The Direct Anterior Approach (DAA) is a technique for performing a total hip replacement. It uses an interval between muscles that have different nerve supplies; an inter-nervous, inter-muscular plane. This prevents cutting of the gluteal muscles or nerves to muscles.
Dr Elliott has been fellowship trained by As. Professor Phong Tran, Melbourne, in Direct Anterior Approach (DAA) total hip replacement using Anterior Minimally Invasive Surgery (AMIS) technique . He has also performed DAA THJR with leading hip surgeons in Switzerland and France, where this technique has been commonly used for decades.
Dr Elliott was the first surgeon in New Zealand to perform DAA total hip replacement using the AMIS technique. He has now been recognised by Medacta International as New Zealand’s first Official Reference Centre for AMIS Direct Anterior Approach hip replacement. Dr Elliott trains surgeons wishing to adopt this technique. Surgeons may visit to observe direct anterior hip replacement surgery.
Utilising the AMIS technique and leg holder, the surgery can be safely performed using mobile x-ray to ensure accurate implant position.
Dr Elliott performs direct anterior hip replacements through a bikini incision for improved cosmetic outcome in suitable patients.
Benefits
Reduced dislocation risk (0.3%)
No post surgical hip position precautions. Patients are allowed to sit in
low chairs, cross their legs and do activities such as yoga
Smaller wound (~8cm)
Enhanced wound cosmesis with bikini incision
Lower risk of leg length discrepancy
More accurate implant positioning with mobile x-ray assistance
Enhanced recovery and quicker discharge post-surgery
Reduced time on crutches
Very low risk of permanent limp due to sparing of gluteal muscles
Risks
Direct Anterior hip replacement has many advantages but can be technically challenging. It is not appropriate for every patient.
Specific risks of the approach include:
Injury to the Lateral Femoral cutaneous nerve. This is sensory nerve that supplies feeling to the skin on the outside of the mid-thigh. Approximately 1/3 of patients will have some numbness in this region. This is similar to the numbness that all patients undergoing total knee replacement have on the outside of their knee. It is usually well tolerated however a small proportion of patients find this unpleasant or painful (neuralgia) and this usually resolves over several months using medication (gabapentin) and desensitisation exercises with a therapist.
Patients with a large abdomen hanging over their groin are at higher risk for wound problems and may be more safely treated through a posterior or lateral approach.
There is an increased risk of femoral fracture during implantation which decreases with surgeon experience.
Due to the small wound and limited exposure it is not appropriate for some complex primary or revision hip replacements.
Request a consultation with Dr Elliott to see if a Direct Anterior hip replacement may be appropriate for you.