Direct Anterior Approach (DAA) Hip Replacement
A new and improved method of hip replacement
Hip arthritis is a common and debilitating musculoskeletal condition. When non-operative measures fail, a hip replacement is an extremely successful procedure to alleviate your pain and allow you to return to your recreational activities. In fact, hip replacement has been quoted as “the operation of the century”¹. There are nearly 500,000 hip replacements performed in the United States each year². However, not all hip replacement procedures are the same.
Historically, there have been 3 options to perform a hip replacement. However, all of these options involve cutting a portion of muscle and repairing it at the end of the operation. The direct anterior approach has evolved over the last 20 years as a novel, minimally-invasive approach where NO muscle is cut.
Many studies show that patients have substantially less pain after surgery and progress much faster than the older ways of performing hip replacements³⁻⁷. As a result, many patients choose to have their hip replacement as an outpatient, where they are able to return to their home the day of surgery, eat their own food, and sleep in their own beds.
Choosing your surgeon is an extremely important part of your outcome. Not all surgeons offer anterior hip replacement as an option to patients because it is a more technically difficult operation. We at Alexander Orthopaedics pride ourselves in offering the most advanced care to our patients so that you can return to your life pain-free and enjoy the activities you love.
What is anterior total hip replacement?
Anterior total hip replacement is the newest version of hip replacement surgery. Traditionally, when hip replacements were performed some muscle was cut and repaired at the conclusion of the operation. In many situations patients were restricted in certain activities (“hip precautions”) in order to protect this muscle repair postoperatively and to avoid a hip dislocation (ball popping out of the socket) in the early recovery period.
In contract to traditional methods of replacing the hip where muscle is cut, anterior hip replacement preserves the muscle so no muscle is cut at all. This is a more technically demanding operation for the surgeon than the traditional version, which is why not all surgeons offer it to patients. As a result of this more advanced technique, however, patients experience substantially less pain and do not have any postoperative hip precautions, allowing for an immensely faster recovery.
What is bikini incision total hip replacement?
Bikini incision hip replacement is an even more advanced addition to anterior hip replacement. The general anterior hip replacement involves a longitudinal (up and down) incision along the front of the thigh. Bikini incision is so-named because the incision is made parallel to where a bikini would sit on the thigh, in line with naturally-occurring wrinkles and creases in the skin. As a result once the incision has healed it is often not visible with traditional underwear or, as the name suggests, if the patient is wearing a bikini or speedo-style swimsuit.
Major benefits of the bikini incision are often faster rates of wound healing and less wound-related complications. In summary, bikini incision anterior hip replacement offers all of the benefits of anterior hip replacement and additionally a more appealing, discrete surgical scar.
References:
1. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007 Oct 27;370(9597): 1508-19.
2. Sloan M, Premkumar A, Sheth N. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am. 2018 Sep 5;100(17):1455-1460.
3. Maldonado DR, Laseter JR, Kyin C, Lall AC, Domb BG. Direct anterior approach in total hip arthroplasty leads to superior outcomes at 3-month follow-up when compared with the posterior approach: a matched study using propensity score analysis. J Am Acad Orthop Surg Glob Res Rev. 2019 Dec 23;3(12):e19.00118.
4. Faldini C, Perna F, Mazotti A, Stefanini N, Panciera A, Geraci G, Mora P, Traina F. Direct anterior approach versus posterolateral approach in total hip arthroplasty: effects on early post-operative rehabilitation period. J Biol Regul Homeost Agents. 2017;31(4 suppl 1): 75-81.
5. Zhao HY, Kang PD, Xia YY, Shi XJ, Nie Y, Pei FX. Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach: a randomized controlled trial. J Arthroplasty. 2017 Nov;32(11):3421-3428.
6. Goebel S, Steinert AF, Schillinger J, Eulert J, Broscheit J, Rudert M, Noth U. Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop. 2012 Mar;36(3):491-8.
7. Barrett W, Turner S, Leopold J. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013 Oct;28(9):1634-8.