The Facts about Direct Anterior Hip Replacement


Headshot of Jonathan Sunkin, MD

Jonathan Sunkin, MD

A man exercising holds his hip in pain.

Hip replacement surgery is one of the most common surgeries in the United States, with hundreds of thousands of procedures performed each year.

As the American population continues to age, it’s a safe bet that the number of hip replacement surgeries performed each year is only going to increase.

At a basic level, hip replacement surgery involves swapping out a painful or worn-out hip joint and using a modern artificial joint in its place to help reduce pain and improve mobility.

Most hip replacement procedures are performed using the posterior approach: the patient lies on his or her side and the surgeon uses an incision slightly behind the hip to access the joint.

In recent years, however, another surgical approach has become increasingly popular: direct anterior hip replacement.

What is direct anterior hip replacement?

Direct anterior hip replacement, sometimes referred to as a minimally invasive hip replacement, involves approaching the hip joint from a different angle, namely from the front (anterior) instead of the back (posterior).

With direct anterior hip replacement, the patient lies on his or her back, not side. 

At South Shore Orthopedics, we use a Hana® orthopedic surgery table, which is a specialized piece of equipment, to make things easier for both the patient and the surgery team.

The Hana® table keeps the patient’s torso securely in place while allowing the surgeon to move each leg individually in order to find the optimal access point for the hip joint.

Once the patient is properly positioned, the surgeon makes a single incision on the upper thigh, near the front of the hip, and the procedure begins.

In most cases, the incision from a direct anterior hip replacement is significantly smaller than the corresponding incision from a posterior hit replacement.

Is direct anterior hip replacement a new procedure?

Direct anterior hip replacement is not new — it has been around for decades, just as long as posterior surgery. 

What is new is its increased popularity, as patients who are more active are seeking a less invasive technique that allows for a quicker recovery. This has led to heightened interest in this approach.

Traditionally, direct anterior hip replacement had been less common than posterior hip replacement for a number of reasons, including the fact that the procedure requires dedicated equipment and surgeons with specialized training.

However, in recent years, as studies have found that the direct anterior approach can offer improved results and a speedier recovery, more patients have been asking about this method.

As a result, more surgeons have sought out training and the direct anterior approach is being used with increased frequency.

What are the benefits of direct anterior hip replacement?

As is the case with any surgery, post-operative outcomes are going to vary from patient to patient.

But in most cases, the most obvious and immediate benefits are a smaller incision and a shorter hospital stay.

In fact, some direct anterior hip replacement patients go home the same day as their procedure, and most return home within 24 hours.

Additionally, because anterior hip replacement surgery does not require cutting major muscles, typically patients experience less pain after surgery and require less pain medication. 

Overall, patients are more comfortable in the early weeks of recovery, and often stop using a cane or crutches soon after the surgery.

Why does direct anterior hip replacement often have a faster recovery time?

While the incision location for anterior and posterior hip replacements may be just a few inches apart, those inches make a big difference.

It all has to do with the position of muscles around the hips: in a posterior hip replacement, surgeons often have to cut through or detach muscles in order to have access to the hip joint.

Then, after the new joint is in place, those muscles must be repaired or reattached before the incision is closed.

With direct anterior hip replacement, surgeons do not disrupt the muscles or attachments, and work between the muscular intervals instead to gain access to the hip joint.

As a result, no reattachment or surgical repair of muscle is required, which often means less pain after the procedure is complete.

Are all patients candidates for direct anterior hip replacement?

While direct anterior hip replacement is a great option for many patients, it won’t work for everyone.

Patients who are obese or very overweight may not be good candidates due to excess tissue around the hip joint and the risk of infection with surgery.  Rarely, patients may have extensive degenerative deformity that also prohibits the direct anterior approach.

However, more than 90% of patients should be good candidates for direct anterior hip replacement.

Interested in learning more about direct anterior hip replacement?

Call South Shore Orthopedics at 781-337-5555 to schedule an appointment to discuss your hip arthritis.

Jonathan Sunkin, MD is a board-certified orthopedic surgeon at South Shore Orthopedics. He is fellowship trained in total joint arthroplasty, with expertise in the direct anterior approach to hip replacement.

Learn more about Total Joint Replacement at South Shore Health.