Who I am
I am an orthopedic surgeon specialized primarily in hip prosthetic surgery, with a particular focus on the minimally invasive anterior technique (Direct Anterior Approach), as well as arthroscopic and prosthetic knee replacement.
In 2009, I started taking my first steps to the minimally invasive anterior approach for hip joint replacement in Brussels (Belgium) under the guidance of Professor Erik De Witte, one of the leading proponents and teaching leader of the Direct Anterior Approach (DAA), which is well recognized today by experts as “revolutionary” compared to traditional lateral and postero-lateral approaches.
To date, I have performed over 5,000 surgeries as the lead surgeon, and approximately 350 hip or knee prosthetic surgeries each year.
Direct Anterior Approach hip replacement technique: the advantages
The minimally invasive hip replacement surgery performed using the Direct Anterior Approach (DAA) differs from the traditional lateral or posterior approaches by preserving bone stock and without detachment of any muscle and tendon (especially gluteus and short external rotators). Sparing periarticular tissues (muscles, tendons, vessels and nerves) aims to reduce complications and shorten recovery times.
In my opinion, there is no specific indications to include patients in this method for hip replacement surgery. I personally use it routinely for all patients suffering from femoral head osteonecrosis or primary hip arthritis, as well as in more complex cases of hip congenital dysplasia or coxa vara profunda and protrusio acetabuli. I consider it a reliable technique that provides greater accuracy and reproducibility in the positioning of prosthetic components. However, it is important to emphasize that in highly muscular individuals, obese patients, and in revision hip cases (an extended anterior approach can be necessary), significant surgical expertise is required, especially during the preparation of the femoral canal, which is undoubtedly the most challenging step of the entire procedure.
But what are the specific advantages for the patient?
- Reduced or absent postoperative pain
- Minimal intraoperative blood loss
- Small and cosmetic surgical scar (bikini incision technique)
- Extreme precision in limb length.
- Early mobilization of the operated hip
- Lower risk of dislocation due to preservation of gluteus and rotator muscle
- Rapid return to daily and occupational working activities.
The postoperative protocol
The minimal or absent postoperative pain and preservation of muscle very important in pelvic stability allow the rehabilitation protocol to start the same day of the surgery. The patient undergoes early active and passive mobilization of the operated hip, is able to sit up in bed and move some steps in the room. Physical therapists provide intensive training in assisted walking using crutches with full weight bearting, focusing on helping the patient regain mobility safely and effectively.
Typically, by the time of discharge after 4-5 days, the patient is able of walking independently, ascending and descending stairs with support, sitting down, and standing up unassisted to go to the bathroom.
The rehabilitation program continues on an outpatient clinics, with regular and consistent kinesiotherapy, even in a rehabilitation pool. This combination aimed to the strengthening the quadriceps and the gluteus muscles, which are crucial for pelvic stability. Especially “the aquatic environment” provides resistance without the stress of weight-bearing, making it an excellent complement to traditional exercises for muscle reinforcement and joint flexibility.
Returning to sports activities is permitted only after a full rehabilitative recovery. The patient is advised to start with low-impact sports (swimming and cycling), which minimize stress on the hip joint while allowing gradual improvement in cardiovascular fitness, muscle strength, and joint mobility. This approach helps ensure that the joint is well-prepared to handle more intense activities (tennis, skiing, etc), reducing the risk of injury and promoting long-term joint health.