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    The Direct Anterior (DA) Total Hip Replacement is a technique used to perform total hip replacement through an approach between the muscles in the front of the thigh.  This approach has become popular since 2010, as it has been advertised as giving a quicker recovery time. While early studies suggested this, more recent studies show that recovery time, even early on, is the same as for other approaches tot he hip. 

    The implants are exactly the same that are used in other approaches, but special surgical instruments have been designed to be used for this technique.  

    There is also theoretically a reduced chance of dislocation out of the back of the hip, but there can be dislocations from the front of the hip using this approach. The incision is located on the front of the hip in the groin area instead of along the side of the hip, which may make it more comfortable for side sleepers during recovery. This approach carries similar medical, and blood clot risks to other hip approaches, but there are some risks which are MORE COMMON with this approach.  These include:

     

    • Nerve Injury: The small nerve that serves the front of the thigh is almost always affected by this approach. It is very likely that there will be a numb area along the front and outside of your thigh with the DA approach.  The nerve which supplies the skin in this area is close to the operative field and is very sensitive.  This nerve is visualized and protected during surgery but this numb area still occurs in almost all patients.  
    • Higher fracture risk: While fracture of the femur bone during surgery is a potential complication with any approach, the femur is less well-seen during the DA approach and is more vulnerable to fracture than with other approaches. Some studies report 5x times more frequent incidence of fracture, even in experienced hands. 
    • Dislocation or instability: Dislocation in the traditional, posterior direction is less common with the DA approach. However, dislocation from the anterior direction has been reported withe the DA approach.  Patients who have had spinal fusion surgery or who have stiff spines may be more likely to have this problem.
    • Infection: Because of the location of the incision and other factors, infection risk has been found to be higher with this approach.  Studies report anywhere from a 4 percent to a 12 percent infection rate with this approach.  Changing or increasing antibiotics can somewhat reduce this, but carries other risks.

     

    Some surgeons perform the DA approach using a special operative table.  This table is not required, carries its own specific surgical risks and many surgeons do not use it.  

    The DA approach is not for everyone. In fact, the "gold standard" mini-posterior approach appears to be a safer and more predictable option for most patients.  At your visit, ask Dr. Lajam if this approach is right for you.