Total hip replacement is one of the most successful orthopaedic procedures, with approximately 95% of patients reporting good or excellent outcomes. Over the past decade, I have refined and standardised my approach, combining the direct anterior technique with 3D planning and patient-specific technology to optimise accuracy, soft-tissue preservation, and longevity.
Muscle-Sparing Surgery
The direct anterior approach is not new — it has been used for decades — but it has become increasingly popular over the past 20 years for excellent clinical reasons. Rather than cutting through or detaching muscles and tendons, the direct anterior technique is truly internervous and intermuscular. A 5–6cm incision is placed at the front of the hip, and the muscle layers are carefully mobilised aside without detachment.
This muscle-sparing philosophy is fundamental to my reasoning. When muscles and tendons remain attached to bone, they provide immediate stability to the new hip joint. There is no need for tendon reattachment, which eliminates a common source of weakness during early recovery. Patients regain strength and stability more quickly, and the risk of late complications is lower.
"Respecting soft tissue structures — not cutting or detaching muscles — is the foundation of my surgical philosophy."
— Dr Chien-Wen LiewPrecision Before Entering Theatre
Years of evolution have shown that precision in implant positioning directly correlates with longevity and patient satisfaction. I now perform 3D imaging on every hip replacement before surgery. This is not an MRI — it is a fast scan requiring only about 60 seconds in the scanner.
Using this 3D data, I perform virtual surgery weeks before you arrive at the hospital. We know the exact size, shape, and position for your individual anatomy. A custom-made "jig" is then manufactured — a precision tool that perfectly matches your bone geometry and enables unparalleled accuracy during the actual procedure.
Watch Dr Chien-Wen Liew discuss this topic.
Real-Time Verification
Very few hip replacement techniques have access to intra-operative X-ray imaging during surgery. We use a special operating table that allows real-time imaging, enabling me to verify implant position before the final component is secured. This further enhances accuracy and provides immediate confirmation that your new hip has been optimally positioned.
Why These Results Matter
The Australian hip replacement registry demonstrates excellent survival — approximately 92% of hip replacements remain in situ without revision by the 20-year mark. With my current approach combining direct anterior access, 3D planning, and patient-specific technology, early results are even more encouraging.
Approximately 95% of patients report their hip replacement as good or excellent. This reflects both the technical precision of modern hip replacement and the commitment to soft-tissue preservation that underpins the direct anterior approach.
Download Approach Overview
A detailed explanation of the direct anterior technique and 3D planning in total hip replacement.