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Direct Anterior Approach — Dr. Nathaniel Stewart
Hip Procedure

Direct Anterior Approach

A muscle sparing hip replacement technique that offers faster recovery, lower dislocation risk, and more precise implant positioning through a smaller front incision.

2013
Performing since
~1.5–2 hours
Procedure time
1 night
Hospital stay
Same day
Most patients walking
Overview

Overview — What is the Direct Anterior Approach?

Total hip arthroplasty is a surgical procedure in which cartilage and bone that were damaged by arthritis are removed from the hip joint and replaced with artificial joint components. This helps relieve hip joint pain from arthritis and restore the normal alignment and function of your hip.

In December of 2013, Dr. Stewart transitioned to using the direct anterior approach for hip replacement surgery. He now performs greater than 99% of his hip replacements through this method. The direct anterior approach allows the orthopedic surgeon to access the joint from the front of the body, working through a natural corridor between the muscles and tendons rather than cutting or detaching them. The result is less muscle damage, a faster recovery, reduced risk of hip dislocation, more accurate component positioning, and fewer restrictions.

What Causes the Need for Hip Replacement?

Degenerative joint disease (DJD) is a chronic condition often resulting in hip pain and the loss of an active lifestyle and quality of life. There are different types of DJD that can affect the hip, including:

  • Osteoarthritis, in which cartilage wears down over time
  • Post-traumatic arthritis, which results from a severe fracture or dislocation of the hip
  • Rheumatoid arthritis, an inflammatory arthritis of the joints
  • Avascular necrosis, a condition where the femoral head has lost a healthy supply of blood flow causing the bone to die and the femoral head to become misshaped
  • Hip dysplasia, a condition where bones around the hip joint did not form properly, which may cause misalignment and hip pain

Contributing factors can include a previous hip injury, repetitive strain on the hip, improper joint alignment, being overweight, and exercise or sports-generated stress placed on the hip joint.

Candidacy — Who Is a Good Candidate?

The direct anterior approach may be right for you if you have hip pain caused by arthritis or joint degeneration that has not responded to conservative treatment, including:

  • Moderate to severe hip osteoarthritis
  • Avascular necrosis of the femoral head
  • Hip joint degeneration due to inflammatory arthritis
  • Failed conservative treatments including injections and physical therapy
  • Significant hip pain affecting your quality of life and daily function
What to Expect

Recovery Timeline

Day of Surgery
Immediate weight-bearing
Most patients who undergo direct anterior approach hip replacement surgery are able to bear weight as tolerated on the surgical leg immediately after surgery. Dr. Stewart may put you on a weight-bearing restriction for a few weeks to reduce the risk of developing a stress fracture, however, this is quite rare.
Week 1 to 2
Early mobility
Most patients use a walker for the first 1 to 2 weeks and then gradually transition to a cane, and eventually to no gait aids. Generally, patients who undergo direct anterior total hip replacement stay in the hospital one night and go home the next day.
Week 2 to 6
Progressive activity
Outpatient physical therapy is arranged for 1 to 2 times per week for the first 3 to 4 weeks after surgery. A blood thinner is prescribed postoperatively to reduce the risk of developing a blood clot. A follow-up appointment with Dr. Stewart is scheduled 10 to 14 days after surgery.
Month 2 to 3
Return to daily life
Most patients are driving, walking independently, and returning to light daily activities within 6 to 8 weeks.
Month 6 and beyond
Forgotten hip
Low impact activities such as golf, swimming, and cycling are generally well tolerated. Higher impact activities are discussed individually based on implant type and patient goals. Our goal is to achieve a "forgotten hip," where it no longer has a significant impact on your daily life. All but the most extreme activities are typically permissible.
FAQ

Frequently Asked Questions

Dr. Stewart transitioned to the direct anterior approach in 2013 after extensive training and now performs greater than 99% of his hip replacements this way. The technique allows him to verify leg length and implant position using fluoroscopic imaging during surgery, and the muscle sparing nature of the approach consistently produces faster recoveries and lower dislocation rates.
Some patients have arthritis affecting both hips. Dr. Stewart offers bilateral total hip arthroplasty, which replaces both hips in a single surgical session and reduces total recovery time by 6 to 12 weeks compared to staged procedures.
The Durability of total hips has impacted dramatically over the last couple decades. Modern hip implants are designed to last 20 or more years in most patients. Longevity depends on activity level, body weight, implant type, and overall health. Dr. Stewart will discuss realistic expectations based on your individual situation.
Yes. Total hip replacement is a covered procedure under most insurance plans when medical necessity criteria are met. Our team will verify your benefits and obtain pre-authorization before scheduling your surgery.
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Ready to Get Back to Doing What You Love?

Dr. Stewart and his team are here to guide you through every step, from your first consultation to your full recovery.

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