Anterior Hip Replacements

What is Minimally Invasive Hip Surgery?

Minimally invasive hip surgery via the direct anterior approach means no muscles are required to be cut to enter the hip joint. This preserves the integrity of the surrounding soft tissues, potentially contributing to a shorter hospital stay, shorter rehabilitation, and decreased post-operative pain.

Purpose-built instruments and devices maximise precision when performing a total hip replacement, minimising soft tissue disruption and giving the surgeon a clear view throughout the procedure.

Intra-operative X-rays are taken during every operation to confirm alignment, leg length, and accuracy of the hip implant - enabling small changes to be made to maximise accuracy of the final prosthesis.

About the Direct Anterior Approach

The direct anterior approach for total hip replacements is one of the more established minimally invasive approaches for inserting a hip prosthesis. It was developed over 50 years ago and popularised from the 1980s by French surgeon Dr Frédéric Laude, who trained under the renowned pelvic surgeon Dr Judet. It aims to achieve the operation safely through a small incision, with minimal muscle and soft tissue disruption beneath the skin.

While the DAA is not the most common approach in Adelaide, it has been widely used in France and Switzerland for over 25 years and has been refined over that time. Dr Liew completed an EFORT fellowship with Dr Frédéric Laude in Paris and has used the direct anterior approach for all of his primary hip replacements since 2013.

Potential Benefits of the Direct Anterior Approach

As with any surgery, the potential benefits below need to be weighed against the risks in the next section, and individual results vary.

• Dislocation precautions: Because the approach does not release the posterior muscles, the usual posterior hip precautions are generally not required. Dislocation remains a possible risk after any hip replacement.
• Post-operative movement: Patients are generally able to sit in a normal chair, use a normal toilet, and get in and out of a car early in recovery, without pillows between the legs.
• Blood loss: The DAA encounters one main vessel - the ascending branch of the lateral femoral circumflex artery - which is tied off during surgery. As minimal muscle is cut, muscle bleeding is reduced.
• Pain relief approach: Dr Liew no longer routinely infiltrates the hip with local anaesthetic or performs nerve blocks, as the discomfort after this approach does not usually require them.
• Inter-nervous and inter-muscular: The hip is accessed between muscles and the nerves that supply them, rather than by cutting through muscle.

Potential Risks of the Direct Anterior Approach

Every surgical approach carries risks. Those more specific to the direct anterior approach include:

• Anterior scar: Unlike posterior scars at the back of the upper leg, the scar sits on the front of the leg, though the wound is generally shorter than with other approaches.
• Lateral cutaneous nerve of the thigh: This purely sensory nerve can be affected, causing altered sensation or numbness on the outer thigh. It does not affect muscle function. It often improves over weeks to months, but in some patients it is permanent.
• Learning curve: The DAA is more technically demanding and requires dedicated training. Dr Liew trained in the approach with Dr Frédéric Laude, Dr Dora and Dr Field, has used it for all primary hip replacements since 2013, and teaches it to surgeons in Australia and internationally.

Is the Direct Anterior Approach Right for You?

Hip replacement can be performed through several approaches, and each can achieve good results in experienced hands. Dr Liew only performs the direct anterior approach for primary (first time) hip replacement surgery, and few patients are not suitable for it.

The Australian body of hip replacement surgeons agrees that the best approach is the one that your surgeon is well trained in and comfortable with. All patients are recommended to seek multiple opinions from medical professionals, physiotherapists, family, friends, and other patients to determine the best option for them.

How to See Dr Liew

A referral to see a specialist is required. A GP is a good starting point to determine whether you need to see a surgeon at all. Once it is established that you need a hip replacement, a referral is made to an orthopaedic specialist.

Private health insurance is required to see Dr Liew privately.

Please bring to your first appointment:

1. GP Referral letter
2. Private Health Card and Medicare Card
3. Loose pants or shorts (for examination)
4. Recent X-rays and relevant scans of your hip

Frequently Asked Questions