Direct Anterior Approach Total Hip Replacement (DAA-THR) 

Direct Anterior Approach Total Hip Replacement (DAA-THR)

Anterior Minimally Invasive Total Hip Replacement is sometimes known as Direct Anterior Approach Total Hip Replacement (DAA-THR). It is a true minimal invasive procedure as it does not involve cutting or detaching muscle or tendon. Because the hip joint may only be accessed in a restricted area between muscle planes, special tools and equipment are required. Importantly, a skilled and very experienced orthopedic surgeon is also needed. There are many limitations associated with this kind of surgery due to the location and access to the hip joint, in contrast to other hip replacement techniques that allow a wider incision, such as the posterior or lateral approaches.

Introduction of Direct Anterior Approach Total Hip Replacement 

The Direct Anterior Approach Total Hip Replacement (DAA-THR) procedure was first performed at Bangkok Phuket Hospital in 2016. It was a simultaneous bilateral total hip replacements carried out in collaboration with Bangkok Hospital. The results of the surgery were very satisfactory. Within a week, the patient was pain-free when walking and able to resume their regular daily activities. They were also able to walk without the need for any mobility assistance. Due to its success, Bangkok Phuket Hospital has begun to perform both regular hip replacement surgery and this anterior hip replacement procedure in certain cases.

Due to its impressive outstanding results in many cases, these days, Bangkok Phuket Hospital has improved and used anterior hip replacement surgery as the primary approach for hip replacement surgery.

DAA-THR at Bangkok Phuket Hospital 

To get a hip replacement surgery at Bangkok Phuket Hospital, the patient will first have a consultation with a hip replacement surgeon for an assessment, physical examination, and diagnostic radiography. Subsequently, a preliminary evaluation is conducted to ascertain the patient’s suitability for hip replacement surgery and rule out any contraindications. 

The patient then gets an electrocardiogram, a chest radiograph, a laboratory examination, and a health checkup—basic tests for patients having surgery. A preoperative evaluation is then performed by a cardiologist. Additional examinations may be required in some cases, particularly for patients who have underlying medical conditions.

*Other specialist including Anesthesiologist may involve in preoperative evaluation of some patients with complicated medical conditions

This second step takes 0-7 days.The patient’s condition, comorbidities, and prescription medications all affect the duration of this second step. This is particularly true for those who use blood thinners. Patients may occasionally have to wait up to seven days for the medication’s effects to subside. When a patient is in good health and schedules an appointment in advance, they can have hip replacement surgery the same day after receiving a medical examination and meeting with the surgeon.

On the day of surgery (Day 0), you must arrive at the hospital in the morning. You must follow the doctor’s instructions and refrain from eating and drinking. The nurse will verify the patient information and you will be administered with IV fluids and an anesthesiologist will evaluate and advise you on appropriate options for anesthesia during hip replacement surgery. While waiting for surgery in your room, the surgeon will visit you again, give advice and answer your questions. The doctor will then confirm the hip side and location of the surgery and mark the surgical site.

At the front of the operating room, the surgical team will verify the patient’s identification, the procedure, the location, and the side of the surgery.

Before giving the patient anesthesia in the operating room, the anesthesia team evaluates the patient and will start the planned anesthesia when they are ready.

In the operating room, the theatre time is approximately 4 hours. The surgery consists of the following steps.

  1. Anesthesia
  2. Patient positioning and installation of devices including catheters.
  3. Surgical skin disinfection
  4. Preparing a sterile field
  5. Hip replacement surgery (90-120 minutes)
  6. Placing an anesthetic line for pain relief after surgery

Following surgery, patient will be moved from the operating room to the adjacent recovery area, where he/she will be monitored for two to three hours.

Anesthesiologist may consider sending the patient to the patient room for recovery and rest following surgery if the patient regains consciousness and has excellent overall symptoms.

Once the patient is conscious and there are no additional abnormalities, the patient can start eating and drinking in their room. Typically, the patient will experience numbness in the surgical site and on the side of their thighs, along with mild hip pain. The anterior femoral nerve anesthesia (Fascia Iliaca Block) may cause a brief period of weakness; however, the numbness and weakness disappear when the anesthesia is stopped. After surgery, nurses will check on you on a regular basis to examine symptoms.

On Day 1, the doctor will visit the patient to assess the overall condition, review post-surgery radiographs and help the patient to sit, stand, and walk with the assistance of nurses, the physical team, and walking aids.

On Day 2, the catheters are taken out, however, the patient may be sedated to relieve pain. Physical therapists will continue to train the patient in walking and mobility. Many patients are pain-free, have good mobility, and can return home. 

On Day 3 and Day 4, the anesthetic is removed, and the patient is trained by a physiotherapist. Unilateral hip replacement patients are often discharged from the hospital.

Recovery from simultaneous bilateral hip replacement is more involved and takes longer than it does for unilateral hip replacement patients. For an additional one to three days, patients must continue their physical therapy in the hospital (the overall length of hospital stay will typically not exceed seven days).

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