A modified direct anterior approach for primary total hip arthroplasty: surgical technique

The direct anterior approach (DAA) for total hip arthroplasty is increasingly adopted because of its muscle-sparing nature and potential for faster recovery. However, its use is often limited by the need for a traction table, dedicated instrumentation, and a demanding learning curve. We present a simplified modification of the DAA that can be performed on a standard operating table without specialised equipment. The technique preserves the Hueter interval but introduces specific refinements, including a slightly lateralised skin incision to reduce the risk of lateral femoral cutaneous nerve injury and a U-shaped capsulotomy to facilitate acetabular exposure and en bloc soft tissue management. These adjustments eliminate traction-related complications, reduce reliance on additional staff and costly instruments, and streamline the operative workflow. In our experience, this modified approach has been reproducible across a wide range of patient phenotypes, including obese or muscular individuals, with a low incidence of typical complications. This variant therefore preserves the benefits of the anterior approach while addressing many of its practical limitations, offering a versatile, safe, and accessible option for primary and selected revision total hip arthroplasty.