Direct Anterior Total Hip Replacement (D.A.A. Minimally Invasive) or A Total Hip Replacement. Everything you need to know.
Total Hip Replacement (THR) and Arthritis
Total hip replacement is typically not recommended for patients with mild arthritis.
For patients with severe arthritis, the Direct Anterior Approach (DAA) is a viable option. However, patients may not be suitable candidates for the DAA if they have abnormal hip anatomy (e.g., dysplasia, post-traumatic arthritis) or morbid obesity (BMI > 35).
When Should You Consider Total Hip Replacement?
Joint replacement should be considered when:
Arthritis affects quality of life.
Arthritis interferes with normal function (e.g., difficulties in activities such as putting on shoes/socks, getting out of a chair).
X-rays show moderate to severe arthritis.
Patients are healthy enough for elective surgery.
Benefits outweigh the risks.
For most patients with hip arthritis, pain is the key limiting factor. Some individuals with a high pain tolerance may manage for years, but for many, the decision to undergo surgery is primarily based on quality of life.
What Happens Without Surgery?
Without surgery, degenerative arthritis typically worsens progressively over time. Symptoms may "wax and wane" with both good and bad days, but over time, they generally become persistent. Though arthritis is not life-threatening, it can severely limit physical activity, which may indirectly affect cardiovascular health, weight, and overall well-being.
Surgical Options
Traditional hip replacement involves making an incision on the side (lateral) or back (posterior) of the hip. Both approaches require detaching muscles and tendons, which may lead to prolonged recovery and increased post-surgical pain. Muscle detachment can also increase the risk of hip dislocation (where the ball and socket separate), a common reason for hip replacement failure. As a result, hip precautions (e.g., no bending greater than 90 degrees, no crossing legs) are generally necessary.
In contrast, the Direct Anterior Approach (DAA) is a minimally invasive technique that involves a 3–4 inch incision on the front of the hip. Muscles are moved aside, rather than detached, minimizing post-surgical pain, speeding up recovery, and reducing the risk of dislocation. This approach typically eliminates the need for hip precautions, allowing patients to resume normal activities more quickly.
Effectiveness
Total hip arthroplasty (THA) has a success rate of 90-95%, with most patients experiencing significant pain relief and improved function. The longevity of a hip replacement is approximately 90% at 20 years. While the DAA aims to improve recovery by minimizing muscle and tendon trauma, the differences become less distinct after 2 years.
Urgency
Hip replacement is generally elective surgery, meaning it can be scheduled based on the patient's convenience. In rare cases of advanced arthritis, where bone loss compromises the joint, surgery may be recommended with more urgency.
Pre-operative Preparation:
Cessation of smoking for at least 6 weeks.
Weight loss to achieve a BMI < 40.
Good diabetic control (HbA1c < 7.0).
Risks of Total Hip Replacement:
Infection, injury to nerves or blood vessels, fracture, stiffness, instability, loosening of components, and leg length discrepancy.
Medical risks include anesthesia complications, heart attack, stroke, blood clots, and blood transfusions.
DAA minimizes the risk of hip dislocation compared to traditional methods, as it avoids cutting the posterior muscles.
Managing Risks
Prompt identification and treatment of complications such as infections and dislocations are essential. Infections are rare but require immediate intervention, which may involve surgery. Hip dislocations often require reduction in the emergency department or, in some cases, additional surgery.
Preparing for Surgery
As hip replacement surgery is an elective procedure, patients should aim to be as healthy as possible before the operation. If it is possible for you to exercise moderately every day, I recommend it. You will have a better outcome if your muscles and tendons are in as healthy a state as possible and if your health is at an optimum level. Check out the suggestions about exercise at the end of this page and look for information about weight loss in my Blog 'Losing excess weight and Constitutional homeopathy' on my website. Do remember it is critical to follow the surgeon’s guidelines to minimize complications.
About the Procedure: Direct Anterior Hip Replacement
DAA involves creating a 3–4 inch incision over the front of the hip, where the surgeon navigates through natural tissue planes to access the hip joint. This approach avoids cutting muscles, allowing for a quicker recovery and reduced pain.
Steps in the Procedure:
Incision made over the hip joint.
Joint exposure without cutting muscles.
Femoral head removal and acetabulum cleaning.
Implantation of the acetabular and femoral components.
Wound closure with absorbable sutures.
Anesthesia: Typically performed under spinal anesthesia, which reduces bleeding and promotes better pain control. Check out the homeopathic remedies which help to clear any difficult symptoms following anesthesia.
Duration of Surgery: Generally takes 1-2 hours, with additional recovery time in the hospital.
Hospital Stay: Most patients can leave the hospital the next day.
Recovery and Rehabilitation
Pain management is crucial in the recovery process. Non-narcotic pain medications (e.g., anti-inflammatories, Tylenol / Paracetamol) are used to minimize side effects, and physical therapy (mostly walking and gentle exercises) starts on the day of surgery. If you have a DAA, this accelerates rehabilitation and the return to daily activities.
Recovery timeline:
Basic activities of daily living: Within 7-10 days.
Driving (for the right hip): Typically after 2 weeks.
Return to manual labor: 6-12 weeks.
Advanced activities (e.g., golf, tennis): After 3 months.
Homeopathic Remedies for Healing before Surgery
For pre-surgery joint pain, remedies like Rhus Tox, Bryonia, and Sanguinaria are effective for relieving joint stiffness and pain. Tissue Salts such as Calc Fluor, Calc phos and Silica are also useful as part of your pre-surgery care package. Note: do not use Silica after this type of surgery because Silica is known for it's ability to expel foreign objects from the body (splinters etc) and although it is unlikely the remedy can do any harm, it makes sense to wait until your body is completely recovered from surgery before taking advice about it's further use.
If you are extremely anxious in the days leading up to your operation, remedies such as Aconite, Arg nit, Arsenicum album, Gelsemium, Kali ars, Lycopodium, or Phosphorous will help to support you.
Homeopathic Remedies for Healing after Surgery
Several homeopathic remedies can help manage pain and support healing after hip replacement surgery but the best solution is to ask a Professional Homeopath for tailored advice so your particular type of pain is addressed well. Please seek advice from a qualified Homeopath if you are on long term blood thinning medication.
Aconite: Best for anxiety, fear, or shock just before or immediately after surgery.
Arnica: Reduces swelling, bruising, and recovery time. Best used immediately after surgery.
Hypericum: Helps with nerve pain and acute sensitivity.
Calendula: Prevents infection and promotes wound healing.
Staphysagria: Aids recovery from invasive procedures and helps with pain from incisions.
Bellis Perennis: Effective for deeper tissue healing and bruising, especially after abdominal or pelvic surgery but remember this type of surgery goes deep into the body so you should benefit from this remedy after a few days of Arnica use.
Ruta: Ideal for joint surgery recovery to help heal fibrous tissues and tendons.
Symphytum: Deep pain relief plus this remedy supports bone healing after fractures or surgeries involving bone incisions and setting.
Phosphorous: Helpful if you have an adverse response to anaesthetic, also look at Nux vomica.
Helios Pharmacy sells an injury mix which is ideal post surgery, it contains Arn / Cale / Hyp / Rhus / Ruta / Symp. Most good Homeopathic Pharmacies will have this or something similar if you enquire.
Looking after your Scar:
You will be given good advice about looking after your wound in hospital. Ensure you do not begin to use creams or oils until the wound has healed sufficiently. Never use topical creams on an open wound. My absolute favourite healing topical preparation is Macerated Calendula Oil. I used Neal's Yard Macerated Calendula Oil and was delighted with it. The Calendula is deeply healing and the company are reputable with a long history. Remedies to take internally are also advised. Thiosinaminum is my number one remedy for helping with wounds that are slow to heal, scar tissue which is problematic and keloids. Our repertory is filled with many other helpful remedies for issues around scarring, come and talk to me if there is a particular issue you need to address.
More about Exercise:
Pre-Surgery Physical Exercises:
Before undergoing hip replacement surgery, it’s essential to strengthen the muscles around the hip and improve flexibility to support the recovery process and reduce complications. Low-impact exercises like swimming, stationary biking, and water aerobics are excellent choices as they minimize strain on the joint while increasing muscle strength and range of motion. Strengthening exercises that target the quadriceps, hamstrings, and glutes, such as leg raises and gentle squats, can help provide stability and support for the hip joint. Balance exercises, such as standing on one leg or using a balance board, can also enhance proprioception and help prevent falls in the lead-up to surgery. Always consult with a physical therapist to ensure exercises are performed correctly and safely.
Additionally, maintaining overall cardiovascular fitness is crucial, as this can improve your stamina for the surgery and speed up recovery afterward. Walking at a moderate pace is an excellent, gentle way to keep your body active without overloading the hip. Stretching exercises, particularly those that target the hip flexors and hamstrings, will help maintain joint flexibility and reduce stiffness. It's important to avoid high-impact activities like running, jumping, or heavy lifting that could worsen hip pain or cause injury leading up to surgery. Your surgeon or physical therapist can provide personalized recommendations based on your specific condition and needs.
Post-Surgery Physical Exercises:
After hip replacement surgery, physical therapy and specific exercises are vital for a smooth recovery and to regain mobility. In the first few days post-surgery, the focus is on gentle movements to encourage circulation, reduce swelling, and begin the healing process. Patients are usually encouraged to perform basic exercises like ankle pumps, knee slides, and straight leg raises to engage muscles without putting pressure on the new joint. Weight-bearing exercises should be introduced gradually as the hip heals, with most people walking with assistance (e.g., crutches or a walker) within the first few days. These exercises help improve flexibility, prevent blood clots, and reduce stiffness.
As the healing progresses, physical therapy will evolve to more active exercises, focusing on regaining strength and range of motion in the hip. Strengthening exercises that target the core, glutes, and thigh muscles are crucial for supporting the hip joint and improving overall balance and stability. Low-impact activities, such as stationary biking and swimming, may be introduced once the joint has sufficiently healed, allowing patients to maintain fitness without putting stress on the new hip. It’s important to avoid high-impact or strenuous activities, like running or heavy lifting, for several months after surgery, and to follow your therapist’s guidelines for progressively increasing activity. Patience and consistency with rehab exercises can ensure the best long-term outcomes.
A final thought:
Having a joint replacement can feel like an extremely daunting procedure but this type of elective surgery can bring enormous long term benefits to your overall health and wellbeing. Prepare your body as best you can and be optimistic, results are almost always life-changing in a positive way - they certainly were for me.
Ann Lovatt's Hip Replacement Surgery and Homeopathy infiormation is priceless. Thorough and reassuring. The best advice I could ask for going into my operation.