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Direct Anterior for total hip replacement

What is the direct anterior approach for total hip replacement?

This less invasive surgery for hip replacement allows exposure from the front of the hip joint as opposed to the side (lateral) or to the back (posterior). In the direct anterior approach, the hip is replaced through a natural interval between muscles. The important muscles for hip function, the gluteal muscles that attach to the posterior and lateral pelvis and femur, are left undisturbed.

Lack of disturbance of the lateral and posterior soft tissues also accounts for immediate stability of the hip and lower risk of dislocation. It is normal for patients undergoing  posterior incisions to follow strict precautions that limit hip motion for the first two months after surgery. Most importantly, they are instructed to limit hip flexion to no more than 60 degrees. These limitations complicate a patient’s simple daily activities such as sitting in a chair or on the toilet or just getting in a car.

Following the direct anterior approach, however, patients may be immediately allowed to bend their hip freely and to avoid these cumbersome restrictions.  Additionally, if patients are sexually active before surgery, there are maybe no limitations on resumption of normal sexual activity after surgery. Check with your doctor.

The direct anterior approach for total hip replacement is less invasive, is easier on the tissues and allows the procedure to be performed through a smaller soft tissue ‘window’. With this approach, muscles are not cut. Instead, they are separated naturally which results in a quicker recovery period and less activity restrictions
than traditional hip replacement surgery.

The payoff for patients is less pain and a faster recovery.

Who is a candidate for the direct anterior approach for total hip replacement?

In general, anyone can benefit from a less invasive surgical technique. In some cases, due to the size or weight of the patient, the incision must be extended, but the trauma to the surrounding tissues will still be reduced when compared to traditional surgery. Your surgeon will try to keep the incision as small as possible, but there are times when the patient is best served by a larger incision. Patients with severe deformities, heterotopic bone formation due to trauma, or previous hip replacement may not be candidates for the direct anterior approach.

Direct Anterior Procedure
Following a natural plane between muscles and without detachment of muscle or tendons from the bone, the hip is exposed. The femoral neck is cut and the arthritic femoral head and neck are then removed.

Next, the arthritic acetabulum undergoes a procedure called reaming. Reamers of gradually increasing diameter accurately shape the bone of the acetabulum to accept the acetabular prosthesis. An acetabular prosthesis slightly larger in diameter than the prepared acetabular cavity is inserted with a press fit that produces initial stability. During insertion X-Ray can be used to position the prosthesis accurately. One or more screws may also be used to enhance stability.

Following insertion of the acetabular shell, the bearing surface is then inserted. A special broach is inserted into the femoral canal. Progressively larger broaches are inserted with the size being limited by the outer cortical bone.

Following insertion of the final broach, the driving handle is then removed. The broach is temporarily left in as a ‘trial’ femoral prosthesis and its upper end is capped with a trial femoral head.  If the initial trial shows undesirable length, offset, or stability, adjustments are made.

The femoral prosthesis can be secured with cement, or by press-fit with subsequent bone on-growth. Whether cement is used or not, a femoral prosthesis of specific size is accurately inserted to reproduce the fit, length, and offset indicated by trial.

The final result is achieved by reducing the hip resulting in the femoral head being placed into the acetabulum. The wound is then washed with antibiotic solution and closed.

The information listed on this site is for informational and educational purposes and is not meant as medical advice. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. The information on this site does not replace your doctor's specific instructions.