Anterior Hip Replacement

Anterior total hip replacement, or Direct Anterior Hip Replacement (DAA), is a technique of hip replacement that involves replacing the hip joint minimally invasively with a prosthesis, without detaching or cutting muscles.  This allows patients to mobilise quicker and results in less tissue damage than traditional hip replacements which involve cutting tendons, or even bone to perform the hip replacement.

The anterior hip replacement is performed using either a vertical or oblique incision in the groin. Sometimes this incision can be placed in the groin crease, the ‘Bikini’ hip replacement.  Typically the incision is smaller than that used for other hip replacements, and typically is 8-10cm in length.

The muscles are then pushed apart and specially designed minimally invasive retractors are used to expose the hip joint and perform the replacement.  No muscles are split, cut or detached during the procedure, and have to be repaired at the end of the procedure, this means that there are no post operative restrictions, in comparison to traditional hp replacements which require restrictions with bending and rotation through the hip to prevent dislocation.

nterior Minimally Invasive Hip replacement (Green Line) going between hip muscles instead of cutting them (Blue and Red Lines).

Advantages

There are several potential advantages to anterior total hip replacement:

  • Smaller incisions (typically 8-10cm vs 15+cm with traditional replacement)
  • Faster recovery. Patients who undergo an anterior hip replacement typically mobilise quicker and return to function sooner than other types of hip replacement.
  • Greater stability. As no muscles are cut during the approach the hip stabilisers remain intact, and the hip retains more inherent stability.  Several studies have showed a lower dislocation rate with the anterior approach when compared to traditional approaches.
  • No post operative restrictions. With the anterior approach there are no post operative restrictions, and patients can bend their hips, lie on the their sides and cross their legs.
  • Avoiding, or requiring less strong opiate analgesia. As there is less tissue damage, typically less opiates and strong analgesia is required with the anterior approach.  This results in less patient side effects, quicker mobilisation and earlier return to function.

As surgery is performed lying on the back (rather than on their side as per other joint replacements), routine x rays are taken throughout the surgery to ensure that the components are positioned correctly, and that leg lengths are restored anatomically. This may correlate with improved long term survival and reduced re-operation rates.

Disadvantages

The anterior hip replacement is a technically demanding procedure and requires specialist training, knowledge and instrumentation.  Surgeons also commonly use a specialised positioning table which is not available in all hospitals and this

The anterior approach is associated with a slightly higher risk of fracture than other hip replacements.  Therefore the anterior approach may not be recommended if you have weaker bones (osteoporosis). There is also a small risk of numbness with the anterior approach down the outside of the thigh due to nerve bruising, this normally resolves by 3-6months post op

Frequently Asked Questions:

Are anterior total hip replacements better than posterior hip replacements?

Anterior hip replacements offer several advantages over posterior hip replacements, but also have some disadvantages as outlined above.  Both offer excellent long term outcomes.

How big is the incision for an anterior hip replacement?

The incision is typically 8-10cm in length.

Am I suitable for an anterior hip replacement?

The majority of patients who require a hip replacement are suitable to have an anterior hip replacement performed.  If you have questions regarding your suitability, please contact us for an appointment today.

When can I drive after an anterior hip replacement?

You can drive once you have stopped taking strong analgesic medications, and you have regained stability and control of your leg.  For a right total hip replacement this is usually at approximately 2 weeks, however, please confirm this with your surgeon prior to driving.

When can I walk after an anterior hip replacement?

You should be able to stand up and start mobilising with the use of crutches within hours of your surgery.

When can I resume work after an anterior hip replacement?

This depends upon the type of work you do.  If you do mainly desk based duties or officework, then you may be able to return to work in 1-2weeks.  If however you perform heavier manual labour then you may require 6-8 weeks off work.

Where can I arrange a consultation for an anterior hip replacement?

Please contact our Melbourne office to arrange an appointment at one of our locations in central Melbourne, Knox, or Holmesglen Hospitals.  We can also arrange telehealth consultations across Australia.

What is the cost of an anterior total hip replacement?

The cost of a hip replacement for a non-insured, non-medicare covered patient is approximately $25,000.  For an insured patient the cost is typically $500-1000, however, this depends upon the type of insurance, hospital, anaesthetist and many other factors. Please contact us today if you would like a quotation or to discuss your options.

References

  1. Free MD, Owen DH, Agius PA, Pascoe EM, Harvie P. Direct Anterior Approach Total Hip Arthroplasty: An Adjunct to an Enhanced Recovery Pathway: Outcomes and Learning Curve Effects in Surgeons Transitioning From Other Surgical Approaches. J Arthroplasty. 2018 Nov;33(11):3490–5.
  2. Cheng TE, Wallis JA, Taylor NF, Holden CT, Marks P, Smith CL, et al. A Prospective Randomized Clinical Trial in Total Hip Arthroplasty-Comparing Early Results Between the Direct Anterior Approach and the Posterior Approach. J Arthroplasty. 2017 Mar;32(3):883–90.
  3. Agten, C. A., Sutter, R., Dora, C. & Pfirrmann, C. W. A. MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches. European Radiology1–10 (2016) doi:10.1007/s00330-016-4455-7.
  4. Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty. 2015 Mar;30(3):419-34. doi: 10.1016/j.arth.2014.10.020. Epub 2014 Oct 22. PMID: 25453632.
  5. Martin JR, Masonis JL, Mason JB. Anatomic Total Hip Component Position Is More Reproducible With the Direct Anterior Approach Using Intraoperative Fluoroscopy. Arthroplast Today. 2020 Sep 8;6(4):777-783. doi: 10.1016/j.artd.2020.07.026. PMID: 32964086; PMCID: PMC7490589.