Direct Anterior Approach for Total Hip Replacement

The Direct Anterior Approach (DAA) is a muscle sparing approach that can be used for performing hip replacements. The procedure itself can be carried out using two slightly different techniques; one uses a specialized table that can be used to move the leg into different positions and to provide traction, the other uses a more standard operating table.   It continues to attract a lot of debate and discussion in hip meetings worldwide. Hip replacement is such a successful procedure that it can be difficult to work out when looking at results, the impact of the particular approach used to actually carry out the procedure. To date there are no longterm studies showing that after 3 months or so, there is any major difference compared with other approaches. Having said that there is no doubt that it is less invasive and less muscle is detached at the time of surgery.

My view is that this does seem to give an advantage in the initial recovery after hip replacement and patients seem to find the recovery easier and require less in the way of strong painkillers. A further advantage is that it can be done through a very cosmetic incision which would not be visible for instance when wearing a bathing costume. The Direct Anterior Approach is certainly my own preferred way of performing a hip replacement but I don’t think it is suitable for all types of hip reconstruction, particularly where this is unusual anatomy or complex deformity that needs to be addressed. Future studies will look at more discriminating functional tasks after hip replacement and over time we should be able to work out if a hip replacement carried out through the direct anterior approach feels more ‘natural’  as a result.