Direct Anterior Approach for Total Hip Replacement

Hip Replacement

Hip replacement surgery is a procedure in which the surgeon makes an incision in the side of the thigh, removes the diseased parts of the hip joint, and replaces them with new artificial parts.

Pre-Travel Steps:


  1. Identification of Treatment Need: Your GP or consultant will diagnose the need for hip replacement surgery based on your medical condition and symptoms.
  2. Contact Healthcare Abroad: You or your GP will initiate contact with Healthcare Abroad to begin the process of arranging your hip replacement surgery in an EU country under the Cross-Border Directive. We specialize in facilitating timely access to medical care, bypassing long waiting lists in Ireland.
  3. Liaison with GP and Diagnostic Tests: Our team will collaborate with your GP to organize a referral letter and any necessary diagnostic tests, ensuring a comprehensive assessment of your hip condition. Test results will be promptly provided to the chosen hospital.
  4. Selection of Hospital and Surgeon: Utilizing our extensive network of hospitals and surgeons, we will match you with a facility and specialist that meet your specific requirements and preferences.
  5. Financial Assistance: If needed, we can assist you in organizing finances through Irish credit unions to cover the costs associated with your hip replacement surgery abroad, allowing you to access treatment without delay.
  6. Arrangement of Surgery Dates: We will liaise with the chosen hospital to secure suitable surgery dates, prioritizing your needs and ensuring timely intervention. Your medical files will be transmitted securely for review by the surgical team.
  7. Confirmation of Travel Dates: Once your healthcare plan is finalized, including surgery dates and logistics, we will confirm your travel arrangements with the hospital team, ensuring seamless coordination for your journey abroad.
  8. Travel Preparation: With all arrangements in place, you are now ready to travel. Upon arrival at the hospital, you will have an outpatient appointment with your consultant the day before your scheduled surgery, providing an opportunity for final pre-operative assessments.
  9. Post-Discharge Paperwork: Following your discharge from the hospital, our team will handle all necessary paperwork, including submission to the Health Service Executive (HSE) for reimbursement. We ensure timely processing to facilitate your refund efficiently.
  10. Update of Medical Records: Your GP will receive a detailed report from the hospital abroad regarding the hip replacement surgery you underwent. This information is essential for updating your local medical records and ensuring continuity of care upon your return to Ireland.

Your doctor may recommend hip replacement if you have significant pain, inflammation, and damage to your hip joint due to:

  • Osteoarthritis (most common)
  • Rheumatoid Arthritis
  • Osteonecrosis (avascular necrosis)
  • Injuries such as hip fractures
  • Hip tumor

How to prepare

Before surgery, you will meet with your surgeon for a checkup. The surgeon will:

  • Ask about your medical history and current medications
  • Examine your hips, noting the range of motion of the joints and the strength of the surrounding muscles
  • Order blood tests and X-rays. MRI scans are rarely required

What to expect

You will be asked to undress and put on a hospital gown when you check in for surgery. You will receive a spinal block, numb your lower body, or general anesthesia.

Your surgeon may also give you a nerve block by injecting anesthesia around the nerve or in and around the joint to help stop postoperative pain.

Driving after surgery

Patients should not drive for at least 6 weeks after surgery, depending on the surgeon’s advice. Getting in and out of a car can be tricky, so it’s best to get help before you feel comfortable driving alone again. It is important to practice braking quickly, hard, and as slowly as may be required in certain situations. Keep in mind that some pain relievers may have a sedative effect and should not be taken before driving.

Walking after surgery

After surgery, you will be able to walk, but may be uncomfortable. Since you will have to use a cane, walker or crutches, furnish your home so you don’t move around. Avoid taking the stairs for the first few weeks. So if your bedroom is upstairs, you may want to consider sleeping in a room that doesn’t require you to move up and down.

Daily exercise

Patients will be provided with a special exercise routine that focuses mainly on strengthening muscles in the hips and upper legs. Bear in mind that walking, although highly beneficial, is not a substitute for the exercises.

Active lifestyle

Physical activity is a critical part of successful recovery. Patients are encouraged to resume an active lifestyle about three months after surgery. Gentle physical activity such as swimming, golfing, or cycling not only helps your joints recover, but can also have a positive impact on your overall health. High-intensity exercise such as running or skiing should be avoided.

Wound care

Drain pipe

After the hip replacement is complete, the incision will be closed and a wound dressing applied. The patient is likely to place a drainage tube in the wound and out of the bottom of the dressing. Drainage tubes prevent serious accumulation at the incision site. Most people have their drains removed before they start walking. Staples should be removed after 10 to 14 days.


Note that the patient should not shower for the first three days. Showers are permitted from then on, however, the wound dressing should not be scrubbed and damaged in any way. Baths and hot tubs should be avoided throughout the recovery period, i.e. until the wound is completely dry and free of scabs and the staples have been removed.


When recovering at home, patients need to change the bandages themselves. Wound dressings may need to be changed daily if recommended by your doctor. To properly change the bandage, thorough hand washing is required before and after removing the old dressing, and the new dressing remains sterile until it is placed over the incision site. The patient will be informed of detailed measurements and types of bandages during the hospital stay.

Importance of Physical Therapy

The patient is likely to begin light recovery exercise on the second postoperative day. Later, the patient will be introduced to a special exercise routine that helps restore muscle strength and mobility more quickly.

Although moving or exercising may be uncomfortable at first, active participation in physical therapy is essential for successful muscle healing and overall recovery time.

The physical therapist will adjust the recovery plan and the difficulty of the exercises based on the individual’s progress. In the early postoperative period, it is recommended that patients exercise 3 times a day for 20 minutes each time. More details about specific exercises will be provided during the hospital stay and rehab center.

How to reduce the risk of flying after hip replacement surgery?

Flying immediately after surgery may increase the risk of deep vein thrombosis (DVT). A DVT is a blood clot that forms in a deep vein in the body, usually in the leg. A blood clot can block blood flow and, in rare cases, can enter the lungs and cause a pulmonary embolism. Sitting for long periods of time can lead to blood clots, so it’s important to know how to reduce your travel risk.

  • To prevent any complications, patients are advised to wear compression stockings, especially during flights of more than 4 hours. Compression stockings tightly compress the legs and reduce the diameter of the veins, thereby increasing the velocity of venous blood flow and valve effectiveness.
  • Walking as much as possible and doing anti-DVT exercises (foot pumps, ankle loops, leg raises, and knee pulls) also reduce DVT risk.
  • Doctors also prescribe blood-thinning medications.
  • Patients should drink plenty of water and avoid alcohol.

Direct Anterior Approach

Dr. Lucas Kleijn who is only available once every six weeks for Irish patients. About 20% of surgeries are conducted through the superior DAA approach. Dr. Kleijn is the only experienced DAA surgeon who offers the direct anterior Approach for a total hip replacement for our team. Dr. Kleijn’s new approach preserves the muscles and is characterised by a smooth recovery and a stable hip. The process is much less invasive for the patient.


Read more: in the study below or here.


Benefits of the direct anterior approach in Primary Hip Arthroplasty

Study conducted by our esteemed surgeon Dr. Lucas Kleijn on the direct anterior approach which shows faster rehabilitation following the procedure.