Total Hip Replacement – Direct Anterior Approach – DAA
This approach has become more popular in recent years and Dr Negus has seen excellent results for patients having hip replacements using this approach.
The patient is positioned lying on their back during the procedure instead of on their side as they are with the posterior approach. The incision runs over the front of their upper thigh at the level of the groin. The joint is accessed through a window between muscles without cutting or splitting muscles. Some smaller muscles may be partially released to help gain access.
As with all hip replacement procedures, a new acetabular cup is inserted into the pelvis (the socket) and the top of the femur (the ball) is removed and a new femoral stem is inserted into the femur bone. A metal or ceramic head is placed on the stem which fits into the plastic or ceramic socket.
Dr Negus routinely uses a longitudinal incision running from the groin down the front of the upper thigh. In the occasional patient, where appropriate, a “bikini” incision can be placed within the groin crease which is less visible. This tends to be more important for women, as the anterior approach scar is more likely to be hidden by underwear compared to the posterior approach scar.
It is common to have an area of numbness next to the wound following the operation caused by stretching of a nerve to the skin. In some patients, this numbness can extend down the front of the thigh. This numbness will get better in some patients but can be permanent. Muscle weakness is rare following this approach but can occur.
Computer Assisted Surgery (CAS)
Dr Negus uses computer assisted surgery with the anterior approach to place the new acetabular cup as accurately as possible. This can be in the form of computer navigation, navigation with robotic placement or an individualised positioning system based on the patient’s scans. These methods help to place the components precisely in the bone though the anterior approach.
Most surgeons don’t use any computer guidance to place their implants. Navigation has been shown to make a difference in helping the surgeon to more accurately achieve the target position of the implants.
Advantages of DAA hip surgery
The anterior approach does have advantages over the posterior approach as it minimises post-operative pain and there is a faster recovery in the early stages. There are no proven long-term benefits to the anterior approach over the posterior approach.
Which Approach is best for me?
Many patients now come to a consultation requesting particular approach based upon their own research and the experiences of family and friends. While this is totally understandable and every attempt is made to accommodate each patient’s wishes, the decision over which approach to use for hip replacement surgery relies on a number of clinical and technical factors. Therefore, Dr Negus will discuss the available options for each patient on a case-by case basis. You will have every opportunity to ask as many questions as you need before we come to an agreement on your treatment course.