Hip replacement surgery is a common procedure that helps relieve pain and improve mobility in people with severe hip problems. It aims to improve the patient’s overall quality of life, reduce discomfort, and increase joint function. The direct anterior approach (DAA) is a less invasive technique and offers faster recovery times. Unlike traditional methods, the DAA involves accessing the hip joint from the front of the body.

This approach allows the orthopaedic surgeon to work between muscles and tissues without detaching them from the bone, leading to less pain, faster recovery and lower dislocation risk. This blog will explain its indications, benefits, detailed procedural steps, recovery and possible risks.

Indications for the Direct Anterior Approach

A direct anterior approach is recommended for people with severe hip discomfort and limited mobility. This method works for:

People with Hip Osteoarthritis

Osteoarthritis is a condition in which the cartilage in the hip joint wears down over time, causing pain and stiffness. Patients with severe osteoarthritis often benefit from hip replacement surgery to restore movement and relieve pain.

People with Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, including the hips. When medications and other treatments don’t work, hip replacement using the direct anterior approach can help improve the patient’s quality of life.

People with Avascular Necrosis

Avascular necrosis occurs when the blood supply to the hip bone is reduced, leading to bone damage. A hip replacement can be necessary when this condition severely affects the hip joint.

People with Severe Hip Fractures

In cases of severe hip fractures, particularly in elderly patients, hip replacement may be necessary. The direct anterior approach allows for a minimally invasive procedure, reducing recovery time and improving overall outcomes.

The direct anterior approach is ideal for people looking for less invasive surgery with the potential for faster recovery and better overall results.

Benefits of the Direct Anterior Approach

The direct anterior approach (DAA) offers several advantages over traditional hip replacement methods:

Less Muscle Damage

The DAA allows the orthopaedic surgeon to work between muscles and tissues without cutting them, reducing pain and speeding up recovery.

Faster Recovery

Patients often experience quicker rehabilitation and shorter hospital stays due to the procedure’s minimally invasive nature.

Reduced Pain

Patients typically report less postoperative pain with the direct anterior approach. The preservation of muscle tissue reduces discomfort and a smoother recovery process.

Lower Dislocation Risk

This approach offers a lower risk of hip dislocation after surgery. The muscles and tissues around the hip joint are left more intact, providing better stability for the new hip joint.

Improved Mobility

Patients may experience a quicker return to normal hip function, improving overall mobility and quality of life.

These benefits make the direct anterior approach a preferred option for many patients needing hip replacement surgery, enhancing both the surgical experience and the recovery process.

Step-by-step Procedure of the Direct Anterior Approach

The direct anterior approach for hip replacement surgery involves several key steps:

Preoperative Preparation

Before the surgery, patients undergo a medical examination that includes imaging procedures, such as MRIs or X-rays, and blood tests to determine the hip joint’s condition. The orthopaedic surgeon plans the surgery based on the patient’s anatomy and joint damage severity. Patients are given instructions on fasting and medication adjustments to prepare for surgery.

Surgical Procedure

Step 1: Anaesthesia

The patient is administered general anaesthesia or spinal anaesthesia to ensure they are pain-free during the surgery.

Step 2: Incision

A small incision, typically 7.6 to 10.2 cm long, is made at the front of the hip. This location allows the orthopaedic surgeon to access the hip joint without cutting through major muscles.

Step 3: Accessing the Hip Joint

The orthopaedic surgeon navigates between the muscles and tissues. This approach reduces muscle damage and preserves strength.

Step 4: Removing the Damaged Joint

The damaged femoral head (the hip joint ball) and the acetabulum (the hip joint socket) are removed.

Step 5: Inserting the Implant

The orthopaedic surgeon inserts the hip replacement components. A metal or ceramic ball is attached to a stem placed into the femur (thigh bone), and a new socket is inserted into the acetabulum. These components are designed to fit together and mimic the natural movement of the hip joint.

Step 6: Ensuring Proper Alignment

The surgeon checks the fit and alignment of the new hip joint to ensure it moves smoothly and is stable. Adjustments are made as needed to achieve the best possible result.

Step 7: Closing the Incision

The incision is closed using sutures or surgical staples. A sterile dressing is applied to protect the wound.

Post-surgery Care

Following the surgery, patients are brought to the recovery area, where they are observed until the anaesthesia wears off. Pain management, physical therapy, and instructions for home care are provided to support the recovery process.

This step-by-step guide highlights the direct anterior approach for hip replacement surgery to provide patients with less pain and improved mobility.

Recovery and Rehabilitation

Initial Recovery Phase

After the procedure, patients begin mobilising with a walker or crutches to promote blood circulation and start healing, usually on the same day.

Physical Therapy

Physical therapy begins shortly after surgery, focusing on exercises to improve motion, strengthen muscles, and prevent stiffness, gradually increasing in intensity.

Home Recovery

Once discharged, patients continue their recovery at home, following prescribed physical therapy routines and attending follow-up appointments to monitor healing and implant function.

Long-Term Rehabilitation

Full recovery can take several months. Over time, patients gradually return to normal activities, with many resuming low-impact sports and exercises. Continuous strengthening exercises and regular monitoring help maintain hip function and prevent complications.

Risks of the Direct Anterior Approach

The direct anterior approach also carries certain risks, including:

Nerve Damage

There is a possibility of injury to the lateral femoral cutaneous nerve, which may result in numbness or pain in the thigh.


During the procedure, there is a risk of causing fractures to the femur or pelvis, particularly in patients with weaker bones.

Implant Issues

The implant may loosen or wear over time and require specialist attention.

Muscle Weakness

There can be temporary or permanent muscle weakness due to the surgical manipulation of tissues.


The direct anterior approach (DAA) for hip replacement surgery offers a less invasive option with potential benefits such as faster recovery and lower dislocation risk compared to traditional methods. However, it also presents challenges and risks that require careful patient selection. Understanding the benefits and risks of DAA helps patients and the orthopaedic surgeon make informed decisions about the most suitable surgical technique for the patient’s needs and circumstances.