Direct Anterior Approach To The Hip

At MCJR, we are proud to offer the direct anterior approach (DAA) for hip replacements. The DAA to the hip is a surgical exposure that places a small incision on the front side of the hip instead of the side or back. Although this approach was initially described decades ago, its popularity has dramatically increased over the last ten years for hip replacement. 

While there are several well-established ways to perform a total hip arthroplasty, the direct anterior approach offers distinct advantages. These are outlined below:

Muscle sparing

Traditional approaches for performing total hip replacements either split through muscles or release major muscle attachments in order to access the hip joint. The DAA does neither. It accesses the hip by retracting muscles out of the way and passing in between muscle groups. This decreases pain and soreness after surgery and prevents a long-term limp.

Less pain

The DAA causes less pain. Several studies have reported this advantage of the DAA. This has resulted in shorter hospital stays, less narcotic requirement, and less use of assistive devices such as canes or walkers. This lends itself naturally to performing outpatient joint replacements, which is an area where MCJR is leading the way in Indiana.

Lower dislocation risk

Hip dislocations after hip replacement are extremely painful and may be challenging to manage. While all surgical approaches have an increased risk of hip instability, the DAA decreases the risk for dislocation.

Faster recovery

Recovery after a DAA hip replacement is faster than after traditional approaches. Several well-designed studies have confirmed this consistent theme. Early recovery has been reported by more patients returning home instead of needing a rehab center, more patients climbing stairs normally, patients walking with a normal gait pattern more quickly, and higher hip function scores in the early weeks after surgery.

No hip precautions

Patients are generally free to move their hip about in any way they wish after hip replacements using a DAA. This is because the DAA spares much of the stabilizing tissue that may be released with other common approaches. These traditional approaches frequently require the patient to have restrictions on hip motions by limiting hip flexion or rotation. 

Ability to use x-ray during surgery

During surgery, the DAA allows for easy use of x-ray machines. This allows for a distinct advantage for the surgeon, because it allows for an accurate assessment of important parameters such as matching leg lengths and optimizing component position. Research has demonstrated more consistency in the positioning of the components when using the DAA compared to traditional methods.

References:

Barrett WP, Turner SE, Leopold JP. Prospective Randomized Study of Direct Anterior vs Postero-Lateral Approach for Total Hip Arthroplasty. J Arthroplasty. 28(9);2013, 1634-8.

Martin CT, Pugely AJ, Gao Y, Clark CR. A Comparison of Hospital Length of Stay and Short-term Morbidity Between the Anterior and the Posterior Approaches to Total Hip Arthroplasty. J Arthroplasty. 28(5);2013,849-54.

Zawadsky MW, Paulus M, Murray PJ, Johansen MA. Early Outcome Comparison Between the Direct Anterior Approach and the Mini-Incision Posterior Approach for Primary Total Hip Arthroplasty: 150 Consecutive Cases. J Arthroplasty. 29(6);2014, 1256-60. 

Mayr E, Nogler M, Benedetti MG, Kessler O, Reinthaler A, Krismer M, Leardini A. A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: A gait analysis study. Clinical Biomechanics. 24(10);2009, 812-8.

Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H. A Clinical Comparative Study of the Direct Anterior With Mini-Posterior Approach : Two Consecutive Series. J Arthroplasty. 24(5);2009, 698-704.

Matta J, Shahrdar C, Ferguson T. Single-incision Anterior Approach for Total Hip Arthroplasty on an Orthopaedic Table. Clin Ortho Rel Res. 441;2005,115-124.

Light TR, Keggi K. Anterior Approach to Hip Arthroplasty. Clin Ortho Rel Res. 152;1980, 255-60. 

Sariali E, Leonard Philippe, Mamoudy P. Dislocation after Total Hip Arthroplasty Using Heuter Anterior Approach. J Arthroplasty. 23(2);2008, 266-72.