New approach to hip replacement surgery

Commentary By John Hur, MD

Recently I began using a new method to perform hip replacement surgery, known as the Direct Anterior Approach.

This new approach allows me to reach the hip joint from the front of the hip as opposed to the lateral (side) or the posterior (back) approach. This way, the hip can be replaced without detachment of muscle from the pelvis or femur during surgery. The greatest benefit to this approach is that the most important muscles for hip function, the gluteal muscles that attach to the pelvis and femur, are left undisturbed and, therefore, do not require a healing process to recover from surgical trauma. This decreases the amount of pain a patient experiences and also reduces complications, such as problems with hip dislocation. With less pain and improved function, most patients are able to return to normal activities sooner, if not immediately.

In comparison, conventional hip replacement surgery approaches require splitting and/or detachment of muscles that control motion of the hip and help prevent dislocation. Trauma to these muscles causes pain and swelling that takes time to heal in order to recover function. Typically, this requires six to 10 weeks of rehabilitation and restrictions of not flexing the hip beyond 90 degrees, which affects basic activities like sitting, crossing the legs, putting on shoes and driving an automobile. It is also common for patients who undergo conventional hip replacement surgery to experience dislocation of the hip due to the weakening of the muscles that are detached during surgery.

The direct anterior approach to hip replacement has been around for some time. In fact, it was first performed in Europe in 1947. Since that time, the technique has been continually refined with advancing medical technology. The most significant advancement that was made was with the creation of a special, state-of-the-art surgical table that allows surgeons to perform the procedure with ease. Today, literally thousands of hip replacement patients have benefited from this minimally invasive approach in Europe and America.

Unfortunately, not all patients are a candidate for this type of hip replacement surgery. It is particularly difficult to perform on patients that are overweight or who have distorted anatomy. Patients should ask their orthopedic surgeons if they are familiar with the direct anterior approach and if they are an ideal candidate for that type of hip replacement surgery. Only an orthopedic hip replacement specialist can make a proper assessment.


John Hur, MD, specializes in adult hip and knee reconstruction and trauma, as well as the direct anterior approach to hip replacement. He is a Methodist Sports Medicine physician who also practices at IU Health North Hospital in Carmel. He can be reached by calling the Methodist Sports Medicine offices at 817-1200, ext. 5010.