replacement.
How is Direct Anterior Hip Replacement Surgery Performed?
The actual hip replacement components are similar regardless of the surgical approach. The main difference is how the hip joint is accessed.
1. Anaesthetic
A spinal or general anaesthetic may be used, together with additional methods of pain relief around the hip.
2. Accessing the hip from the front
An incision is made at the front of the hip.
The muscles are carefully separated through a natural interval rather than routinely cutting through the major muscle groups surrounding the hip.
This provides access to the hip capsule and joint.
3. Removing the damaged hip joint
The damaged femoral head is removed.
The natural hip socket is then carefully prepared to accept the new acetabular component.
4. Placing the new hip socket
A metal shell is inserted into the pelvis.
A highly durable plastic or ceramic liner is placed inside this shell to form the new socket.
5. Replacing the femoral head
The femur is carefully prepared and a metal stem is inserted into the thigh bone.
A new ceramic or metal ball is attached to the stem and placed into the new socket.
The hip is checked for stability, movement, implant position and appropriate leg length.
6. Closing the incision
The deeper tissues are closed with absorbable sutures.
I generally close the skin using a fine absorbable suture underneath the skin so that no external sutures need to be removed.
A glued mesh is then placed over the incision to support the skin while it heals.
Is the Direct Anterior Approach Suitable for Everyone?
No. I try to use the Direct Anterior Approach for most primary hip replacements, but some patients are better treated using a different approach.
The objective is not simply to perform every hip replacement through the same incision. The objective is to perform the safest and most appropriate hip replacement for the individual patient.
Factors that may make another approach preferable include:
- unusual hip or femoral anatomy
- severe hip deformity
- previous operations or scars around the hip
- retained metalwork from previous fracture surgery
- significant bone loss
- certain complex or revision hip replacements
- some fractures around the hip
- circumstances where specialised implants or greater surgical exposure are required
Body shape and soft-tissue distribution can also influence surgical planning and wound management.
A recent systematic review examining wound complications following Direct Anterior hip replacement identified factors including obesity as being associated with increased wound complications following DAA surgery.
If I believe another surgical approach provides safer access or a better opportunity to reconstruct the hip properly, I will recommend that approach instead.
Preparing for Direct Anterior Hip Replacement Surgery in Brisbane
Good preparation can reduce the risk of complications and make early recovery easier.
Health optimisation
Before surgery:
- stop smoking or vaping if possible
- optimise diabetes and blood sugar control
- improve general fitness and weight where appropriate
- maintain good nutrition
- tell us about previous blood clots, sleep apnoea, heart or lung problems
- tell us about previous operations or injuries around the hip
- provide a complete list of medications and supplements
Exercise before hip replacement
Maintaining general fitness and strengthening the muscles around the hip and legs can assist 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 your 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.
Your treating team will also advise which medications should be continued or temporarily stopped.
What to Expect After Direct Anterior Hip Replacement
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 the risk of blood clots
- progression from a walking frame or crutches as your confidence improves
Some suitable patients may leave hospital the following day, while others benefit from a longer stay.
First 2–6 weeks
Walking often improves relatively quickly following hip replacement, although recovery varies considerably between patients.
During this period:
- walking aids are gradually reduced as strength and confidence improve
- swelling and bruising around the hip and thigh are common
- physiotherapy focuses on walking, strength and function
- the surgical incision is monitored as it heals
- everyday activities are gradually reintroduced
Driving should only resume when you can safely control the vehicle, perform an emergency stop and are no longer affected by medications that impair driving.
6 weeks to 3 months
Most patients notice substantial improvement in their ability to walk and perform everyday activities.
Strength and endurance continue to improve.
The early recovery advantages reported with the Direct Anterior Approach tend to become less important over time. Published comparative studies generally show similar longer-term function between established surgical approaches.
3 to 12 months
Strength, balance, confidence and overall hip function can continue improving for 12 months or longer.
The long-term aim is not for you to have an “anterior hip replacement”, but rather a well-functioning hip replacement that allows you to return to comfortable everyday activity.
Long-Term Outcomes After Direct Anterior Hip Replacement
Pain relief and function
Total hip replacement is generally a very successful operation for appropriately selected patients with advanced hip arthritis.
The Direct Anterior Approach is one method of performing that operation.
A systematic review comparing Direct Anterior and posterior hip replacement found evidence of better early recovery with DAA but no significant difference in pain or hip function at later follow-up.
This is important when considering the benefits of the approach: DAA may offer advantages during early recovery, but current evidence does not demonstrate that it produces a better hip replacement in the long term.
How long does a hip replacement last?
The longevity of the hip replacement is more closely related to factors such as implant fixation, bearing surfaces, patient factors and implant positioning than to the location of the skin incision.
A major systematic review and meta-analysis of long-term total hip replacement survival estimated that approximately 58% of hip replacements remained unrevised at 25 years using national joint replacement registry data.
Many modern hip replacements therefore function successfully for decades.
Does the Direct Anterior Approach have additional risks?
Every surgical approach has advantages and disadvantages.
One complication particularly associated with the Direct Anterior Approach is irritation or injury to the lateral femoral cutaneous nerve, a sensory nerve supplying the skin on the outer thigh.
This can produce an area of numbness, tingling or altered sensation around the outer thigh.
A systematic review of lateral femoral cutaneous nerve symptoms following Direct Anterior hip replacement found considerable variation in reported rates between studies. These symptoms are often sensory rather than affecting the strength of the leg.
Other complications, including fracture, infection, blood clots, dislocation and implant problems, can occur following any hip replacement approach.
Things to Look Out for After Direct Anterior Hip Replacement
Contact our office, your GP, or seek urgent medical attention if you develop:
Possible infection
- increasing redness or warmth around the incision
- increasing pain after initially improving
- persistent wound leakage or pus
- fever, chills or feeling significantly unwell
Possible blood clot
Seek medical attention for:
- new calf pain or tenderness
- significant one-sided leg swelling
- sudden shortness of breath, chest pain or coughing blood
Sudden breathing symptoms require emergency assessment.
Wound problems
Because the anterior incision sits near the crease at the front of the hip, keeping the wound and dressing clean and dry is particularly important.
Persistent leakage, opening of the incision, increasing redness or other concerns about wound healing should be assessed.
Numbness around the thigh
An area of numbness or altered sensation around the outer thigh can occur following the Direct Anterior Approach because of the nearby lateral femoral cutaneous nerve.
Please let us know if symptoms are severe, painful or worsening.
Hip dislocation
Dislocation is uncommon but can occur after any hip replacement.
Sudden severe hip pain, inability to move the leg or a leg that appears shortened or abnormally rotated requires urgent assessment.
Nerve or circulation problems
Increasing weakness, extensive numbness, a cold or pale foot, or severe escalating pain requires urgent medical 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 orthopedic 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 and later underwent specialist orthopaedic training in Queensland, achieving Fellowship status with the Royal Australasian College of Surgeons in Orthopaedic Surgery.
He offers consultations in Hamilton, Brisbane, and conducts private orthopaedic surgery at Brisbane Private Hospital.