The Lister Hospital
Chelsea Bridge Road SW1W 8RH London
Direct anterior approach hip replacement surgery
Anterior hip replacement is a minimally invasive and muscle-sparing procedure to replace the hip joint. Our hip experts can provide you with a direct anterior hip replacement surgery (DAA) to relieve your hip pain and restore your mobility.
At HCA UK:
- Have your appointments confirmed within 24 hours
- Meet with specialist hip consultants
- Our orthopaedic care is rated very good or excellent by 97% of patients
What is anterior hip replacement surgery?
Anterior hip replacement is a minimally invasive procedure in which a surgeon operates on your hip joint through a small incision near the front of your hip. It’s known fully as direct approach anterior (DAA) hip replacement.
The hip is a ball and socket joint. The hip socket is called the acetabulum, while the round, ball-like structure that fits inside the socket is called the femoral head. The femoral head is connected to the shaft of your thighbone (the femoral bone) by the femoral neck.
The inner surface of the acetabulum and the outer surface of the femoral head are covered by a layer of very smooth, flexible and tough tissue called articular cartilage. This cartilage is lubricated by joint fluid and this enables the joint surfaces to slide smoothly against each other. When wear-and-tear causes the cartilage to break down, the underlying bone begins to rub and the hip joint becomes stiff and painful.
Hip replacement (also known as hip arthroplasty) is a surgery to replace a damaged hip joint with artificial components, relieving pain and restoring mobility. Surgeons can perform this type of surgery by accessing the hip from behind, from the side or from the front. A hip arthroplasty performed from the front of the hip is called a direct anterior approach (DAA) or simply anterior hip replacement. The anterior approach can be used for a partial or total hip replacement.
What are the benefits of DAA hip replacement surgery?
In contrast to other hip surgery techniques, anterior hip replacement avoids cutting through muscles or dividing the tendinous muscle attachments to bone. Instead, the hip is accessed by separating muscles, doing so between muscle groups that are supplied by different nerves. This is known as an intermuscular and internervous path.
In experienced hands, avoiding muscle damage and minimising soft tissue disturbance can also reduce blood loss during surgery, cause less postoperative pain and a faster return to independent mobility. Patients are normally less dependent on mobility aids and usually require less support from family and friends during their recovery. The incision is relatively short (less than ten centimetres). A growing number of surgeons can offer anterior hip replacement using the cosmetically more attractive ‘bikini’ incision - a smaller, shorter incision that can be hidden by a bikini.
The anterior approach also offers less risk of hip instability or hip dislocations after surgery. Since you lie on your back rather than your side during the procedure, the surgical team can use fluoroscopy (live x-ray imaging), which allows the surgeon to position the artificial components with greater accuracy and better ensure your leg lengths are equal.
What are the risks of a DAA hip replacement?
As with any medical procedure, there are risks involved with an anterior hip replacement. These include:
- Infection at the incision site or in the joint
- Excess bleeding into the joint or surrounding soft tissues following surgery
- Nerve damage
- Cracks or breaks in the bones around the hip replacement
- Deep vein thrombosis
- Uneven leg lengths
Your consultant will only recommend anterior hip replacement surgery if they think it'll be the most effective treatment for you. They'll discuss all the potential risks with you, answering any questions you might have.
Is DAA hip replacement right for me?
If you’re suffering from a hip condition such as hip osteoarthritis, rheumatoid arthritis or hip fracture, anterior hip replacement surgery should be a suitable treatment. However, some circumstances could mean it isn't a good fit. These include if you:
- Have a colostomy bag in the groin on the same side as your arthritic hip
- Have a stubborn skin infection in your groin.
- Need a revision (redo) hip replacement. This can usually be undertaken using the DAA anterior approach, but other approaches may be more suitable when discontinuities in the back wall of the hip socket need to be reconstructed, or if you have a long, well fixed, cemented stem that needs to be removed from the thigh bone.
If you'd like to find out if anterior hip replacement surgery is right for you, book an appointment with one of our hip consultants. Our specialists can tell you which treatment will be most effective for relieving your hip pain and restoring your mobility.
The DAA hip replacement process
At your initial appointment, your consultant will ask you about your hip pain and perform a physical examination to check your mobility. They will likely need to carry out some imaging tests to better understand and diagnose your condition.
Your consultant will recommend you undergo anterior hip replacement if they think it's the best treatment for your circumstances. They'll explain the procedure and what it involves, including any potential risks and side effects. If you decide you want to receive the treatment, you'll schedule a surgery date.
The surgery is typically carried out under spinal anaesthesia with sedation. General anaesthesia is also possible. Some surgeons use live x-ray imaging to confirm that the placement of the prosthetic components is as accurate as possible. A growing number of surgeons now offer MAKO robotic assisted surgery for their anterior hip replacements.
The procedure takes place in four main stages:
- Accessing the hip joint: The surgeon makes a small incision at the front of the hip, typically between six and ten centimetres in length. Many surgeons use a slightly oblique, longitudinal incision but, a growing number of anterior hip surgeons offer the bikini incision for women and prefer this incision for high BMI patients.
The fatty tissue underneath the skin is held apart and the surgeon separates the underlying muscles, called rectus femoris and tensor fascia lata, at their natural interval. The muscles are simply held apart while the operation takes place. This provides direct access to the underlying hip joint capsule. A flap of capsule is mobilised to provide entry to the joint. - Removing the damaged bone: With the hip joint exposed, the surgeon uses an oscillating saw to cut through the femoral neck. The femoral head and the upper part of the femoral neck can then be removed from the hip socket.
The surgeon then assesses the hip socket to see where the soft fibrous rim (labrum) has been replaced by the growth of new bony projections called osteophytes. The remaining labrum and bony osteophytes are removed from the socket rim to reveal the patients original socket anatomy.
The surgeon then uses a specialised instrument called a reamer that looks like a hemispherical cheese grater. This is used to remove the remaining articular cartilage and the surface layer of the underlying bone to create a hemispherical recess for insertion of the new hip socket. The surgeon will use reamers of increasing size (usually one milimetre increments) so that the socket can be prepared very accurately, and the diameter of the hemispherical recess is known exactly.
- Fitting the new acetabular socket: A titanium acetabular shell is hammered directly into the hemispherical socket. The prosthetic shell has a very slightly larger diameter than the reamed socket so it fits tightly and cannot budge. The patient’s bone can then grow onto its rough outer surface.
Some surgeons will also put screws through holes in the titanium shell. The screws pass into the pelvic bone to provide additional hold while the patient’s bone attaches itself to the socket surface. Once the shell is secure, a polyethylene or ceramic liner is placed inside the shell to complete the artificial socket.
- Fitting the new stem and femoral head: On the thigh bone (femoral side) the surgeon must first find a path through the spongy bone in the upper part of the femur to the marrow canal inside the shaft of the bone. The surgeon then prepares the canal either for a cemented stainless-steel stem or an uncemented titanium stem depending on the patients age, bone density, anatomy and preference.
When the new stem is securely fixed, a ceramic or metal head is attached to the spigot at the top of the stem. This is the ball that will sit in the acetabular socket. The leg is then repositioned with the ball in the artificial hip socket and the stability of the joint is checked. An X-ray machine can be used to check that the components are perfectly positioned. When the MAKO robot is used, measurements can be made to confirm that planned leg length and hip geometry have been achieved.
- Completing the procedure: The muscles and fatty tissue that were separated to access the hip joint are put back into position and closed with dissolvable sutures. Finally, the incision site is closed and covered with a sterile dressing.
The anterior hip replacement approach helps rapid post-operative recovery and rehabilitation, getting you back to normal daily life as soon as possible. Most patients can get out of bed and start walking within a few hours of returning to their room.
The ward physiotherapists ensure that you are safe and confident ascending and descending stairs before they allow you to leave the hospital. Some anterior hip replacement patients are keen to leave the hospital on the day of their operation and, if this is your preference, you should request that your operation is undertaken during a morning operating session. The great majority of anterior hip replacement patients will be ready to leave the hospital after one night in hospital but, if a patient does need a longer hospital admission, this can be accommodated.
You'll receive instructions to aid your recovery, which might include:
- Taking prescribed medications to relieve pain and minimise the risk of blood clots.
- Participating in physical therapy to restore hip mobility and strength
- Eating a healthy diet to promote healing
- Avoiding activities that could delay your healing, such as smoking
- Contacting your consultant or the hospital’s clinical nurse specialist if you observe excessive swelling or redness at the incision site.
How anterior hip replacement surgery helped Keith get back on the court
“Given that yesterday I had the operation, I feel it's incredible that now I'm on my way back. But I imagine now that I will get back to playing tennis in three or four months.”
Sir Keith Ajegbo, member of the All England Tennis Club
Sir Keith Ajegbo was an avid tennis player until severe pain stopped him from enjoying the sport he loved. He underwent an anterior hip replacement at The Lister Hospital. As with so many people, this procedure helped him get back on his feet faster. Watch the video to learn more about Keith’s story.
Anterior hip replacement FAQs
As the procedure doesn't involve cutting through any muscles or tendons surrounding the hip joint, there is normally less pain compared to a lateral or posterior hip replacement. However, as with any surgery, some post-operative, reactive swelling will occur around the hip joint and in the thigh.
While many patients experience remarkably little pain and are only taking paracetamol by the end of the first week, this is not universal and you may require stronger painkillers for a while. Your consultant will prescribe you medication to help you manage any pain immediately after the operation and during your recovery.
Anterior hip replacement surgery minimises soft tissue damage and some anterior hip replacement patients are able to leave the hospital on the day of their operation. If this is your preference, you should request that your operation is undertaken during a morning operating session. The great majority of anterior hip replacement patients will be ready to leave the hospital after one night but, if you need a longer hospital admission, this can be accommodated.
However your operation is undertaken, it takes many months to fully recover from hip replacement surgery. Tissues healing is a biological process that has taken millions of years to evolve and healing will take place at the rate that your body allows. The main advantage of anterior hip replacement surgery is that the operation is performed with less tissue disturbance and this makes recovery easier. Once healing is complete the results are very similar irrespective of how your operation is performed:
- First 48 hours: Your rehabilitation begins once your spinal or general anaesthetic wears off and you have regained strength in your legs. The ward nursing staff will help you get out of bed to sit in your chair or go to the toilet. The physiotherapists will help you walk, initially with a frame or two crutches and then one crutch as you progress and gain confidence.
The physiotherapists will also ensure that you are safe ascending and descending stairs before they give you the green light to leave the hospital. Good pain control must be achieved during the first day after surgery as this will help you recover with less pain or discomfort over the next few weeks.
- Three days to one week: The post-operative discomfort should become less challenging and many people find that they are able to start walking without assistance. Your mantra should be “little and often”. Using the muscles around your hip to get up and walk short distances will reduce your need for painkillers. Trying to do too much will simply increase soft tissue swelling and make the hip more uncomfortable.
- One to three weeks: You'll need to monitor for signs of infection such as heightened pain, swelling or discharge from the incision site. You should increase movement at this stage but be careful not to overexert yourself
- Three to six weeks: You should be able to resume basic activities, as long as they aren't too strenuous. You may be able to return to work, depending on how physically demanding it is. You'll perform targeted physical therapy exercises to strengthen your hip and aid your recovery
- Six weeks to three months: Your incision should have fully healed by this time. You'll need to continue to focus on physical therapy to aid your recovery
- Three+ months: You should be able to return to physical activities such as sports or manual labour. You'll still attend follow-up appointments with your consultant to monitor your progress.
You should only begin driving again when you can safely use the pedals and control your car. Generally, this means being able to fully bear your body weight on your new hip and no longer needing any strong pain medications. This could happen anywhere between one to six weeks. Your consultant will be able to advise you on whether you're ready to resume driving if you're unsure.
You won't be able to drive yourself home from the hospital following the procedure, so you'll need to arrange for transportation.
The cost of your anterior hip replacement will depend on the specifics of the treatment you agree with your consultant. Once you've decided to go ahead with your treatment, you can typically pay for an anterior hip replacement through private medical insurance or by paying for yourself.
If you opt for self-pay, you may qualify for a fixed-price package. It's beneficial to know the inpatient hospital costs associated with your surgery in advance, as it helps you with budgeting and brings peace of mind before your hospital stay begins.
There are two fixed-price packages:
- Standard hip replacement including prosthesis: £14,626
- Robotic assisted hip replacement or premium prosthesis: £16,171
If relevant, your consultant will advise which applies to you. Find out more about treatment costs with HCA UK.
Why choose HCA UK for anterior hip replacement?
There are several advantages of choosing HCA UK to treat your hip condition:
- Convenient access: Appointments are confirmed within 24 hours and you could have same-day imaging if required, helping you get treatment for your hip pain with minimal impact on your schedule
- Cutting-edge facilities: With the help of our state-of-the-art diagnostic centres, our consultants can diagnose your hip condition quickly and accurately
- Specialist care: With several hip specialists in our network, we can connect you with experts in the various HCA UK facilities
- Orthopaedic leaders: According to data from the Private Healthcare Information Network (PHIN), we perform the highest number of private hip replacements in London. We've helped people recover from hip pain like yours before and we want to do the same for you
- Patients trust us: 99% of orthopaedic patients said they'd recommend us to their friends and family in our 2023 patient satisfaction survey.
Personalised care
The orthopaedic unit at The Lister Hospital is home to specialist consultants from many of London's top teaching hospitals. The Arthroplasty Unit at The Lister Hospital specialises in DAA minimally invasive hip replacement and provides anterior hip replacement experience that is unmatched anywhere in the UK. The team operate regular ‘joint schools’, where you can receive care and support from a multidisciplinary team including occupational therapists, physiotherapists, pharmacists and an orthopaedic nurse specialist before you undergo surgery.
Our specialists will ensure that you know what to expect from your anterior hip replacement procedure and will assist with your recovery. Our inpatient and outpatient physiotherapists are also available to aid in your recovery post-discharge by helping to restore, maintain and strengthen your hip movement and function.
In partnership with Medacta
The Lister Hospital in Chelsea is the UK Centre of Excellence for the anterior minimally invasive surgery (AMIS) approach to hip replacement. In partnership with the clinical service provider Medacta, our specialist hip surgeons perform over 100 AMIS hip replacements every year – more than any other private UK hospital.
Medacta has become the global leader in assisting orthopaedic hip surgeons with their transition to the anterior approach. The Lister Hospital is the UK reference centre for training hip surgeons from across Europe in the anterior hip replacement procedure.
This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Our hip replacement locations
The Princess Grace Hospital
42-52 Nottingham Place W1U 5NY London
London Bridge Hospital
27 Tooley Street SE1 2PR London
Request a hip appointment
We're happy to help you make an appointment with one of our experienced hip consultants. They'll be able to advise you on which treatment will most effectively reduce your hip pain, whether that's anterior hip replacement surgery or otherwise. We can also make imaging and outpatient physiotherapy appointments for you.
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