Direct Anterior Approach (DAA)

The direct anterior approach is one of the minimally invasive techniques used in hip replacement surgery. Continuing orthopedic experience suggests that this procedure may offer several advantages over the more traditional surgical approaches to hip replacement.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 is only 3-4 inches in length and located at the front of the hip.¹ In this position, the surgeon does not need to detach any of the muscles or tendons.¹

Traditional vs. Direct Anterior Approach

Traditional Hip Replacement

8-12 inch incision
Surgical approach - side (lateral) or back (posterior)
Disturbance of the joint and connecting tissues

Direct Anterior Approach

3-4 inch incision
Surgical approach - front (anterior)¹
Muscles or tendons not detached¹

Typical Precautions: Traditional vs. Direct Anterior

Traditional Hip Replacement

Do not cross legs⁵
Do not bend hip more than a right angle ⁵
Do not turn feet excessively inward or outward ⁵
Use a pillow between your legs when sleeping ⁵

Direct Anterior Approach

Under doctor's supervision, may be immediately allowed to move their hips
May potentially avoid restrictions associated with traditional hip replacement ²

Benefits of Direct Anterior

Decreased hospital stay and quicker rehabilitation²
Smaller incision and reduced muscle disruption may allow patients a shorter recovery time and less scarring¹
Potential for less blood loss, less time in surgery, and reduced post-operative pain^1,3,4
Risk of dislocation may be reduced ²
May allow for a more natural return to normal function and activity^{1, 3}

Discuss Your Options With Your Physician

Hip replacement, no matter how minimally invasive, is major surgery and patients are at risk for complications. However, the complication rate following joint replacement surgery is generally very low. Serious complications, such as joint infection, occur in less than 2% of patients.⁶ Besides infection, possible complications include blood clots, lung congestion or pneumonia. The risks that are normally encountered in conventional hip joint replacement remain. Recovery success depends on several factors including surgeon training and experience, the surgical approach, the implant and the patient’s health and commitment to post-operative physical therapy. Although the direct anterior approach may make sense for some patients, only your surgeon can help you decide what is best for you. Talk with your doctor if you have any questions about the direct anterior approach for total hip replacement or hip replacement in general.

¹ Wenz, J., Gurkan, I. Jibodh, S., “Mini-Incision Total Hip Arthroplasty: A Comparative Assessment of Perioperative Outcomes,” Orthopedics Magazine, 2002.
² www.anteriorhip.org, Kreuzer, S.
³ Keggi, Kristaps I., “Total Hip Arthroplasty Through a Minimally Invasive Anterior Surgical Approach,” JBJS, Vol. 85-A. 2003.
⁴ Baerga-Varela, L., Malanga, G.A., “Rehabilitation after Minimally Invasive Surgery.” Hozack, W., Krismer, M., Nogler, M., Bonutti, P., Rachbauer, F., Schaffer, J., Donnelly, W., ed. Minimally Invasive Total Joint Arthroplasty. New York, NY: Springer-Verlag; 2004: 2-5.
⁵ AAOS website, http://www.orthoinfo.org/topic.cfm?topic=A00377#Other%20Precautions, accessed Nov. 2008.
⁶ Hanssen, A.D., et al., “Evaluation and Treatment of Infection at the Site of Total Hip or Knee Arthroplasty,” JBJS, pp. 910-922.