Muscle-sparing technique:
Works through natural tissue planes, avoiding detachment of major muscle groups.
Leo Zalikha, MD is a fellowship-trained orthopaedic surgeon in Long Beach, CA who performs direct anterior hip replacement for appropriate candidates. His approach to surgical planning is focused on matching each patient with the technique and tools that best fit their anatomy, health, and goals.
What Makes the Anterior Approach Different?
In a traditional posterior or lateral hip replacement, the surgeon accesses the hip joint from the back or side. This typically involves splitting or detaching muscles to reach the joint, which then need to heal after surgery.
The direct anterior approach enters through a small incision on the front of the hip. The surgeon navigates between existing muscle groups (the sartorius and tensor fasciae latae) to access the joint capsule and perform the replacement. Because muscles are moved aside rather than cut, the surrounding soft tissue experiences less surgical trauma.
Key distinctions of the anterior approach:
Potentially faster early recovery:
Many patients experience less pain in the initial postoperative period and may progress more quickly through early milestones like walking and stair climbing.
Fewer traditional hip precautions:
Because the posterior soft tissues remain intact, some surgeons, including Dr. Zalikha, are able to reduce or eliminate the traditional hip precautions (restrictions on bending, crossing legs, and certain positions) that are common after posterior-approach surgery.
Intraoperative fluoroscopy:
The anterior approach allows the use of real-time X-ray imaging during surgery to verify implant position and leg length.
It is important to understand that the anterior approach is a technique, not a guarantee of a specific outcome. All approaches to hip replacement can produce excellent results when performed by an experienced surgeon. The anterior approach may offer advantages in early recovery, but long-term results are comparable across well-performed surgical approaches.
Who is a Candidate?
Most patients who are candidates for total hip replacement can be considered for the direct anterior approach. However, certain anatomical factors (such as body habitus, prior hip surgery, or specific deformities) may make a different approach more appropriate.
During your consultation, Dr. Zalikha assesses your anatomy, imaging, health status, and goals to determine whether the anterior approach is the best fit. He will give you an honest recommendation, and if a different approach would serve you better, he will explain why.
What to Expect During Surgery
01. Anesthesia and Surgical Approach
The procedure is performed under anesthesia (typically spinal with sedation or general anesthesia). Using a specialized operating table, Dr. Zalikha makes an incision on the front of the hip, typically six to ten centimeters in length.
02. Hip Joint Replacement and Intraoperative Imaging
Through this incision, the damaged bone and cartilage of the hip joint are removed and replaced with prosthetic components: a metal socket with a liner, and a metal stem topped with a ball. Intraoperative fluoroscopy (live X-ray) is used to confirm component position, alignment, and leg length before closing.
03. Surgery Duration and Hospital Stay
The surgery typically takes one to two hours. Many patients are candidates for same-day discharge, going home just hours after surgery. Others may stay overnight depending on their health and comfort level.
04. Robotic-Assisted Surgical Technology
Dr. Zalikha may also utilize robotic-assisted technology in combination with the anterior approach when it adds value to the surgical plan.
Recovery After Anterior Hip Replacement
One of the most commonly cited advantages of the anterior approach is the potential for a smoother early recovery:
Day of surgery
Most patients stand and walk with assistance before leaving the hospital or surgery center.
First 1 to 2 weeks
Walking with a walker or cane. Discomfort is typically manageable with prescribed pain medications. Many patients report that the surgical pain is less than the chronic arthritis pain they were experiencing.
2 to 4 weeks
Transition to a cane or independent walking. Many patients begin driving (timing depends on the side of surgery and medication status).
6 weeks
Most patients are walking comfortably and beginning to return to light recreational activities.
3 to 6 months
Continued improvement in strength, endurance, and confidence.
Every recovery is individual. Visit the Hip Replacement Recovery and Rehab page for a more comprehensive overview.
Risks and Considerations
The anterior approach shares the same general risks as any total hip replacement, including infection, blood clots, dislocation, nerve injury, leg length discrepancy, and implant loosening or wear. There are also some considerations specific to the approach:
- The learning curve for the anterior approach is steeper than for some other approaches. Surgeon experience matters.
- Lateral femoral cutaneous nerve irritation (numbness or tingling on the front of the thigh) can occur, though it is usually temporary.
- In patients with certain body types or complex anatomy, the anterior approach may be technically more challenging.
Dr. Zalikha discusses all relevant risks and approach-specific considerations as part of your preoperative consultation.
Anterior Approach vs. Other Approaches
Patients often ask how the anterior approach compares to the posterior or lateral approach. Here is a balanced perspective:
- Early recovery: Some studies suggest faster early milestones (walking, stair climbing, less initial pain) with the anterior approach. However, by three to six months, outcomes tend to equalize across approaches.
- Long-term results: Published evidence does not consistently show that any one approach produces better long-term implant survival or patient satisfaction than the others when performed well.
- Dislocation risk: The anterior approach may carry a lower risk of posterior dislocation because the posterior soft tissues remain intact. However, modern implant designs and surgical techniques have reduced dislocation rates across all approaches.
- Surgeon expertise: The most important factor in hip replacement outcomes is the surgeon performing the procedure, regardless of approach. An experienced surgeon using the approach they know best will typically produce better results than a surgeon using an unfamiliar technique.
Dr. Zalikha performs the anterior approach as his preferred technique for the majority of primary hip replacements, but he is trained in multiple approaches and selects the one that best serves each patient.
Why Choose Dr. Zalikha for Anterior Hip Replacement
Dr. Zalikha completed fellowship training in adult reconstruction at Stanford, where he trained extensively in the direct anterior approach and other advanced hip replacement techniques. With over 30 peer-reviewed publications in orthopaedic surgery and a research profile cited hundreds of times in the literature, he brings both clinical expertise and a deep understanding of the evidence to every surgical decision.
He practices at Memorial Orthopaedic Surgical Group in Long Beach and performs surgery at MemorialCare Long Beach Medical Center, the Surgery Center of Long Beach, and DISC Sports & Spine Center in Marina del Rey, serving patients from across Los Angeles and Orange County.