Direct Anterior Approach

The Direct Anterior Approach is one of the minimally invasive techniques used in total hip replacement surgery. Continuing orthopaedic experience suggests that this technique may be associated with reduced muscle damage and pain, as well as faster post-operative recovery.1

Traditional hip replacement techniques involve operating from the side (lateral) or the back (posterior) of the hip, which requires a significant disturbance of the joint and connecting tissues and an incision approximately 8-12 inches long.

In comparison, the Direct Anterior Approach requires an incision that may be 3-4 inches in length and located at the front of the hip.2 In this position, the surgeon does not need to detach any of the muscles or tendons.2 The table below illustrates the key potential benefits between traditional replacement and the Direct Anterior Approach.

Surgical Considerations
Traditional Hip Replacement Direct Anterior Approach
8-12 inch incision2 May be a 3-4 inch incision2
Surgical approach - side (lateral) or back (posterior)2 Surgical approach - front (anterior)2
Disturbance of the joint and connecting tissues2 Reduced muscle damage2
Typical Precautions
Traditional Hip Replacement Direct Anterior Approach
Do not cross legs3 Under a doctor's supervision, patient may be assisted to walk later on the day of surgery
Do not bend hip more than a right angle3 May potentially avoid some restrictions associated with traditional hip replacement4
Do not turn feet excessively inward or outward3
Use a pillow between your legs when sleeping3

General Surgical Complications

As with any surgery, hip replacement carries certain risks. Some complications may be more common with the Direct Anterior Approach, including bone and soft tissue complications. You should talk with your doctor to better understand the risks and complications before making the decision to undergo total hip replacement. Below are some complications that may arise in DAA total hip replacement procedures.

  • Soft tissue injuries
  • Blood loss
  • General hip surgery complications which may include inadvertent leg lengthening, dislocation, and medical complications such as deep vein thrombosis (DVT) and infection.
Potential Benefits of Direct Anterior
Decreased hospital stay and quicker rehabilitation4-7
Potential for smaller incision and reduced muscle disruption may allow patients a shorter recovery time and less scarring2
Potential for less blood loss, less time in surgery, and reduced post-operative pain2, 8-9
Due to the minimally invasive nature, patients may have a decreased risk of hip dislocation after surgery.4,7
May allow for a more natural return to normal function and activity compared to the posterior lateral approach2,5,8

It's Your Move. Find a surgeon in your area familiar with the Direct Anterior Approach and see if hip replacement is right for you.

Back on the Move
Lorre Haschke
Hip Replacement Patient
To this day, people who live in my Houston subdivision still knock on my door and ask: Are you the lady who had both hips and a knee done and then we saw you walking? Who do you go to? I'm fine. I go. I do. I'm happy." Individual results vary. Not all patients will have the same post-operative recovery and activity level. See your orthopaedic surgeon to discuss your potential benefits and risks.
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Ron Ivy
Hip Replacement Patient
"People used to ask me what was wrong: You have problems walking. Is it your hip?" recounts Ron. "Now, I walk, get up from my chair, get up and down off the floor, lift weights, dance, play golf and much more. It's been a remarkable story." Individual results vary. Not all patients will have the same post-operative recovery and activity level. See your orthopaedic surgeon to discuss your potential benefits and risks.
View Full Testimonial
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References:

    References

    1. Post, Zachary D., MD, Orozco, Fabio, MD, Diaz-Ledezma, Claudio, MD, Hozack, William J., MD, Ong, Alvin, MD 2014© Journal of the American Academy of Orthopaedic Surgeons.
    2. Wenz, J., Gurkan, I. Jibodh, S., “Mini-Incision Total Hip Arthroplasty: A Comparative Assessment of Perioperative Outcomes,” Orthopedics Magazine, 2002.
    3. AAOS website, www.orthoinfo.org/topic.cfm?topic=A00377#Other%20Precautions, accessed Nov 2014.
    4. www.anteriorhip.org, Kreuzer, S.
    5. J Moskal, MD. “Anterior Approach in THA Improves Outcomes: Affirms”. Orthopedics 34.9 (2011): e456-e458.
    6. W Barret, MD, S Turner. “Prospective Randomized Study of Anterior vs. Postero-Lateral Approach for Total Hip Arthroplasty”. American Academy of Orthopaedic Surgeons Annual Meeting 2012. Presentation number 655.
    7. E Sariali, MD, P Leonard, MD, P Mamoudy, MD. “Dislocation After Total Hip Arthroplasty Using Heuter Anterior Approach”. The Journal of Arthroplasty 23.2 (2008): 269.
    8. Keggi, Kristaps I., “Total Hip Arthroplasty Through a Minimally Invasive Anterior Surgical Approach,” JBJS, Vol. 85-A. 2003.
    9. Baerga-Varela, L., Malanga, G.A., “Rehabilitation after Minimally Invasive Surgery.”
Important information

U.S. Modular Hip Settlement Program

Stryker's Voluntary Recall of Rejuvenate and ABG II Modular-Neck Hip Stems

Hip Replacements

Hip joint replacement is intended for use in individuals with joint disease resulting from degenerative and rheumatoid arthritis, avascular necrosis, fracture of the neck of the femur or functional deformity of the hip.

Joint replacement surgery is not appropriate for patients with certain types of infections, any mental or neuromuscular disorder which would create an unacceptable risk of prosthesis instability, prosthesis fixation failure or complications in postoperative care, compromised bone stock, skeletal immaturity, severe instability of the joint, or excessive body weight.

Like any surgery, joint replacement surgery has serious risks which include, but are not limited to, pain, infection, bone fracture, change in the treated leg length (hip), joint stiffness, hip joint fusion, amputation, peripheral neuropathies (nerve damage), circulatory compromise (including deep vein thrombosis (blood clots in the legs)), genitourinary disorders (including kidney failure), gastrointestinal disorders (including paralytic ileus (loss of intestinal digestive movement)), vascular disorders (including thrombus (blood clots), blood loss, or changes in blood pressure or heart rhythm), bronchopulmonary disorders (including emboli, stroke or pneumonia), heart attack, and death.

Implant related risks which may lead to a revision of the implant include dislocation, loosening, fracture, nerve damage, heterotopic bone formation (abnormal bone growth in tissue), wear of the implant, metal and/or foreign body sensitivity, soft tissue imbalance, osteolysis (localized progressive bone loss), audible sounds during motion, and reaction to particle debris. Hip implants may not provide the same feel or performance characteristics experienced with a normal healthy joint.

The information presented is for educational purposes only. Speak to your doctor to decide if joint replacement surgery is appropriate for you. Individual results vary and not all patients will return to the same activity level. The lifetime of any joint replacement is limited and depends on several factors like patient weight and activity level. Your doctor will counsel you about strategies to potentially prolong the lifetime of the device, including avoiding high-impact activities, such as running, as well as maintaining a healthy weight. It is important to closely follow your doctor’s instructions regarding post-surgery activity, treatment and follow-up care. Ask your doctor if a joint replacement is right for you.

Stryker Corporation or its other divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Mako, Mobile Bearing Hip, Stryker, Together with our customers, we are driven to make healthcare better. All other trademarks are trademarks of their respective owners or holders.

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