An incision is made on the front of the thigh, centred over the tensor fasciae latae. The surgeon accesses the hip joint through the interval between the sartorius/rectus femoris and tensor fasciae latae — no muscles are cut or detached. The hip is dislocated anteriorly, the femoral head removed, the socket prepared and cup implanted, and the femoral stem inserted. A specialised operating table with traction capability may be used. The implants are the same as any other approach. The operation takes one to one and a half hours.
The DAA is offered by surgeons trained in this approach who believe the muscle-sparing nature provides benefits in early recovery — potentially less pain, faster mobilisation, shorter hospital stay, and fewer hip precautions than posterior or lateral approaches.
All standard non-operative hip arthritis treatments. Other surgical approaches (posterior, lateral, anterolateral) are alternatives — all produce excellent long-term outcomes.
Standard THR pre-assessment. X-rays and templating. The approach is determined by the surgeon's training and preference.
Potential advantages: reduced early pain, faster return to walking, shorter hospital stay, lower dislocation rate (no posterior capsule disruption), and fewer post-operative hip precautions. Long-term outcomes (implant survival, function) are equivalent to other approaches.
Lateral femoral cutaneous nerve irritationCommon
Numbness or tingling on the outer thigh. Occurs in approximately 5–15%.
All standard THR risksSee standard risks
Dislocation, infection, blood clots, leg length discrepancy.
Learning curveExpected
The DAA has a recognised learning curve for surgeons.
Femoral fractureUncommon
Slightly higher risk of intra-operative femoral fracture, particularly early in the surgeon's learning curve.
Wound complicationsUncommon
The anterior thigh incision may have higher wound complication rates in obese patients.
Component malpositionUncommon
May be more challenging with the anterior approach, particularly on a standard table.
Anterior dislocationRare
While posterior dislocation is very rare, anterior dislocation can occur with hyperextension.
General or spinal anaesthesia. Supine on a specialised or standard table.
Walking on the day of surgery. Hospital stay one to two days. Fewer hip precautions than posterior approach — no restrictions on crossing legs or bending beyond 90 degrees in most protocols. Driving at two to four weeks. Full recovery three to six months. Long-term outcomes are the same regardless of approach.
Same as standard THR: reviews at six weeks, one year, then every two to five years.
Is the anterior approach better than the posterior?
The anterior approach may offer faster early recovery, but long-term outcomes (ten to twenty years) are equivalent regardless of approach. The best approach is the one your surgeon is most experienced and comfortable with. A well-performed posterior approach gives excellent results, as does a well-performed anterior approach.
Why doesn't every surgeon use this approach?
The DAA has a significant learning curve and requires familiarity with different anatomy. Some surgeons find it more challenging for complex cases, revision surgery, or very muscular/obese patients. Many excellent hip surgeons prefer the posterior or lateral approach and achieve outstanding outcomes.