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Total Hip Replacement in Singapore - Direct Anterior Approach


In total hip arthroplasty, the direct anterior approach is minimally invasive, often performed using a smaller incision than traditional hip replacement techniques. The procedure is performed with the patient lying flat on their back to enable the use of real-time x-ray imaging during surgery — ensuring accurate placement of the hip implant.

Total Hip Replacement in Singapore - Direct Anterior Approach

Moreover, this approach is associated with a lower risk of hip dislocation after surgery, as it avoids cutting key posterior hip muscles that contribute to joint stability. While the direct anterior approach offers many benefits, it’s not the best fit for every patient. The choice hinges on a combination of factors such as the surgeon’s skill level and familiarity with the procedure, the unique physical characteristics and health status of the patient, and the specific aims of the surgery.

With DAA, patients can often leave the hospital sooner, feel less pain, and hit recovery goals faster — owing to the “muscle-sparing” nature of the procedure. It doesn’t need to cut through muscles and tendons to get to the damaged area. Instead, the surgeon carefully moves them aside, puts in the implants, and then puts them back. This way, healing can happen faster and with less pain.

It’s important to note that while the DAA has certain potential benefits, it is a technically challenging procedure and may not be suitable for all patients. The surgeon’s experience with the DAA can significantly affect the outcome of the surgery. As with all surgical procedures, the DAA for hip replacement also carries potential risks, including infection, blood clots, and complications related to anaesthesia.

General potential complications and risks of hip replacement surgery

Like all surgical procedures, the direct anterior approach for total hip arthroplasty also has potential risks and complications, including nerve damage, infection, and fracture. Always consult with your orthopaedic surgeon to understand the best approach for your situation.


  • Minimally Invasive. DAA minimises trauma to the body by steering clear of muscles and tendons during the surgery, for less tissue damage
  • Reduced Postoperative Pain. Patients generally experience a relatively easier recovery, and can resume daily activities in lesser amount of time
  • Surgical Specialty. DAA requires the high-level surgical skills of professionally trained and technically proficient surgeons — owing to DAA’s sustained success
  • Comprehensive Treatment: DAA is not just about replacing the hip. It is a holistic treatment plan that also focuses on trauma and fracture care

Please note that while the DAA offers these potential benefits, it may not be suitable for all patients, and the outcomes can depend significantly on the surgeon’s skill and experience. Moreover, factors such as age, weight, medication usage, general health status, and whether you smoke can all affect the potential risks involved with any surgery. Always discuss with your surgeon the best surgical approach for your specific condition and needs.


The posterior and anterior approaches are surgical methods used in total hip replacement surgery, referring to the direction from which the surgeon accesses the hip joint.




Accesses the hip joint from the back

Accesses the hip joint from the front


Good view of the hip joint, making it easier to place the artificial component

Less muscle disruption, potentially leading to less post-operative pain, shorter hospital stays, and quicker recovery times

Lower risk of hip dislocation post-surgery


Greater muscle disruption, possibly leading to longer recovery times
Slightly higher risk of hip dislocation post-surgery

More technically demanding, requiring special training and equipment

Not all surgeons are trained to perfrom this approach

Ideal For       

Patients with complex hip conditions where a more direct view of the joint is necessary

Patients looking for potentially faster recovery and less postoperative pain

Both approaches have been found to be effective for hip replacement surgery. At the end of the day, the best approach depends on the patient’s specific condition and the surgeon’s expertise and comfort with the procedure.


For compromised hip function due to injuries or degenerative bone disease, seek professional help from A/Professor Andrew Quoc Dutton. He is a Harvard fellowship-trained orthopaedic surgeon practising at Mount Elizabeth Hospital, Singapore with subspecialty interests in arthroscopic/keyhole surgery, sports injuries, and hip replacements.


Frequently Asked Questions on Hip Arthroscopy

In a DAA procedure, the patient is placed on their back (supine position), which contrasts with other approaches where the patient may be placed on their side or stomach. The surgeon accesses the hip joint from the front (anterior) of the body, typically between the tensor fascia lata muscle and the sartorius muscle, without the need to cut through major muscles. This is believed to lead to less muscle damage, reduced postoperative pain, and a potentially quicker recovery time. As for the procedure itself, the surgeon removes the damaged hip joint and replaces it with the prosthesis. Modern prosthetic hip joints are designed to mimic the natural action of the hip joint and are made from materials like metal, ceramic, or high-grade plastics, which are designed to be long-lasting and wear-resistant.
In terms of recovery DAA does not require cutting through major muscles, hence, patients may experience a quicker recovery and rehabilitation period compared to other approaches. Patients often start walking with assistance soon after the operation. But do keep in mind that results vary depending on each patient’s unique condition.
Although hip replacements, including those using DAA, are typically safe and effective, they are not exempt from potential risks, just like all types of surgery. One common concern after hip surgery is the possibility of hip dislocation, particularly within the weeks following the operation. However, this risk may be lower with the anterior approach, as it largely preserves muscles and soft tissues, which help prevent such dislocation.
A risk specific to DAA involves possible numbness in the front of the thigh due to nerve stretching in the skin. Usually, this numbness subsides within a few months after the operation. It’s important to remember that the risks associated with hip replacements, like many surgical procedures, are often tied to a patient’s overall health.
A doctor would recommend the Direct Anterior Approach for total hip replacement to patients who are good candidates for this procedure. This includes those who may benefit from a minimally invasive technique, such as:
  • Patients who are otherwise healthy or have well-controlled medical conditions.
  • Individuals who are within a healthy weight range, as excess weight can sometimes make the procedure more challenging.
  • Patients with specific anatomical considerations that make this approach feasible and likely to succeed.
  • Individuals who are motivated and able to actively participate in the post-operative rehabilitation process, which is crucial for recovery.
However, it’s ultimately a clinical decision based on a comprehensive evaluation of the patient’s overall health, hip anatomy, lifestyle, and personal preferences. Each case is unique and should be discussed thoroughly with the orthopaedic surgeon.

Total Hip Replacement (THR) surgery is a procedure where a damaged or worn-out hip joint is replaced with an artificial one (prosthesis). This procedure is usually recommended for individuals who experience chronic hip pain and loss of function due to conditions such as osteoarthritis, rheumatoid arthritis, hip fractures, or other degenerative diseases that affect the hip joint.

The primary goal of this procedure is to relieve pain, improve hip function, and enhance the patient’s overall quality of life. The new, artificial joint typically reduces pain and offers a wider range of motion than the damaged joint. However, it’s important to understand that there are potential risks, as with any surgery, such as infection, blood clots, and complications with anaesthesia.

THR is considered in the medical field as a good operation for hip arthritis, with good long-term results. In today’s rapid technology innovation, the durability of the replaced hip joint has been improving with newer materials and designs.

Before the procedure, the patient is given either general anaesthesia or a spinal block, which numbs the lower half of the body. The surgeon then makes an incision over the hip to expose the hip joint. Afterwards, the damaged ball, which is the top part of the thigh bone (femur), is cut and removed. The damaged surface of the socket (part of the hip bone, or pelvis) is also cleaned out.

The replacement socket is usually secured into the pelvis, and the replacement ball attached to a stem is secured into the femur. The materials used for the artificial joint could be metal, ceramic, or plastic, and they’re designed to allow the joint to move smoothly. After the joint replacement, the surgeon closes the incision. The area is often drained to remove fluid build-up, and the drain is usually removed a few days after surgery.

Post-surgery, patients will be required to undergo physiotherapy to regain strength and improve mobility in the hip. This could include exercises to improve balance, flexibility, and strength.
Total hip arthroplasty (THA) is also known as total hip replacement (THR), a surgical procedure where the damaged or worn-out hip joint is replaced with an artificial joint or prosthesis. The hip joint is a ball-and-socket joint.
The ball is the head of the femur (thigh bone), and the socket is part of the pelvic bone. In THA, both the ball and socket components of the joint are replaced.
To prepare for a Direct Anterior Approach total hip replacement surgery, follow the steps below. Remember to always consult your healthcare team to understand your personalised pre-operative instructions.
  • Attend all preoperative appointments and evaluations.
  • Follow your doctor’s guidelines on medication use, including when to stop certain medications before surgery.
  • Maintain a healthy diet and stay hydrated.
  • Quit smoking as it can impede the healing process.
  • Arrange for transportation and help at home post-surgery.
  • Follow instructions regarding when to stop eating and drinking before the procedure.
  • Do pre-surgery exercises if recommended by your doctor or physical therapist.
  • Ensure all necessary pre-op tests (blood tests, EKG, etc.) are completed.
  • Shower with antibacterial soap the night before and morning of surgery as per your doctor’s instruction.
  • Avoid applying any cosmetic products (makeup, lotion, nail polish) on the day of surgery.
Fees include the surgeon’s expertise, the specific health condition and needs of the patient, the type of implant used, hospital charges, and whether it’s a private or public hospital. Additionally, costs may also fluctuate based on any additional medical services required, such as pre-operative tests, post-operative care, and rehabilitation services. It’s best to consult directly with healthcare providers in Singapore for the most accurate and current cost estimates.
According to MediGence, a medical concierge, the cost of hip replacement in Singapore starts from around $14,000 for a single side of the hip, presumably excluding doctor’s fees. Generally, hip replacement surgery in Singapore private hospitals using DAA ranges from $35,000 to $45,000, inclusive of doctors’ fees.
Hip implants typically last between 15 to 20 years, although this can vary depending on several factors including the patient’s age, activity level, weight, and overall health. Advancements in implant materials and surgical techniques may also extend the longevity of hip implants.
Regular follow-ups with your orthopaedic surgeon are crucial to monitor the condition of your implant.
It is possible for hip replacement to be done as an outpatient procedure for suitable candidates. This allows the patient to go home on the same day of the surgery. Ultimately, the decision depends on several factors including the patient’s overall health, support system at home, and the specific surgical technique being used.
Always consult your surgeon to understand if outpatient hip replacement is the right option for you.
Simultaneous bilateral hip replacement, or having both hips replaced at the same time, is possible but not commonly done due to the increased risks and complications associated with this procedure. It requires a thorough medical evaluation and typically is only recommended for relatively healthy individuals with severe bilateral hip joint disease.
Your orthopaedic surgeon will make a recommendation based on your individual health status, pain levels, and functional limitations.