Hip · Direct anterior approach
Direct anterior hip replacement, with specialist guidance on surgical options and recovery. Meet your specialists and understand what to expect before booking.
5.0 from 250+ Pathway patient reviewsIn this 3-minute demonstration, Dr. Sebastian Rodriguez-Elizalde walks through how ROSA® is used to map the hip from X-rays taken in the operating room, place the cup at the planned angle, fit the stem, and check leg length and offset.
Map
X-rays taken in the operating room are used to map the patient’s hip.
Place
The cup is placed at the planned angle and the stem is fitted.
Verify
Leg length and offset are checked against the plan, to the millimetre.
Speaker: Dr. Sebastian Rodriguez-Elizalde, orthopedic surgeon. Recorded in the operating room during a ROSA®-navigated direct anterior total hip replacement.
Hi, I’m Dr. Rodriguez. Today we’re going to talk about hip replacement and the importance of technologies such as navigation and robotics, and how they help me do a better job when you need a hip replacement. As you can see, this is the anterior approach, which is the only surgical approach that I use when I’m doing a hip replacement.
When our C-arm comes in, we get an initial image like this. This is an AP pelvis. These are all important landmarks, because Daphne is going to landmark out this hip so that we can move to the next stage of our robotically navigated, assisted total hip replacement. As you can see here, Daphne is putting landmarks on the X-rays that we’ve just taken in the operating room. These are important because we’re trying to recreate that same image with the prosthetic components once we put in our trials, or practice pieces.
What we do is we impact this cup. The nice thing with navigation is that this cup traditionally was just eyeballed in how we put it into the acetabulum. So, this fits your bone perfectly. Normally, we would take landmarks of: does this look like it’s 45 degrees, or 10 degrees? But that could lead to error in people that are exceptionally big, exceptionally muscular, or people that have poor bone quality. Normally these numbers would again be eyeballed, or looked at in the patient, but we don’t have any real objective numbers. The beautiful thing with navigation and robotics is we can put a number to this cup every single time.
The ROSA robotic hip system allows us now to take an image of this and give us instant feedback on where the cup is positioned and how it’s positioned in that body, making sure we get it right just for you. As you can see here, the landmarks that we’ve got from the cup that we’ve put in, in this case, are perfect: 38 degrees of inclination and 20 degrees of anteversion, which is what we were aiming for.
As you can see here, this is our hip stem. It’s designed to sit inside your hip and have bone grow onto it, securing it to your body, hopefully for life. This fits perfectly into the broached aspect of the femur, and then we give it a few final taps to fully seat it. Now we’re going to put a practice head on and reduce our hip and see how stable it is clinically.
You can see here Daphne is putting back the same landmarks that we used initially to map out her hip and recreating them, so we can see the femur with a before and after, if you will. The nice thing is that with that we can take measurements and compare. We can look at things like leg length, abduction, offset: all these measurements that we as surgeons use to make decisions about the stability of your hip and the restoration of your normal anatomy.
This is really what’s interesting for me as a surgeon. I can tell here that I’ve lengthened this patient by 1 millimetre and offset by 8 millimetres. Here, I can really dial in to whatever the problem is with this patient and make it personalized for them. Some people have a leg length discrepancy because they’ve worn away the cartilage in their hip and need to be lengthened up to a centimetre in some cases. This also gives me a lot of different options based on the heads and sizes. As we’ve talked about before, hip and knee replacements come in many different sizes, and we can really tailor-make it just for you.
I hope this gave you an overview of how navigation and technology can help me do your hip replacement to make sure it’s perfect for you.
Hip replacement surgery (total hip arthroplasty) removes the worn ball-and-socket surfaces of an arthritic hip and replaces them with implant components: a cup fixed into the pelvis, a stem fixed into the thigh bone, and a ball and liner between them. The result is a joint that moves smoothly and without the bone-on-bone pain of advanced arthritis. It is one of the most reliable operations in medicine, and modern implants commonly last 20 years or more.
Pathway’s surgeons perform the direct anterior approach, reaching the hip between muscles rather than detaching them, with ROSA® robotic or navigation assistance to confirm cup position, leg length and offset during the operation. Most patients walk the same day and go home within 1–2 nights.
Consultation is within 1–4 business days and surgery typically 2–4 weeks after quote approval, at accredited surgical centres in Toronto or Montreal. No referral is required.
5.0 from 250+ patient reviews
The hip joint is designed for durability, but cartilage can degrade over time due to age, genetics, or activity. This degeneration — osteoarthritis — causes pain, stiffness, and reduced mobility.
When conservative treatments no longer provide relief, hip replacement may restore function and quality of life.
Our surgeons use the Direct Anterior Approach — a muscle-sparing technique that accesses the hip through a natural interval between muscles rather than cutting through them.
Specialized table designed for the Direct Anterior Approach, providing optimal positioning and real-time fluoroscopic imaging during surgery.
Our fellowship-trained surgeons explain hip replacement in plain language — from diagnosis to recovery.
Robotic arm that assists with bone preparation and implant positioning using real-time 3D mapping.
Digital navigation system that maps your anatomy for precision guidance without a robotic arm.
Your surgeon will recommend the technology best suited for your anatomy. The surgeon remains in full control throughout.
We use only proven, high-performance implant systems designed for longevity and optimal function.
Acetabular cup system with advanced bearing surfaces for reduced wear.
Optimized for the Direct Anterior Approach with tissue-sparing design.
Royal College board-certified (FRCSC) and fellowship-trained in hip and joint replacement surgery. Dr. Rodriguez-Elizalde was the first surgeon in the Greater Toronto Area to perform direct anterior hip replacement on a Hana table and has performed more than 5,000 combined robotic knee and hip replacements; Dr. Zywiel is one of the few surgeons in the region with specific fellowship training in the direct anterior approach.
Anterior hip & robotic knee · 5,000+ robotic knee & hip replacements
Anterior hip & robotic knee · Toronto Western Hospital (UHN)
Anterior hip & knee replacement · UHN & U of T fellowships
Mako robotic knee & anterior hip · UCLH robotic fellowship
Before
1Before
Imaging review and diagnosis
2
Personalized surgical blueprint
Day of
3Day of
Direct anterior approach
After
4After
Most patients, same day
5
Guided rehab and ongoing support
2–4 weeks
Driving
Once off pain medication
6–8 weeks
Light activity
Walking, swimming, golf
20+ years
Implant longevity
With proper care
Clinical plan first
Individualized written quote after specialist review
Your surgeon first determines whether hip replacement, and which approach or implant plan, fits your case. Facility, implant, complexity, and expected stay then shape the written quote. For broad Canadian budgeting context, review Pathway's planning ranges and methodology.
The Direct Anterior Approach is a muscle-sparing technique that accesses the hip through a natural interval between muscles rather than cutting through them. This typically results in faster recovery, fewer post-operative restrictions, and reduced dislocation risk.
ROSA is a robotic arm that assists with bone preparation and implant positioning using real-time 3D mapping and haptic feedback. VELYS is a digital navigation system that provides precision guidance without a robotic arm. Your surgeon will recommend the appropriate technology based on your anatomy.
The procedure typically takes 60 to 90 minutes. Most patients are walking with assistance on the same day and are discharged within 1 to 2 nights.
Modern hip implants are constructed from titanium and medical-grade polyethylene. With proper care and activity levels, they typically function well for 20 years or more.
Most hip replacements are performed under spinal anesthesia with sedation. This allows you to breathe on your own and typically results in less post-operative nausea. You will be comfortably asleep during the procedure.
Yes. Pathway treats patients travelling from across Canada, including Ontario, Alberta, and British Columbia, and arranges accommodation, airport transfers, and post-operative follow-up around their surgical care.
No referral is required. You can book a consultation directly. Having recent hip X-rays or MRI is helpful but not mandatory—we can arrange imaging if needed.
As with any surgery, hip replacement carries risks including infection, blood clots, and dislocation. The Direct Anterior Approach and robotic technology are designed to minimize these risks. Your surgeon will discuss your individual risk profile during consultation.
Most direct anterior hip replacement patients walk with a walker the same day as surgery, are discharged within 1–2 nights, and transition off the walker to a cane within 1–2 weeks. Because the anterior approach goes between major muscles rather than cutting through them, many patients return to driving by 2–4 weeks (right hip; left hip earlier if automatic), desk work by 2–4 weeks, and most normal daily activities by 6 weeks. Full recovery — including return to higher-impact activities like hiking or doubles tennis — typically takes 3–6 months, though this varies with pre-operative fitness and rehab adherence. Your surgeon will tailor activity restrictions to your case.
Yes — robotic assistance (ROSA®) supports planning and verification where it fits your anatomy, alongside the direct anterior approach. The robot never operates independently: your fellowship-trained surgeon performs the surgery and uses the technology to check component position and leg length during the procedure. Whether robotic assistance fits your case is your surgeon’s call, explained at consultation.
It depends on how long you can wait and what the hip is costing you day to day. In the public system, CIHI reports that only 68% of Canadian hip replacement patients received surgery within the 182-day benchmark in 2024, and that clock starts only after a surgeon has decided to operate — the wait to be seen comes on top. Pathway patients have a consultation within 1–4 business days and surgery typically 2–4 weeks after the quote is approved, with fellowship-trained surgeons who also hold appointments at Toronto teaching hospitals. Going private is most often worth it for people who are losing mobility, work, or sleep to hip pain and want the robotic direct anterior approach on a timeline they choose. See our hip replacement wait times guide for the full data.
Publicly, CIHI’s benchmark is 182 days from the decision to operate to surgery. In 2024, 68% of hip replacement patients met it, down from 75% in 2019. That figure excludes the wait to see a surgeon in the first place, which can be months on its own — Nova Scotia’s portal showed a 174-day median consultation wait before a further 97-day surgical wait in early 2026. At Pathway the timeline is 1–4 business days to consultation and 2–4 weeks from quote approval to surgery.
Pathway's surgeons regularly perform hip replacement for patients from British Columbia. Surgery takes place in Toronto, where our surgeons offer the Robotic Direct Anterior approach — which our patients consistently prefer to the traditional approach — using ROSA® planning on a HANA® table. BC patients have a virtual or in-person consultation within 1–4 business days, and our team arranges flights, accommodation, and post-operative follow-up around the surgical date. Most patients fly home within days of surgery and complete rehabilitation with a physiotherapist near home. See our British Columbia patient guide.
Pathway’s hip replacement surgeons are fellowship-trained arthroplasty specialists who also hold appointments at Toronto teaching hospitals. Dr. Sebastian Rodriguez-Elizalde trained in adult hip and knee reconstruction at the Hospital for Special Surgery in New York, was the first surgeon in the Greater Toronto Area to perform direct anterior hip replacement on a Hana table, directs the Humber Hip and Knee Arthroplasty Fellowship, sits on Intellijoint Surgical’s Scientific Advisory Board, and has performed more than 5,000 combined robotic knee and hip replacements. Dr. Michael Zywiel is one of the few surgeons in the region with specific fellowship training in the direct anterior approach, practises at Toronto Western Hospital (UHN), and is an Assistant Professor of Surgery at the University of Toronto. Dr. Thomas Zochowski completed dual fellowships in adult lower-extremity reconstruction (UHN) and orthopaedic sports medicine (University of Toronto). Dr. Justin Chang trained in robotic hip and knee arthroplasty at University College London Hospitals.
Both approaches can produce an excellent hip replacement, and the surgeon’s experience with the approach matters more than the incision. The direct anterior approach reaches the joint between muscles rather than detaching them, which is why patients tend to walk sooner, need fewer hip precautions, and have a lower early dislocation risk. All Pathway hip replacement surgeons use the direct anterior approach as their standard technique, with robotic or navigation assistance to verify component position and leg length. Read our anterior vs posterior comparison for the trade-offs in detail.
Yes. Ontario patients can book a consultation and have surgery through Pathway’s private-pay pathway, which is a separate pathway from OHIP-insured care rather than a paid place in an OHIP queue. Consultations take place in Toronto or virtually, and surgery is performed at accredited private surgical centres. See our Ontario patient guide for how private-pay and OHIP-insured care differ and what to confirm in writing before booking.
Schedule an evaluation to discuss your eligibility for hip replacement surgery. No referral required.
