Learning the Direct Anterior Approach to Total Hip Arthroplasty When a Fellowship Is Not Possible

The direct anterior approach (DAA) to total hip arthroplasty (THA) is increasingly favored due to its potential benefits for patient outcomes and functional recovery; however, its steep learning curve poses challenges for surgeons without formal arthroplasty fellowship training.This article presents a structured, phase-based learning protocol designed to facilitate safe and effective adoption of the DAA by experienced surgeons transitioning from other approaches.Drawing from the methodology of a senior joint replacement surgeon, the protocol outlines foundational knowledge acquisition, observational learning, simulation and cadaveric training, proctored surgical experience, iterative refinement, advanced observation, and peer validation.By treating the learning process as an active, team-based, and iterative endeavor, our model aims to mitigate complications associated with early DAA cases and enable surgeons to expand their procedural repertoire while maintaining high standards of patient care.