In the United States, there are over 235,000 Total Hip Replacements (THR) performed each year. The first total hip replacement procedure was performed in the United States in 1969. Since that time, significant improvements in the techniques and technology have dramatically improved the surgical outcome and quality of life for those people undergoing this procedure.

Most individuals who have THR surgery are between the ages of 50-80. The most common reasons for undergoing THR surgery are severe pain and decreased mobility interfering with activities of daily living.

These chronic conditions are most often caused by some form of arthritis due to chronic wear and tear, trauma or disease in the hip joint. The hip, known as a “ball and socket joint” with the head of the femur (the ball) gliding against the acetabulum (the socket) is one of the most common total joint surgeries performed.

While the risks of complications with Total Hip surgery are low, they include infection, blood clots, nerve injury, and stiffness. When choosing a surgeon it is important to consider the amount of experience the physician has had performing either procedure.

During this procedure the damaged head of the femur is removed and replaced with a metal stem and a metal or ceramic ball and the damaged cartilage is removed from the socket and replaced with a metal socket. A plastic spacer is placed between the new ball and socket to allow for a smooth gliding movement.

When Dr. Robert Detch, Peninsula Bone & Joint orthopedic surgeon trained in the anterior approach to hip replacement arthroplasty, assesses the severity of your injury and conducts a pre-surgical evaluation to obtain clearance for the procedure, he will take into consideration several important factors, including:

  • Your age

  • Condition of the hip joint

  • Which disease is causing your inflammatory arthritis

  • Progression of the disease

The most common surgical procedures performed for inflammatory arthritis of the hip include total hip replacement and synovectomy.

Direct Anterior Approach to Total Hip Replacement (Arthroplasty)

The Direct Anterior Approach for total hip replacement is a tissue-sparing alternative to traditional hip replacement surgery that provides improvements for the patient:

  • the potential for less post-operative pain

  • potential for less blood loss

  • decreased hospital stay and quicker recovery

  • less anesthesia and complications due to prolonged anesthesia use

  • improved mobility because the muscle tissues are spared during the surgical procedure

  • range of motion assessment during surgical procedure (Dr. Kornreich moves the leg and hip joint before completely closing up the incision to test and confirm full range-of-motion for the patient).

The technique allows Dr. Detch to work between the patient‘s muscles and tissues without detaching them from either the hip or thighbones—sparing the tissue from trauma. Keeping the muscles intact may also help to prevent dislocations.

With the Anterior Approach, Dr. Detch uses one small incision on the front (anterior) of your hip as opposed to the side or back.

Since the incision is in front, the patient avoids the pain of sitting on the incision site.

During this procedure the damaged bone and cartilage is removed and replaced with prosthetic components. The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or “press fit” into the bone. A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.

The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place. A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.


How long it takes to recover and resume your daily activities will depend on several factors, including your general health and the type of surgical procedure you have. Initially, you may need a cane, walker, or crutches to walk. Dr. Detch may recommend physical therapy to help you regain strength in your hip and to restore range of motion.