Total Hip Replacement (Direct Anterior Approach)

This information is useful for adults
active, older woman smiling, possibly after receiving a total hip replacement
Why Yale Medicine?
  • Our doctors are pioneers in performing anterior hip replacements that have dramatically improved patients’ lives.
  • A diverse team of specialists will work together to determine the best, safest treatment options for your situation and condition.
  • We aim to perform a minimally invasive procedure that will allow you to go home and recover quickly, with minimal pain.

If you need a hip replacement, you may be worried about what lies ahead. That’s natural and understandable—but you will be pleased to learn that, in terms of outcome, a hip replacement is one of the most successful operations you can have. Though they sound dramatic and off-putting, hip replacements can be counted upon to reliably deliver pain relief and restore quality of life.

A type of hip replacement surgery called the direct anterior hip approach can make the early recovery after surgery even better. This is a minimally invasive technique. With anterior hip replacement, the surgeon makes a small incision near the front of the hip to allow for removal of damaged bone and cartilage, and implantation of an artificial hip without damaging surrounding muscle and tendons. Patients leave the hospital sooner than they would with some other approaches.  

Lee Rubin, MD, a Yale Medicine orthopedic surgeon and chief of the Total Joint Replacement Program at the Center for Musculoskeletal Care at Yale New Haven Hospital and Yale School of Medicine, is a leading expert in the direct anterior approach. He is one of the few surgeons in the U.S to have learned the approach directly from Kristaps J. Keggi, MD, a Yale Medicine orthopedic surgeon who was among the first to recognize the benefits of the direct anterior approach. Since Dr. Keggi started performing direct anterior hip surgeries in the 1970s, the technique has sparked the evolution of minimally invasive hip surgery, according to Dr. Rubin. “As a result of this innovation, hip surgery has become a positively transformative experience for my patients,” he says.

A total hip replacement is exactly what it sounds like—a surgery to replace a natural hip joint that has worn out or been damaged with an artificial one. There are several surgical approaches that generally follow the same path: Your surgeon makes an incision near the hip joint, carefully extracts the diseased or damaged bone and cartilage, then inserts an artificial hip and secures it in place. (Your new hip might be made out of metal, plastic, or ceramic—or some combination of those materials.)

The direct anterior approach is a minimally invasive way to perform hip replacement surgery, and surgeons who perform it say it has advantages over traditional approaches. For example, the incision for the direct anterior approach is only three or four inches, compared to up to 12 inches with the traditional approach. Also, recovery after surgery is generally quicker. Patients typically go home sooner than with other approaches, have less pain, and can reach therapy milestones more rapidly after the procedure.

Why is this? The key difference is in how the surgery is done. The direct anterior method is considered “muscle sparing” because it does not involve cutting into (and later repairing) muscles and tendons to reach the damaged bone and tendon. Instead, the surgeon gently pushes the groups of muscle and ligaments aside, inserts the implants, and then moves them back to their proper position.

Because the anterior approach is more technically demanding, some surgeons use a minimally invasive posterior approach. This involves making an incision of about four to five inches on the back of the hip, while the patient lays on their side on the operating table. The posterior approach involves detaching some muscles and tissues to reach the hip joint. However, the surgeon avoids cutting into abductor muscles, which are the major walking muscles.

There has been much debate about which minimally invasive approach is better. While some surgeons may continue to prefer the posterior approach, the anterior approach may become more popular as more surgeons learn the technique.