What is direct anterior hip replacement?
Total hip replacement involves removing the worn ball and socket of the hip and replacing them with an artificial joint. The question is how the surgeon gets there — and that choice has a significant effect on how quickly you recover.
Traditional hip replacement approaches — posterior (from the back) and lateral (from the side) — require cutting through or splitting muscle to reach the joint. The muscle is repaired afterwards, but while it heals, movement is restricted. That is where the familiar rules come from: no bending the hip past 90 degrees, no crossing the legs, no twisting for six weeks.
The direct anterior approach is different. The surgeon enters the hip through a natural gap between muscles at the front of the thigh, without cutting or splitting them. Because the muscles are left intact, the joint is immediately stable after surgery — and those restrictions are not required.
“I use the direct anterior approach as my preferred technique because it gives my patients a faster, more comfortable early recovery. The muscles that stabilise the hip are untouched. Patients are walking the same day, driving at around four weeks, and living normally — without the restrictions that come with traditional approaches.”
— Dr Luke Mooney
Dr Luke Mooney is an Adelaide orthopaedic surgeon who teaches the direct anterior approach to other orthopaedic surgeons, as faculty on national instructional courses combining lectures with cadaveric surgery. In August 2026 he taught surgeons from Sydney, Melbourne, Adelaide and New Zealand at a course in Melbourne. You can read what that training involves, or see his research and teaching record.
Who it suits
Most adults who need a total hip replacement are suitable for DAA. Common reasons include osteoarthritis, inflammatory arthritis, avascular necrosis, post-traumatic arthritis, and selected cases of hip dysplasia. Dr Mooney will review your imaging, anatomy and medical history at your consultation to confirm DAA is the right approach for you.
What happens during surgery
DAA hip replacement is performed under spinal anaesthesia, usually combined with a regional nerve block. You will be positioned on your back on a specialised operating table. Dr Mooney makes a 7–10 cm incision on the front of the thigh and works through the natural gap between muscles to reach the hip joint.
In most cases, robotic assistance (MAKO) provides real-time confirmation of implant position, leg length and offset. The worn femoral head and acetabular cartilage are removed, the bone is prepared, and the new implants are placed. The operation typically takes 60–90 minutes.
What to expect after surgery
Day 1Walking with a frame or stick, usually within hours of surgery.
Days 2–5Home or short-stay discharge. Waterproof wound dressing — showering is fine.
Week 1–2Walking with a stick. No posterior precautions — sit, dress and move normally.
Week 4Most patients are driving again by this point, once comfortable, confident of an emergency stop, and eight hours clear of opioid pain relief.
Week 4–6Return to light desk work and most daily activities.
3 monthsSwimming, stationary cycling, golf, bowls for most patients.
6–12 monthsFull recovery for most patients.
