Direct Anterior Total Hip Replacement (DAA)

Hip Replacement

Hip Replacement

Hip pain can come from a multitude of sources, many of them not related to arthritis. But for many unlucky patients the surface of their joints are worn out and the only surgical option for them is hip replacement. This involves removing the arthritic portion of the femoral head (ball) and placing a stem (metal wedge) into their femur (thigh bone) as well as resurfacing their acetabulum (socket) and placing a shell or cup into their socket.  At this point a liner, either ceramic or highly cross-linked polyethylene (plastic) is placed into the socket. A new head (ball) is placed onto the femoral stem and is made out of either ceramic or cobalt chrome (metal). The hip is then put back into place and the incision closed.

There are many different approaches to the hip:

Anterolateral, Posterior, and Direct Anterior

All three approaches have advantages and disadvantages. Well trained in all three approaches to the hip I prefer the direct anterior (DA) approach. While it's variable how quickly a patient recovers from a hip replacement and likely there’s limited if any difference regardless of approach, I prefer DA for a few reasons.

  1. Intra-operative fluoroscopy allows me to place the acetabular cup (new socket) and screws precisely
  2. Given the DA approach is from the front I generally do not place restrictions on patients post-operatively (this is important in elderly demented patients presenting with hip fracture)
  3. It is a muscle sparing approach and does not destabilize the hip

In short the direct anterior approach is performed through an approximately 8-10cm incision on the front of the thigh that can be angled from the belt line toward the side of the hip, straight down the thigh or a "bikini" incision. Regardless of skin incision the deep dissection goes between muscles until the hip capsule is encountered. Some surgeon will remove the capsule, whereas I prefer to preserve the capsule and repair it at the end of the procedure. From here a standard hip replacement is performed where the acetabulum or socket is shaped to fit a new titanium socket and the femur or thigh bone has a titanium stem placed into it with a new ball.  Once complete the hip is reduced and sutured closed. 

As a patient you will be up and walking the day of surgery and most patients go home the next day. If deemed a candidate, some patients can have their hip replacement performed in an outpatient setting and go home the same day as their hip replacement.  

Call to schedule an appointment today. Whether you need a hip replacement or just have hip pain!



Direct Anterior hip Replacement Video (Animation)


Information on Direct Anterior Total Hip Replacement

Dr. Dustin Woyski Orthopedic Surgeon and Hip Specialist

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