Direct Superior Hip Replacement Overview

Total hip replacement surgery is a common treatment for advanced arthritis of the hip joint. When a hip replacement surgery is performed, the surgeon removes the worn ball and socket hip joint, and replaces these with an artificial implant made of metal, plastic, and/or ceramic. While total hip replacement is considered a safe and effective treatment for severe arthritis, surgeons and patients are constantly looking to improve the results of this treatment.

hip replacement


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There are possible complications associated with hip replacement surgery, and avoiding potential complications is a critical concern. In addition, people are looking for faster recovery, minimally invasive techniques, and surgical options that will allow them to resume their activities as quickly as possible.

One of the ways to improve hip replacement has been to limit the amount of soft tissue damage that occurs at the time of the surgical procedure. Various surgical approaches and minimally invasive techniques have been employed in an effort to reduce damage to surrounding muscles, tendons, and ligaments. One of the surgical approaches that seems to be gaining interest recently is called the direct superior approach.

Direct Superior Approach

The direct superior approach is a surgical technique to gain access to the hip joint. When performing a hip replacement, your surgeon can get to the hip joint from the front, from the side, or from the back. The direct superior approach has been developed as a minimally invasive technique to enter the hip joint without causing damage to some key muscle groups. Specifically, this surgical approach avoids the iliotibial band and some of the external rotator muscles of the hip.

The surgical procedure is performed with the patient lying on their side. The incision location is similar to the incision used for a posterior approach hip replacement, but the incision is much shorter, and higher up on the hip joint. The surgeon enters the hip joint through the gluteal muscles of the buttocks but does not extend as far down into the iliotibial band.

Specialized instruments and retractors are used to allow your surgeon to manipulate the hip joint without having to enter the muscles surrounding this area. The goal is to perform the same hip replacement procedure, without having to detach or disrupt key muscle groups. By doing so, the hope is that people will have less pain, resume activities more quickly, and not have to worry about potential complications such as hip dislocation.

Is Direct Superior Approach Better?

There is no clear consensus on the best surgical approach to perform a total hip replacement. That said, there are possible benefits, and there is an ongoing investigation into whether or not this surgical procedure is better than other options. Direct superior hip replacement is performed by a relatively small number of surgeons, so studying the results will take time.

It is well-known that any surgical approach to the hip joint requires training and experience. Whenever a new surgical approach is developed, surgeons tend to see less successful outcomes when they have not performed the procedure for very long or very frequently. For that reason, it is critically important that you find a surgeon with experience performing any surgical technique, especially a new minimally invasive technique.

A particular advantage of some of these minimally invasive techniques is that because there is less muscle and tendon damage, the hip joints are theoretically more stable, and people do not need as many postoperative restrictions. One of the most worrisome complications of hip replacement surgery is a dislocation of the hip replacement. When this complication occurs, the ball comes out of the socket of the artificial hip.

This is an uncommon complication, but a problem that can occur because of the changed mechanics of the hip joint and the decreased stability of the hip as a result of the surgical intervention. By preserving more muscle, tendon, and ligament attachments, these minimally invasive techniques may lower the potential for dislocation following hip replacement surgery.

Alternative Surgical Approaches

As stated, the direct superior approach is not the only minimally invasive technique that surgeons are using to perform hip replacement surgery. Other options to perform hip replacement surgery include the posterior approach (the most common surgical approach for performing hip replacement), the direct anterior approach, lateral and anterolateral hip replacement, and the two-incision "mini" hip replacement. All of the surgical procedures have potential advantages and disadvantages, and no single surgical procedure has consistently been shown to be the "best."

The surgical approach that seems to be growing the fastest is the direct anterior approach. Much like the superior approach hip replacement, the direct anterior approach is also favored by those seeking to avoid muscle damage and wanting fewer restrictions after surgery. The direct anterior approach has grown dramatically over the past decade.

Minimally invasive surgical techniques are intended to allow patients to recover faster, and with fewer limitations, when compared to traditional surgical techniques. It is not uncommon in the medical literature to find support for these minimally invasive surgical techniques, but in general, when larger studies comparing multiple surgical treatment options are performed, the results look more similar than they look different. That does not mean that these new, minimally invasive surgical procedures are not effective, it just means that we do not know if they are necessarily more effective than other surgical options.

A Word From Verywell

Hip replacement surgery is one of the most effective surgical treatments performed. The vast majority of patients will recover uneventfully and resume full activity. That said, there are possible complications, and people want to get better even faster. Trying to refine surgical techniques to allow for faster recovery and fewer complications has led to the development of alternative surgical approaches to perform hip replacement. Direct superior hip replacement is one of the options that you may want to consider.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Orthopedic Surgeons. Total Hip Replacement.

  2. Kayani B, Konan S, Chandramohan R, Haddad FS. The direct superior approach in total hip arthroplasty. Br J Hosp Med (Lond). 2019;80(6):320-324. doi:10.12968/hmed.2019.80.6.320

  3. UW Medicine Orthopedics. Direct Anterior Approach Total Hip Replacement.

Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.