Direct Superior Approach

The Direct Superior Approach (DSA) is a minimally invasive approach used in total hip replacement surgery. This muscle sparing approach for total hip replacement was developed to minimize damage to the soft tissues and muscles that are critical to the proper function of your hip and leg.1 The Direct Superior Approach was developed to allow the surgeon to avoid cutting key muscle groups, the most important being the Iliotibial (IT) band and muscles referred to as external rotators.1

Did you know that these muscles play an important role in your ability to perform everyday activities? For example, the IT band is a large muscle that extends down the outside of your leg from the pelvis to the knee. Activities such as walking and bending may be affected when this muscle is injured.

Dsa infographic

Take a Look: Incision Location and Length

Surgery is performed with the patient lying on his or her side, with an incision on the back of the hip joint that is smaller and higher up (superior) compared to a traditional posterior approach to hip replacement.1

Traditional Hip Replacement

Traditionl incision

Direct Superior Approach

Dsa incision
Patient incisions

Below are some of the potential benefits to having a total hip replacement done through the Direct Superior Approach.


  • The Direct Superior Approach was developed to minimize damage to soft tissue, muscle, and tendons that are critical to the functionality of the hip. For example, this approach avoids cutting the IT band and other key muscles around the hip.1

Smaller Incision

  • The Direct Superior Approach was developed to be performed through a smaller incision compared to a traditional posterior approach.1
  • Traditional hip replacements often require an incision that is approximately 10-12 inches long.2 In comparison, the Direct Superior Approach requires an incision that may be 3-6 inches in length.1 As a result, your scar may be smaller than traditional total hip replacement procedures.
Ruler incisions


  • The Direct Superior Approach offers the potential for enhanced hip stability and post-operative recovery.1,3,4

General Surgical Complications

Like any surgery, joint replacement surgery has serious risks. You should talk with your doctor to better understand the risks and complications before making the decision to undergo total hip replacement. Complications that may arise in the Director Superior Approach are comparable to those for other total hip replacement surgeries. Please click here to read Important Information.

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

Back on the Move.
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Trish Vogel
Hip Replacement Patient
“My Direct Superior hip replacement surgery allowed me to get back to the things I love!” 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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    1. Roger, D. J., & Hill, D. (2012). Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report. Clinical Orthopaedics and Related Research, 470(1).
    2. AAOS website,, accessed March 2016.
    3. Penenberg BL, Bolling WS, Riley M. Percutaneously assisted total hip arthroplasty (PATH): a preliminary report. J Bone Joint Surg Am. 2008;90(suppl 4):209–220
    4. Khan RJ, Fick D, Khoo P, Yao F, Nivbrant B, Wood D. Less invasive total hip arthroplasty: description of a new technique. J Arthroplasty. 2006;21:1038–1046.
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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