The first edition of this textbook, published in 2016, was a landmark milestone in the long history of the direct anterior approach (DAA) to hip reconstruction. For the first time, the basic, intermediate, and advanced concepts were drawn together comprehensively in a single, definitive text. As Dr. Kristaps J. Keggi wrote in his Introduction to that volume, the central goal of the text was to “organize and illustrate the many details of the DAA for the ultimate benefit of patients everywhere.”

In the Foreword, Dr. Larry Dorr offered his own support, writing “I know that DAA surgeons will continue to grow their approach. They may ultimately prove it to be superior. The DAA is an important and lasting contribution to our orthopaedic profession.” Furthermore, the original conclusion from that first edition was forward-thinking, stating:

Indeed, in 2023, the DAA has now become an accepted method of performing THA. We are seeing a shift in academic practices toward use of the DAA, such that resident and fellowship training has now routinely incorporated DAA education as a fundamental of surgeon training. Ultimately, this will lead to the elimination of the DAA learning curve. In fact, recently published data from the Anderson Institute showed that for new fellowship trained DAA surgeons, their early practice performance over their first 300 cases was not associated with higher complication rates when compared with an experienced posterior hip surgeon.¹In the past few years, we have seen young surgeons enter practice using the DAA as their preferred approach with very little difficulty. Most Adult Reconstruction Fellows now expect DAA training to be a standard part of their surgical education, and surgeons at the Mayo Clinic, OrthoCarolina, Anderson Clinic, the Rothman Institute, Hospital for Special Surgery, the Cleveland Clinic, Virginia Tech Carilion, Brown University, Columbia University, Yale University, and many others now teach these DAA skills as a routine part of practice. A survey of adult reconstruction fellows published in 2022 identified that their exposure to operative techniques in revision surgery and in primary surgery were the two highest ranking priorities for their seeking training in the survey.²