DIRECT ANTERIOR HIP REPLACEMENT
Preserve muscle. Personalize the replacement. Support your recovery.
Hip arthritis can make ordinary movement feel like a negotiation: how far to walk, whether to take the stairs, and which activities to avoid. My goal is to help you regain useful movement while respecting the healthy tissues that make that movement possible.
I use a muscle- and tendon-sparing direct anterior approach for appropriate hip replacement patients. Rather than routinely detaching the major hip muscles to reach the joint, this approach uses a natural interval between muscles. I combine that exposure with individualized implant planning, rapid-recovery care, and modern opioid-sparing pain management. [1, 2]
Austin C. Nabet, DO, FAAOS | Atlantic Orthopaedic Specialists
Request an AppointmentUnderstand the Anterior Approach
More Than a New Hip: A Plan for How You Recover
A hip replacement is not just an implant. It is a series of decisions about your anatomy, the route into the joint, component positioning, fixation, pain control, and rehabilitation. Those decisions should work together rather than compete for attention.
My starting point is the person, not simply the X-ray. What has hip pain stopped you from doing? What would make surgery worthwhile to you? Walking comfortably, traveling, returning to work, and keeping up with family are different goals. Understanding yours helps us plan both the operation and the recovery that follows.
A muscle-sparing approach is one part of that plan. It describes how I reach the joint; it does not determine every other choice. Implant selection, anesthesia, medicines, discharge location, and therapy are individualized. The aim is to limit avoidable disruption while delivering the reconstruction you need.
Preserve
respect the muscles and tendon attachments around the hip.
Personalize
plan the replacement around your anatomy, bone quality, health, and goals.
Recover
connect the operation to practical pain management, swelling control, safe walking, and support at home.
The Anterior Approach: Between Muscles, Not Through Them
Anterior means front. The direct anterior approach reaches the hip from the front through an interval between muscle groups. At the superficial level, this interval lies between the sartorius and tensor fasciae latae muscles. The surgical exposure continues through deeper tissue layers to the hip capsule. [2, 3]
In the usual muscle-sparing exposure, the major hip muscle attachments are not routinely detached to gain access. The tissues are carefully moved aside. This is different from an approach that requires releasing and later repairing a muscle attachment as part of the exposure.
Muscle-sparing does not mean tissue-free surgery. The skin and fascia are opened, the capsule is opened and managed, and damaged bone and cartilage are treated. Retraction and manipulation can still affect muscle. Additional releases may be necessary for a safe reconstruction in an individual case. [1, 2]
The purpose is to preserve healthy muscle where possible, not to insist that nothing can ever be touched. Safe exposure and accurate implant placement always take priority.
What is actually replaced?
Total hip replacement treats the worn ball-and-socket joint. The damaged femoral head is removed, the socket is prepared for a new cup and liner, and a stem and ball reconstruct the femoral side. The choice of components and how they are fixed depends on the patient's bone and reconstruction needs. [4]
This is still a total hip replacement, not a hip arthroscopy, muscle repair, or a different brand of implant. The distinguishing feature is the pathway used to reach the joint.
A Smaller Scar Is Not the Whole Story
A short incision can look appealing, but it does not tell you what happened beneath the skin. An operation can use a relatively short incision and still require a muscle or tendon release. Conversely, extending an incision when needed can make an operation safer without changing the goal of careful tissue handling. [1]
I prefer to explain the structures I am trying to preserve rather than promise a particular scar length. The incision should provide enough room to perform your replacement accurately and safely. Your body shape, anatomy, prior surgery, and the complexity of the reconstruction influence that decision.
When comparing techniques, useful questions are: Which muscles are preserved? Which tissues are opened or repaired? How is the hip reconstructed? What does the recovery plan involve? Those questions are more informative than asking only how many inches long the incision will be.
Same Goal. Different Surgical Pathways.
Several approaches can produce a successful hip replacement. The comparison below describes typical exposures; variations exist within each approach. It is not a ranking of surgeons or a prediction of your individual outcome. [1, 2, 5]
Direct anterior: access from the front
Uses an interval between muscles, aiming to preserve the major muscle attachments during exposure. The capsule still requires surgical treatment. This is the approach I favor for appropriate primary hip replacements within my muscle-sparing program.
Posterior: access from behind
A traditional posterior exposure commonly releases the short external rotator tendons and opens the posterior capsule, with repair as appropriate. Muscle-sparing posterior variations also exist. A well-performed posterior replacement remains an effective option.
Direct lateral: access from the side
A direct lateral exposure typically splits or releases part of the abductor mechanism and repairs it at closure. Lateral and anterolateral techniques differ, so the precise method matters more than a broad label alone.
The shared goal is a stable, well-positioned hip replacement. My preference for the anterior approach reflects a tissue-preserving philosophy, not a claim that another approach cannot work well.
Why Muscle Preservation May Matter Early
When you first get out of bed, stand from a chair, or begin walking, you depend on the muscles around your hip. Preserving their attachments is particularly relevant to those early practical tasks. At the same time, pain and swelling can temporarily limit function even when a muscle has not been divided.
Some randomized trials have reported earlier gains in pain or function after direct anterior hip replacement. Other trials have found little difference. These findings support discussing potential early advantages, not promising a painless recovery or a permanently superior hip. [5, 6, 7]
For my patients, the practical aim is to create a good starting point for rehabilitation: careful tissue handling, appropriate pain control, and clear instructions about movement. The approach cannot replace any of those other elements.
Progress is also personal. A patient with longstanding weakness or limited mobility may need a different pace from someone who remained active before surgery. Using a walker, needing therapy, or taking rescue pain medicine does not mean that muscle-sparing surgery has failed.
Personalized Reconstruction: The Approach Is Only One Decision
Position, stability, and leg length
Your surgical plan considers the relationship between the ball, socket, and surrounding tissues. Restoring hip mechanics includes component position, stability, and appropriate leg length and offset. Exact equality of leg length cannot be promised, and stability may sometimes require a compromise. [4]
I review your imaging and examination in the context of your symptoms and goals. Pain from the spine or another joint may not disappear with hip replacement, so understanding the source of symptoms is important before proceeding.
Fixation and implant choices
Cementless fixation allows suitable bone to grow onto an implant surface; cemented fixation secures a component with bone cement. Bone quality and the reconstruction determine which option is appropriate. The anterior approach does not automatically require one fixation method. [4]
Technology that supports the operation
Preoperative planning and intraoperative imaging may help assess the reconstruction. Fluoroscopy can be used when useful to evaluate component position and leg length. Equipment and positioning are selected for the patient and the facility; neither a special table nor a robot is what makes the approach muscle-sparing.
My priority is a well-executed operation. Technology is a tool to support that goal, not a substitute for surgical judgment or careful handling of tissue.
Muscle-Sparing Surgery and Opioid-Sparing Care
Preserving tissue and managing pain are related, but they are not the same intervention. A tissue-sparing operation still needs a thoughtful pain plan. My program combines the surgical approach with appropriate anesthesia, non-opioid medicines, local swelling measures, and rescue medication when needed.
Multimodal means using complementary tools rather than expecting one medicine to do everything. Acetaminophen addresses pain. An anti-inflammatory may address pain and inflammation when medically appropriate. Ice, rest, elevation, and paced activity have their own roles. The combination is tailored around allergies, other medicines, kidney or liver conditions, and other health considerations.
Where JOURNAVX fits
JOURNAVX (suzetrigine) is a prescription non-opioid option for moderate to severe acute pain in adults. It acts on a peripheral pain-signaling pathway rather than opioid receptors and may be included in your plan. It is a pain medicine, not an anti-inflammatory or a replacement for swelling control. [8, 9]
It is not appropriate for everyone. Interactions and medical conditions can require changes or avoidance, and side effects can occur. Follow your personal prescription rather than a general website schedule. Your prescribing team will give you a personal medication schedule for surgery and recovery. [9]
Opioid-sparing means reducing unnecessary opioid exposure, not withholding pain treatment. Some patients still need a limited opioid prescription. The goal is pain control that supports rest and safe movement, not a requirement to recover without help.
Rapid Recovery Is a Coordinated Plan, Not a Race
Preparation, surgery, anesthesia, nursing, therapy, and the home plan should fit together. The first goals are straightforward: get up safely, walk with the correct support, manage medicines, and know when to contact the team.
Many patients begin standing and walking with assistance on surgery day. Some return home that day; others need observation. Discharge depends on medical stability, recovery from anesthesia, pain control, safe mobility, and support at home. An overnight stay is not a setback, and the size of the incision does not decide when it is safe to leave. [1, 4]
Your surgery may be scheduled at Sentara Leigh Hospital, Bon Secours Surgery Center at Harbour View, or Leigh Orthopedic Surgery Center. The location and anesthesia plan are selected around your needs. Follow the arrival, fasting, and medication instructions from your assigned facility.
The First Week: Control Swelling and Walk a Little, Often
My early recovery message applies to hips as well as knees: the first week is about swelling control, not testing how far you can walk. Take short walks every hour while awake with your prescribed walking aid, then allow time for rest, elevation, and icing as directed.
Follow cold-therapy instructions for skin protection, treatment sessions, and breaks. More intense exercise or longer walks are not automatically better. If activity leaves you substantially more swollen or sore, reduce the intensity and ask for guidance.
Outpatient physical therapy generally begins around postoperative day seven or shortly afterward. Selected patients receive home-health therapy first, typically three visits during the first two weeks, then transition as directed. Arrange the plan before surgery, and continue the safe walking and exercises taught by your care team.
Muscle-sparing does not mean no hip precautions
Follow your hip-specific instructions. My current routine guidance avoids extreme hip positions and keeps knees and feet pointing in the same direction for six weeks. Avoid hip hyperextension and straight-leg raises for four weeks unless I clear you. Different instructions may apply to your operation.
New or worsening calf pain, marked swelling, drainage, or an unexpected change in function needs prompt attention. Call 911 for chest pain or difficulty breathing. Do not assume every postoperative symptom is harmless.
Your Path From Consultation to Recovery
Before surgery: prepare the person and the plan
We begin with your symptoms, examination, imaging, and a discussion of alternatives. Complete the medical optimization and testing ordered for you. At your surgical planning appointment, generally one to two weeks before surgery, we review readiness, the operation, medicines, and your questions.
Have your prescribed recovery medicines at home before surgery. When JOURNAVX is arranged through District Pharmacy, respond to its call to coordinate delivery; other prescriptions go to your preferred local pharmacy. Practice the hip-specific exercises as tolerated, arrange help at home, and confirm the therapy plan.
The first two weeks: protect healing and establish a routine
Focus on swelling control, brief walks, medicines including clot prevention as prescribed, and your personal wound-care instructions. Do not borrow a friend's exercise or medication schedule. The separate discharge directions explain dressing layers and SYLKE removal at day 14 as directed by my team.
The following weeks: build function, not deadlines
Follow-up commonly occurs around two and six weeks. We review the incision, walking, comfort, strength, and any concerns. Return to driving, work, travel, and recreational activity depends on progress and safety, not an advertised recovery date. Keep communicating about the activities you want to regain.
Is Muscle-Sparing Anterior Hip Replacement Right for You?
The first decision is whether hip replacement is appropriate, not which incision sounds most appealing. Surgery may be considered when hip disease is substantially limiting everyday life and reasonable nonsurgical care no longer provides enough relief or is unsuitable. [4]
For patients considering replacement, I assess anatomy, stiffness, prior operations, bone quality, medical risks, and the complexity of the reconstruction. A diagnosis, age, or body-size label alone does not describe the whole person. We discuss what the proposed operation can realistically address and what recovery will require.
The direct anterior approach can be used in many primary replacements, but some complex cases are better approached differently. Revision surgery, scarring, deformity, or a fracture can change the plan. A different exposure may be the safest decision; it is not a lesser commitment to personalized care.
Understand the Risks and the Evidence
Total hip replacement can involve infection, bleeding, blood clots, fracture, dislocation, nerve or blood-vessel injury, wound problems, leg-length difference, persistent pain, implant wear or loosening, and further surgery. A muscle-sparing approach does not remove these risks. [4]
With an anterior exposure, numbness, tingling, or burning over the outer thigh can result from irritation of the lateral femoral cutaneous nerve. Some symptoms may persist. Femoral exposure and wound healing also require careful technique and patient selection. We discuss the risks that matter for your particular situation. [3, 6]
What comparative studies actually tell us
A randomized trial reported lower early pain and better early function after the anterior approach, with similar function by six months. Another randomized trial using objective walking measurements found comparable early recovery between anterior and posterior approaches. A longer-term follow-up of a separate randomized trial found no clinically meaningful differences at an average of 7.5 years. [5, 6, 7]
The message is balanced: there can be early-recovery advantages, but they are not universal and do not establish a guaranteed better long-term result. These studies compare approaches; they do not prove that every component of my combined program independently causes a benefit.
I use the direct anterior approach because tissue preservation fits my treatment philosophy, while keeping careful reconstruction, complication prevention, and your individual needs central to the decision.
See Recovery in Real Life
My patient-video library includes a direct anterior hip replacement recovery story. Seeing a patient's progress can help you understand the experience and prepare questions for your consultation.
A video is an individual example, not a timetable for your recovery. The most useful comparison is with your own starting point and goals, not the fastest recovery you see online.
Frequently Asked Questions
Is direct anterior hip replacement truly muscle-sparing?
It uses a natural interval between muscles and is designed to preserve the major muscle attachments during routine exposure. The skin, fascia, capsule, and bone still require surgical treatment. Muscle-sparing describes the approach, not an absence of tissue injury. [1, 2]
Are muscles or tendons ever released?
The usual anterior exposure avoids routine detachment of major hip muscles. Anatomy or a difficult reconstruction can require additional releases. Safety takes priority over promising that no tissue will ever need treatment. Your surgeon can explain the plan for your hip. [2]
Is it the same as minimally invasive hip replacement?
Not necessarily. Minimally invasive can refer to incision length or several different techniques. Direct anterior names the specific route into the hip. Ask what happens under the skin rather than relying on incision size alone. [1]
Is the anterior approach better than a posterior approach?
It offers a tissue-sparing route and may provide some early benefits. It is not universally superior. Surgeon experience, accurate reconstruction, patient selection, and the recovery program matter, and well-performed approaches can achieve similar longer-term outcomes. [5, 6, 7]
Will I recover without opioids?
That cannot be promised. My program emphasizes non-opioid options and appropriate rescue treatment. Your medical history, prior medicine use, pain response, and recovery needs guide the prescription. Needing an opioid temporarily is not a failure.
Does every patient receive JOURNAVX?
No. It may be included when suitable, after reviewing other medicines and medical conditions. It is one tool in the plan, not a requirement for anterior hip replacement. Use it only as prescribed. [8, 9]
Can I go home on surgery day?
Some patients can after meeting discharge criteria. Others need observation. Safe walking, medical stability, comfort, and help at home determine the decision. Your plan is discussed before surgery and reassessed afterward.
Will I need a walker?
Yes, plan to use the prescribed aid. My usual hip discharge instructions call for crutches or a walker for at least two weeks, followed by progression as directed. Muscle-sparing surgery is not a reason to risk a fall.
When does physical therapy begin?
Outpatient therapy generally starts around day seven. Home therapy may begin in the first week when prescribed, commonly with three visits in the first two weeks. Your therapist and surgical team determine the transition and progression.
Are there still movement restrictions?
Yes. Follow your hip-specific precautions even if you feel well. My usual guidance avoids extreme positions for six weeks and hip hyperextension or straight-leg raises for four weeks, unless I direct otherwise. Do not use a knee exercise program.
Does anterior surgery require a special implant, table, or robot?
No single implant or device defines this approach. Component selection, fixation, positioning equipment, and any imaging assistance serve the reconstruction. They are separate decisions from using an interval between muscles. [2, 4]
Will my legs be exactly the same length?
Restoring appropriate leg length is an important goal, but exact equality is not guaranteed. Stability, anatomy, and the reconstruction all matter. Discuss a pre-existing leg-length concern during planning and any persistent concern during follow-up. [4]
What does outer-thigh numbness mean?
Skin sensation can change if the lateral femoral cutaneous nerve is irritated during an anterior approach. Tell the team about new or persistent symptoms. New weakness or a sudden change in function also needs assessment rather than being dismissed as routine numbness. [3, 6]
When can I drive or return to work?
The decision depends on safety, the operated side, job demands, walking ability, and medicines. Do not drive while taking an impairing medicine. Follow your discharge instructions and obtain clearance rather than treating another patient's return date as your target.
Can someone with previous hip surgery use this approach?
Sometimes. Previous surgery can change tissue planes, anatomy, and implant needs. I review your history and imaging to choose an exposure that permits safe reconstruction. A different approach may be appropriate without changing the overall goal of thoughtful care.
How long will the replacement last?
A hip replacement is intended for long-term use, but it does not have a guaranteed lifespan. Implant fixation, wear, bone health, activity, complications, and follow-up all matter. The incision alone does not determine durability. [4]
A Thoughtful Operation. A Practical Path Back to Life.
My goal is not simply to replace the painful joint. It is to help you understand the choices, preserve healthy tissue where possible, and recover with a plan that makes sense for you.
For appropriate patients, muscle-sparing direct anterior hip replacement brings together a tissue-preserving exposure, individualized reconstruction, opioid-sparing care, and practical guidance for recovery. That is the conversation I want you to have before choosing surgery.
If hip pain is limiting your life, schedule a consultation to discuss your options. We will review your symptoms, health, anatomy, and goals, then decide together whether hip replacement and the anterior approach are appropriate.
Austin C. Nabet, DO, FAAOS | Atlantic Orthopaedic Specialists | Norfolk, Virginia Beach, and Hampton Roads.
Patient Resources
Download Keys to Success - PDF, 1 page
Download Hip Discharge Instructions - PDF, 3 pages
These reminders supplement your personal instructions. Use the discharge directions supplied for your operation; complex or revision surgery may require a different plan.
Selected Medical References
- American Academy of Orthopaedic Surgeons. Minimally Invasive Total Hip Replacement. Read source.
- Hozack WJ, Heller S. Direct Anterior Hip Exposure for Total Hip Arthroplasty. JBJS Essential Surgical Techniques. 2015;5(4):e22. Read source.
- The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint. Journal of Orthopaedic Surgery and Research. 2016. Read source.
- American Academy of Orthopaedic Surgeons. Total Hip Replacement. Read source.
- Zhao HY, et al. Comparison of Early Functional Recovery After Total Hip Arthroplasty Using a Direct Anterior or Posterolateral Approach: A Randomized Controlled Trial. Journal of Arthroplasty. 2017;32(11):3421-3428. Read source.
- Bon G, et al. Does the direct anterior approach allow earlier recovery of walking following total hip arthroplasty? A randomized prospective trial using accelerometry. Orthopaedics & Traumatology: Surgery & Research. 2019;105(3):445-452. Read source.
- Roberts HJ, et al. A Randomized Clinical Trial of Direct Anterior Versus Mini-Posterior Total Hip Arthroplasty: Small, Early Functional Differences Did Not Lead to Meaningful Clinical Differences at 7.5 Years. Journal of Arthroplasty. 2024;39(9 Suppl 1):S97-S100. Read source.
- U.S. Food and Drug Administration. FDA Approves Novel Non-Opioid Treatment for Moderate to Severe Acute Pain. January 30, 2025. Read source.
- JOURNAVX (suzetrigine). U.S. prescribing information and patient information. Read source.
This page provides general education, not individualized medical advice or a substitute for informed consent. Surgical approach, implants, medicines, restrictions, and recovery plans vary by patient. Results are not guaranteed.
