The Direct Anterior Approach

The Direct Anterior Approach (DAA) is the only techinique which follows a path which is both intermuscular and internervous and therefore considerably reduces the risk of damage to periarticular structures such as muscles, tendons, vessels and nerves.

For this reason the DAA approach is the ideal approach for elective primary hip replacement surgery - especially where reduced length of stay and fast patient recovery is a priority.

The technique is fully established and proven over decades of use.  It has been in common use in France and other European countries since the 1960’s but it is relatively new to the English-speaking world. 

Link to BBC Hip Op Story>>

We had two 3 minute slots on Saturday (03/03/12) morning's BBC1 'Breakfast Show' at 8:20 and 9:40 am.

Hip replacement device helps to halve recovery time

You can see the video here:

FLOTE on the BBC


Doctors develop new techniques for hip replacements

BBC national news reporter Anthony Bartram and cameraman Steve came to see us at Wrexham Maelor hospital on Wednesday.

They spent a great deal of time filming;

1. FLOTE assembly and commissioning in the operating theatre

2. The first patient both before and after surgery

3. The whole surgical procedure carried out by Jamie

4.  A representative of the hospital management who spoke about the surgical impacts, etc

5.  A previous patient at his 6-week follow-up consulatation

They then came to see us at our design and development centre at Hathersage in the heart of the Derbyshire Peak District National Park.

Here is Anthony's story>>:

The Direct Anterior Approach to hip replacement is not new:

  • Referred to by Heuter in 1881

  • Pioneered by Robert Judet in 1947

  • Using a trauma table designed by his father (Henri)

  • Robert’s son Thierry has carried out >2,000 cases

  • Letournel in 1980’s

  • Laude in late 1990’s

  • Matta in 2005  over 1,000 cases

  • Wootton in 2008  over 400 cases

How is the Direct Anterior Approach Different?

  • The only truly minimally invasive technique

  • Not simply a small incision

  • Patient is supine throughout

  • 6-12cm single incision in front of thigh

  • Follows a particular intermuscular and internervous path

  • Considerably reduces damage to muscles, tendons, vessels and nerves

  • Rapid recovery with less pain

  • Lower dislocation risk

  • Virtually no limping

  • Improved control of leg length

 What are the Direct Anterior Approach Benefits?

  • Minimal post-operative pain

  • Shorter/quicker rehabilitation

  • Shorter hospital stay ('LOS')

  • Small, single incision scar

  • Reduction in blood loss

  • Elimination of limping

  • Reduced risk of dislocation

  • Quicker return to 'normal life'

Why Is it not more widely adopted in the UK?

  • It is considered to be a ‘more difficult’ procedure which takes longer (over 2 hours versus 45-60 minutes)

  • It requires either Several skilled assistants, or an expensive, specialist piece of equipment

  • Charnley started ‘supine’ but his successors progressed to lateral/posterior because of complications - and this is what is now taught to trainee orthopaedic surgeons

  • It must be very difficult for experienced, hard working surgeons to stick their necks out trying a new technique without very good reasons