Direct Anterior Hip Replacement is a minimally invasive, muscle sparing surgery using an alternative approach to traditional hip replacement surgery.  Traditionally, the surgeon makes the hip incision laterally, on the side of the hip, or posteriorly, at the back of the hip.  Both approaches involve cutting major muscles to access the hip joint.  With the anterior approach, the incision is made in front of the hip enabling the surgeon to access the hip joint without cutting any muscles.  A special operating table is used that facilitates various anatomical positions enabling the surgeon to replace the hip joint anteriorly.

Potential benefits of direct anterior hip replacement compared to the traditional hip replacement surgery, may include the following:

  • Smaller incision

    Smaller incision

  • Minimal soft tissue trauma

    Minimal soft tissue trauma

  • Reduced post op pain

    Reduced post op pain

  • Less blood loss

    Less blood loss

  • Shorter surgical time

    Shorter surgical time

  • Faster healing time

    Faster healing time

  • Less scarring

    Less scarring

  • Earlier mobilization

    Earlier mobilization

  • Less post operative restrictions

    Less post operative restrictions

  • Reduced hip dislocations

    Reduced hip dislocations

  • Decreased hospital stay

    Decreased hospital stay

Surgical Procedure

Anterior Hip Replacement is performed in a hospital operating room under general or regional anesthetic depending on you and your surgeon’s preference. You will be placed supine, on your back, on a special operating table that enables the surgeon to perform your hip replacement anteriorly. Flouroscopic imaging is used during the surgery to ensure accuracy of component positioning and to minimize leg length inequality.

The surgeon makes one incision to the front of the hip, about 4 inches long. The surgeon then pushes the muscles aside to access the hip joint to begin the replacement. At no time during the surgery are any muscles cut.

The femur (thigh bone) is separated from the acetabulum (hipbone socket).The acetabulum (socket) is prepared using a special instrument called a reamer. The acetabular component is then inserted into the socket. This is sometimes reinforced with screws or occasionally cemented.

A liner, which can be made of plastic, metal or ceramic material, is then placed inside the acetabular component. The femur (thigh bone) is then prepared. The femoral head which is arthritic is cut off and the bone prepared using special instruments to exactly fit the new metal femoral component.

The femoral component is then inserted into the femur. This may be press fit relying on bone to grow into it or cemented depending on a number of factors such as bone quality and surgeon’s preference. The real femoral head component is then placed on the femoral stem. This can be made of metal or ceramic. The artificial components are fixed in place.

The surgeon withdraws the instruments and sutures the incision closed. The incision is then covered with a sterile dressing.

Post Operative Care

After surgery your surgeon will give you guidelines to follow. It is important that you follow your surgeons’ instructions for a safe and successful outcome.

Normally, after a traditional hip replacement, your surgeon would give you instructions on hip precautions to prevent dislocating the new joint. Hip precautions are very restrictive and usually include the following:

Do's

  • You should sleep with a pillow between your legs for 6 weeks

    You should sleep with a pillow between your legs for 6 weeks

  • An elevated toilet seat should be used

    An elevated toilet seat should be used

Don'ts

  • Avoid the combined movement of bending your hip and turning in your foot

    Avoid the combined movement of bending your hip and turning in your foot

  • Avoid crossing your legs and bending your hip past a right angle

    Avoid crossing your legs and bending your hip past a right angle

  • Avoid low chairs

    Avoid low chairs

  • Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes

    Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes

A total hip replacement is one of the most successful operations that orthopedic surgeons perform.  A hip replacement is an elective surgery, which means patients decide if and when to have their hip replaced. As a physician, I never tell patients they have to have a hip replacement surgery, but many times surgery may offer the only possibility for pain relief. Although the surgery is elective, it is covered by most insurance companies; however, depending on your policy you maybe required to make a small co-payment. My philosophy is to give my patients as much information as they need to make informed decisions regarding their health and hip pain and then treat their hip pain according to their wishes.


A hip joint is basically a ball and socket joint.  A hip replacement involves removing the ball (femoral head) and replacing it with a metal prosthetic ball. The femoral prosthesis is inserted into the hollow part of the femoral shaft. The socket of the pelvis is machined into a hemisphere and a metal hemisphere is inserted into the socket. The new metal ball and new metal socket form the new hip joint and allow the same and often times more motion than the native hip joint. The femoral and acetabular prosthesis are attached to your bones by creating a space in the bone that is slightly smaller than the metal prosthesis and then pressing the metal prosthesis into this tight space. Occasionally, the metal prosthesis is attached to the bone with bone cement. The parts are made of stainless steel, titanium, ceramic and/or polyethylene. I typically make an incision about 3-4 inches long for a hip replacement.


The purpose of this web page is to educate patients about the major aspects of hip replacement surgery. Many studies have shown that an informed patient will have less surprises and more satisfaction with their surgery. I do not intend to scare people away from getting their hip pain treated. Although the following information is a reasonable overview of what I consider the major aspects of hip surgery, it is not a substitute for a clinical consultation where I can directly answer your questions. If you would like more information, please schedule an appointment to see me.

After surgery your surgeon will give you guidelines to follow. It is important that you follow your surgeons’ instructions for a safe and successful outcome.


Normally, after a traditional hip replacement, your surgeon would give you instructions on hip precautions to prevent dislocating the new joint. Hip precautions are very restrictive and usually include the following:

Post Operative Care

Anterior Hip Replacement</strong> is performed in a hospital operating room under general or regional anesthetic depending on you and your surgeon’s preference. You will be placed supine, on your back, on a special operating table that enables the surgeon to perform your hip replacement anteriorly. Flouroscopic imaging is used during the surgery to ensure accuracy of component positioning and to minimize leg length inequality.


The surgeon makes one incision to the front of the hip, about 4 inches long. The surgeon then pushes the muscles aside to access the hip joint to begin the replacement. At no time during the surgery are any muscles cut.


The femur (thigh bone) is separated from the acetabulum (hipbone socket).The acetabulum (socket) is prepared using a special instrument called a reamer. The acetabular component is then inserted into the socket. This is sometimes reinforced with screws or occasionally cemented.


A liner, which can be made of plastic, metal or ceramic material, is then placed inside the acetabular component. The femur (thigh bone) is then prepared. The femoral head which is arthritic is cut off and the bone prepared using special instruments to exactly fit the new metal femoral component.


The femoral component is then inserted into the femur. This may be press fit relying on bone to grow into it or cemented depending on a number of factors such as bone quality and surgeon’s preference. The real femoral head component is then placed on the femoral stem. This can be made of metal or ceramic. The artificial components are fixed in place.


The surgeon withdraws the instruments and sutures the incision closed. The incision is then covered with a sterile dressing.

Surgical Procedure

Potential benefits of direct anterior hip replacement compared to the traditional hip replacement surgery, may include the following:

Direct Anterior Hip Replacement is a minimally invasive, muscle sparing surgery using an alternative approach to traditional hip replacement surgery.  Traditionally, the surgeon makes the hip incision laterally, on the side of the hip, or posteriorly, at the back of the hip.  Both approaches involve cutting major muscles to access the hip joint.  With the anterior approach, the incision is made in front of the hip enabling the surgeon to access the hip joint without cutting any muscles.  A special operating table is used that facilitates various anatomical positions enabling the surgeon to replace the hip joint anteriorly.

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