SMART Total Hip

A superior alternative to traditional total hip replacement

The U.S. sees over 300,000 cases of hip replacement surgery each year, making it one of the most common procedures in the country.

However, traditional total hip replacements run the risk of postoperative hip dislocation, nerve damage, fractures, and other complications.

These risks led to Dr. Vladimir Alexander to develop the SMART Total Hip Replacement procedure, which ultimately helps reduce the risk associated with hip replacement surgery.

SMART total hip replacement surgery is proven to reduce pain and restore mobility. It can also prevent worsening chronic or degenerative conditions and add years of happy, active living to a patient's life.

An overview of SMART total hip replacement surgery

In a traditional total hip replacement procedure, a surgeon uses either Standard Posterior Approach (a medium or large incision on the buttocks), or Direct Anterior Approach (a more extensive incision through the front of the leg).

After making the incision, the surgeon typically removes the ball and socket from the damaged joint and replaces them with prosthetics made from metal, plastic or ceramic.

How SMART total hip replacement surgery works

The SMART Total Hip Technique with DCC (Direct Capsular Closure) allows optimal exposure to the hip, with several key steps that create a safe and stable approach with far less potential complications when compared to a standard Posterior Approach or a Direct Anterior Approach (DAA).

“The smart total hip replacement is a procedure that’s been developed over the years of my practice in orthopaedic surgery,” Alexander Orthopaedic founder Dr. Vladimir Alexander said. “It’s a semi-posterior approach that’s done from the side of the patient, and it’s done in a manner in which we can reduce the risks of postoperative complications like postoperative dislocation, a major concern in traditional hip replacements.”

This approach allows the surgeon to directly see the area of operation, meaning that there's no need for fluoroscopy, X-ray, or a special operating room table during this procedure.

This technique recreates the natural closure of the joint capsule which makes the results superior and the risks & complications significantly decreased when compared to all other approaches.

With a higher success rate and lower complication rate than all other hip replacement techniques combined, our results speak for themselves.

What conditions do SMART total hip replacement procedures treat?


The most common form of arthritis; causes gradual wearing down of protective cartilage in the joints due to overuse or injury.


Cell death around bones, which is caused by decreased blood flow in the surrounding areas. Most commonly affects hips, knees and shoulders.

Bone Tumors

Lumps or abnormal tissue growth in bone cells due to the uncontrollable dividing of cells in the surrounding area.

Rheumatoid Arthritis

An autoimmune disorder that causes inflammation to form in the joints as a result of the body attacking its own tissue or even organs.

Hip Fractures

Bone breaks in the upper portion of the thigh bone; typically due to trauma in younger patients (i.e. sports or car accident), or osteoporosis in older patients.

Who needs SMART total hip replacement surgery?

People typically seek SMART total hip replacement if they experience hip pain that:

  • Interferes with daily activities and sleeping
  • Persists despite taking pain medication
  • Increases while walking
  • Makes it difficult to get dressed, climb stairs or rise from a seated position

How do I know if I need SMART total hip replacement surgery?

Because your hip is one of the most used joints in your body, you’ll begin to notice pain almost immediately. in the groin area or inside the hip, followed by a loss of range in motion. We recommend seeking treatment as soon as possible so you can prolong your range of motion.

Signs that you should seek immediate medical help for a hip injury include:

  • Bleeding
  • Exposed bone or muscle
  • Inability to bear weight

It’s also important to seek help right away if you experience swelling, redness, warmth, tenderness, or soreness in the area of your hip joint because these could be signs of more serious conditions.

If your symptoms don’t improve with non-invasive treatments like physical therapy, your doctors and specialists will likely inform you of your surgical treatment options.

Although total hip replacement surgery is designed to repair damaged hip cartilage and overall hip structure, some cases of severe hip pain can be managed without invasive treatments.

Other types of total hip replacement surgery

There are two traditional approaches to total hip replacement surgery procedures: posterior, which uses a medium or large incision through the back of the joint (buttocks) and anterior, which uses an incision at the front of the hip.

Standard Posterior Approach (SPA)

As the more common approach to total hip replacement, posterior total hip replacement surgery involves a medium or large sized incision through the back of the joint (buttocks).

The posterior approach is preferred by doctors because it offers clear visibility of the hip which allows for more optimum placement of the hip implants. Posterior hip replacement has a lower risk of fracture and provides the surgeon with full visualization of the hip cup and femur.

Time and technological progressions have allowed doctors to streamline and refine this procedure to make smaller, less invasive incisions that prevent trauma and reduce hospital stays and recovery times.

Direct Anterior Approach (DAA)

Another traditional surgical method for total hip replacement, the direct anterior approach is often applied on a case-by-case basis. It involves an incision at the front of the hip, which may require the surgeon to cut muscles and soft tissue. It cannot be performed on large or obese patients as the incision in such patients is covered by the belly flap & can lead to infection.

According to Arthritis Health, patients who undergo anterior total hip surgery are more likely to experience infection due to wound healing.

Due to this risk, plus the complicated technical nature and the specialized instruments needed to complete an anterior total hip replacement surgery, most doctors will opt for the posterior approach.

This approach requires a special operating table & x-ray to be used throughout the procedure because visualization is poor. Thus, complication rates are much higher, including intra-operative fracture & permanent nerve damage.

How is SMART total hip replacement surgery different?

One key difference of SMART Total Hip Replacement is that it can be performed as an outpatient surgery in most cases.

Other benefits of this procedure, when compared to the Standard Posterior Approach (SPA) & the Direct Anterior Approach (DAA), include:

Higher success rate

Decreased complication rate.

Decreased dislocation rate.

Decreased chance of nerve damage.

Decreased exposure to radiation when compared to DAA.

Preserved and repaired joint capsule

Performed as an outpatient surgery in most cases.

“Essentially, I have taken all the techniques that I’ve learned and developed my own modification of [said] techniques,” states Dr. Alexander. “This technique is something that I’ve been using for over the last 15 to 18 years, and it’s become the standard of care in our practice.”

Is the SMART total hip replacement procedure considered major surgery?

Thanks to technological breakthroughs in surgical procedures, the SMART Total Hip Replacement procedure can be performed quickly.

As a result, our SMART Total Hip Replacement surgeries are performed same-day as an outpatient procedure, meaning that you can go home right after surgery and get to healing sooner.

What is recovery like after SMART total hip replacement surgery?

Pain is a significant concern to most patients following surgery. The anesthetic and nerve block used during surgery will help alleviate the pain the day of the procedure, but having a plan in place once you get home will save you from suffering later.

Here are some tips to help you stay comfortable post-op:

  • Ice pack: Putting an ice pack on your hip for 20 minutes at a time will help reduce inflammation and relieve pain. Place a towel around the ice pack to keep your incision dry.
  • Medications: Talk to your doctor about what medications and techniques are best for managing pain. They might prescribe a pain reliever or recommend over-the-counter medications. Develop a pain management plan with your physician before surgery.
  • Rest: Sleep is crucial to a successful recovery, but resting after total hip replacement surgery can be difficult. It can take up to six weeks after surgery to sleep comfortably. Propping yourself up or sleeping in a recliner might be easier for a few days.

While you may be able to walk a day or so after your hip replacement surgery, resuming normal activities such as driving might take a few weeks. Our physical therapists will work with you to ensure a speedy and safe hip replacement recovery.

What are the benefits of outpatient surgery?

Having your hip replacement surgery performed in an outpatient environment:

  • Reduces the time you spend in a surgical facility
  • Reduces your chance of secondary infections.
  • Promotes a closer relationship between the patient and surgeon.
  • Gets you home faster so you can recover where you are most comfortable.

Our Alexander Outpatient Advantage includes a total joint liaison to help you through the process and Medical and therapy teams prep your home and evaluate you after surgery.

SMART total hip replacement surgery at Alexander Orthopaedics

With surgical advancements, an outpatient total hip replacement surgery can help improve your quality of life and help you avoid a long hospital stay.

Our outpatient orthopedic surgery centers and expert surgeons provide the care you need before, during, and after surgery.

Get on the road to recovery by connecting with Alexander Orthopaedics today.

Recovery starts here.

A member of our team will reach out to you within 24 hours.