Pune, Aug 28: A 42-year-old Pune man who suffered a displaced fracture of the femoral head in a two-wheeler accident underwent a total hip replacement through the Direct Anterior Approach at Sahyadri Hospital, a Network Hospital of Manipal Hospitals. The technique involves accessing the hip joint from the front while preserving the surrounding muscles. Following the surgery, the patient was able to bear full weight on the operated leg and begin walking the very next day.
He was admitted following a fall from his two-wheeler. Further assessment revealed a fracture of the left collarbone and a displaced fracture of the femoral head, the ball-shaped upper end of the thigh bone that forms the hip joint. One treatment option for the femoral head fracture was to realign the fractured bone and secure it with screws. However, this would have required around six to eight weeks of limited weight-bearing and carried risks such as non-union, where the fracture fails to heal properly, and avascular necrosis, where reduced blood supply can cause the bone tissue to deteriorate.
Considering his age, activity level and functional requirements, the medical team opted for a total hip replacement using the Direct Anterior Approach. In this technique, surgeons access the hip joint from the front through natural spaces between the muscles, helping preserve the surrounding muscle tissue and allowing early mobilisation.
Dr. Abhijit Agashe, Consultant Orthopaedic Surgeon, Sahyadri Hospital, said,
“For a young patient with a displaced femoral head fracture, the treatment needs to address both the immediate fracture and long-term function. The Direct Anterior Approach allows us to access the hip through natural tissue planes while preserving important muscles around the joint. In this case, the patient was able to bear full weight from the next day and begin rehabilitation early, which is important for restoring mobility and helping him return to his routine.”
Evidence from Indian studies has also reported positive functional outcomes with the Direct Anterior Approach. A 2026 Indian study involving 76 patients aged 22–50 years found that 40.8% of patients could be discharged within 24 hours, with no significant postoperative complications or readmissions. Mean hip-function scores improved significantly at one year, from 44.6 to 97.1. Another Indian study involving 157 patients reported significant functional improvement following DAA, while also highlighting the importance of surgeon experience and appropriate patient selection due to the technique’s learning curve.
After the procedure, the patient was able to bear full weight and begin mobilisation from the next day. He progressed well during his hospital stay and was subsequently discharged. The collarbone fracture was managed conservatively with a clavicular brace.