If you need a hip replacement, you may be surprised to learn that how the surgeon reaches your hip joint matters almost as much as the new joint itself. Dr. MacNeille performs hip replacement through the direct superior approach, a modern, minimally invasive technique designed to protect the muscles and tendons around your hip.
In a traditional posterior hip replacement, the surgeon must release the iliotibial (IT) band — the long band of tissue running down the outside of your thigh — along with several small muscles that stabilize the hip. The direct superior approach uses a smaller incision placed higher on the hip and works between tissues rather than through them.
Key structures that are protected include:
A 2024 systematic review in JBJS Reviews by Van Dooren and colleagues confirmed that the direct superior approach preserves the IT band and most of the short rotators, and found that hip implants were consistently placed within the recommended "safe zone" for stability.
Because less soft tissue is disturbed, patients tend to get moving sooner. A 2024 meta-analysis in the Journal of Clinical Medicine by Shin and colleagues, pooling studies that compared the direct superior approach to the standard posterior approach, found:
Stability is another major advantage. The 2024 JBJS Reviews analysis cited a large registry study reporting a dislocation rate of just 0.3% with the direct superior approach, compared with 1.0% for the traditional posterolateral approach. Because the repair is so stable, many patients do not need the strict "hip precautions" (avoiding bending past 90 degrees, crossing the legs, and so on) that were once routine after hip replacement.
You might wonder whether a newer technique is riskier while surgeons learn it. Reassuringly, a 2020 study in Orthopaedic Surgery by Duijnisveld and colleagues found no meaningful learning curve — outcomes were consistent even in a surgeon's early cases.
Dr. MacNeille combines the direct superior approach with Mako robotic-arm assistance, which uses a CT scan of your hip to plan implant position with a high degree of precision. Together, the muscle-sparing exposure and robotic accuracy support the goals that matter most to patients: walking within hours of surgery, a low risk of dislocation, and — for most patients — no formal hip precautions during recovery.
Most patients who need a hip replacement are candidates for this approach, though every hip is different. At your consultation, Dr. MacNeille will review your X-rays, anatomy, and health history to recommend the safest plan for you.
This article is for general education and is not a substitute for medical advice.
Recovery videos courtesy of Dr. Lige Kaplan, whose patients underwent the same minimally invasive techniques Dr. MacNeille uses. Robotics videos from Stryker and partner hospitals. We will be adding videos of our own patients over time. Browse the full video library →
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