Direct Anterior Approach for THR

The Direct Anterior (DA) approach to perform total hip replacement is a newer way of opening up the hip joint through an incision in the front of the thigh. It is generally right around where your front pocket would be, approximately 4-5 inches in length. The incision is positioned between the muscles of the thigh, namely the tensor fascia lata and the sartorius muscles, so neither muscle is disrupted.

The procedure is performed with the assistance of x-ray guidance, so component position and leg lengths are very accurately reproduced. Because the posterior capsule is intact, patients are able to move their hip into positions that they wouldn’t be allowed to with a posterior approach THR. These movements include sitting in chairs, using regular toilet seats, crossing the legs, and driving a car.

Additionally, patients are able to sleep without a pillow between their legs, and bend down to pick things up earlier than with a posterior approach. Because the hip can move in these directions, many patients feel that their recovery is faster and that they may be able to return to work earlier.

Scientific studies have not demonstrate that the recovery with an anterior approach THR is any faster than with a posterior approach. I believe that both approaches will produce a functional, pain-free hip in a short amount of time after surgery.

With the anterior hip approach, there is the risk of damage to a cutaneous (skin) sensory nerve that supplies the lateral part of the thigh. Therefore, there is the possibility of a permanent “numb” spot on the lateral thigh. Most patients find that they get used to this numbness and don’t feel any disability.