The AMIS technique represents an internationally recognised and structured training pathway for performing direct anterior hip replacement. It incorporates defined surgical steps, instrumentation, and intraoperative imaging principles that are consistent across centres worldwide. This structured approach has been widely described in international literature, with published data on its learning curve, complication profile, and clinical outcomes (e.g., Nairn et al., Int Orthop2021; Reichert et al., Orthop Rev 2022; MDPI Clin Med 2023).

 

Other anterior hip approaches are also used in New Zealand and internationally. These may vary in instrumentation, patient positioning, or intraoperative imaging protocols. Dr Ailabouni’s practice follows the internationally validated AMIS protocol, which includes the a validated leg holder and routine use of intraoperative X-ray imaging during every DAA hip replacement. This allows real-time assessment of leg length, offset, and component alignment, helping achieve more accurate reconstruction to minimise variability in implant positioning.

 

Multiple randomized trials and systematic reviews (high level research papers) have reported that, on average, patients undergoing DAA may experience reduced early postoperative pain and faster initial functional recovery compared with some other approaches. These early differences usually lessen over time, and long-term outcomes are similar across techniques.

 

Dr Ailabouni is well beyond the DAA learning curve, and his operative times are comparable to other hip replacement procedures.

 

Several studies have also reported lower rates of dislocation after anterior approaches compared with posterior approaches without capsular repair. However, this difference is less pronounced when a full posterior capsular repair can be achieved. In patients with significant arthritis or when increased leg length and offset are required, a complete posterior repair may not always be technically possible, contributing to the variation seen between outcomes with that approach.

 

Dr Ailabouni continues to perform posterior hip replacement surgery for patients who are not suitable candidates for the anterior approach, such as those with particular body-habitus considerations or concurrent abductor tendon pathology that requires abductor tendon repair. The choice of approach is made individually, based on patient anatomy, lifestyle, and clinical requirements, and will be discussed thoroughly as part of the shared decision-making process.

 

Postoperative recovery and activity. No routine post operative restrictions

One of the main advantages of the anterior approach is that it avoids cutting through major muscles, allowing a more natural early recovery. Because the hip capsule and posterior soft tissues are preserved, patients usually do not require traditional postoperative movement restrictions.

 

In Dr Ailabouni’s practice, most patients are mobilised on the day of surgery and progress to normal daily activities, including driving, as comfort and mobility allow—usually within the first few weeks. There are generally no restrictions on hip flexion or sleeping position, and most patients do not need special equipment such as elevated toilet seats or abduction pillows.

 

The exact pace of recovery varies among individuals and depends on comfort, strength, and safety. All patients receive personalised physiotherapy, education, and follow-up guidance to ensure safe return to activity.

 

Every surgical approach has advantages, limitations, and potential risks.