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Direct Anterior Approach
The anterior approach to the hip joint is a technique used to perform a variety of procedures, including total hip replacement.
The direct anterior approach (DAA) to the hip is also known as the Heuter Approach, the Hip Anterior Approach (HAA), Anterior Supine Intermuscular approach (ASI), Minimally Invasive Surgery (MIS) Anterior Supine Approach, Anterior Minimally Invasive Surgery (AMIS).
Advantages of Direct Anterior Approach
The benefit of the anterior approach for hip replacement is as the approach allows access to the hip joint exploiting the interval between muscles. There is no cutting of muscle required. There is scientific evidence to demonstrate that patients having this approach may have a shorter stay in hospital and a less painful, and more rapid recovery, compared to other approaches.
As muscles are not cut, the anterior approach provides a more stable hip replacement. At this stage, long-term studies have not yet demonstrated a difference in long term function between the different approaches for a total hip replacement.
Disadvantages of Direct Anterior Approach
Due to the anatomy of the superficial nerves in the region of the approach, there may be a numb patch of skin on the outer aspect of the thigh post surgery. This usually reduces significantly over time, but may be persistent.
How is the Direct Anterior Approach Performed?
The direct anterior approach for hip replacement surgery can be performed with the patient positioned on a specialised surgical table (on-table) or a standard operating table (off-table). Dr Agolley is an experienced and specialised hip surgeon adept at both on-table and off -table direct anterior hip replacement surgery.
On-Table Direct Anterior Hip Replacement
Dr Agolley uses a specialised surgical table to allow for access to the hip joint whilst the patient is in the supine position.
The table allows for precise positioning and manipulation of the leg during surgery, which can improve access and visibility for the surgeon.
Off-Table Direct Anterior Hip Replacement
Off–table Direct Anterior hip replacement is performed on a standard operating table without the use of specialised equipment.
The surgeon relies on manual techniques and traditional positioning methods.
Recovery and Outcomes
Studies suggest that outcomes such as pain, joint function and overall satisfaction are improved with the direct anterior approach when compared to other approaches for hip replacement. Both on-table and off-table direct anterior hip techniques when performed by experienced surgeons have similar outcomes. 2
The choice of technique often depends on the surgeon's expertise and the availability of specialised equipment. Dr Agolley is an experienced and specialised hip surgeon adept at both on-table and off -table direct anterior hip replacement surgery.
Is the Direct Anterior Approach for everyone?
The reason for requirement of hip surgery varies in all patients. Although most patients may be suitable for the anterior approach, some patients are not suitable due to the shape of the bone and the type of implant needed to address the pathology. Alternative approaches to the hip are available. Ask Dr Agolley which is right for you.
What alternatives are there?
Some may ask, “Which approach is ‘better’ than the other?”
No one approach is necessarily better or worse, as different pathology requires different treatment, and each approach has their advantages and disadvantages.
Does it make a difference in the long term which approach I have?
The most important factor for a hip replacement to be successful and provide long term function and pain relief, is that the hip replacement is performed technically well, with implants that are likely to give an excellent outcome. There is currently no evidence to definitively prove that one approach provides better function than the other in the long term.
Does Dr Agolley perform the Direct Anterior Approach?
Yes, Dr Agolley uses the anterior approach in suitable patients requiring hip replacement.
Dr Agolley uses implants that have shown to have some of the lowest revision rates, and bearing surfaces that have some of the lowest revision rates on the Australian National Joint Registry.
Hip Replacement
Dr David Agolley performs complex hip replacement procedures with some of the most reliable prostheses and modern techniques including minimally invasive direct anterior approach, posterior and robotic assisted hip replacement.
References
1 Narayanan AS, Densley SM, McCauley JC, Kulidjian AA, Bugbee WD, Wilde JM. 'On Table' Versus 'Off Table' Direct Anterior Approach Total Hip Arthroplasty: Is There a Difference? Arthroplast Today. 2024 Jan 23;25:101283. doi: 10.1016/j.artd.2023.101283. PMID: 38313192; PMCID: PMC10834458.
2 Narayanan AS, Densley SM, McCauley JC, Kulidjian AA, Bugbee WD, Wilde JM. 'On Table' Versus 'Off Table' Direct Anterior Approach Total Hip Arthroplasty: Is There a Difference? Arthroplast Today. 2024 Jan 23;25:101283. doi: 10.1016/j.artd.2023.101283. PMID: 38313192; PMCID: PMC10834458.