A MODIFIED DIRECT LATERAL APPROACH IN TOTAL HIP-ARTHROPLASTY - A COMPREHENSIVE REVIEW

A retrospective review of 770 consecutive primary total hip arthroplas ties was conducted to determine the complications and utility of a mod ified direct lateral approach, which involves elevation of the anterio r one-third of the gluteus medius and vastus lateralis in continuity. In 640 patients, 712 total hip arthroplasties were followed up for a m inimum of 2 years (maximum 6.5 years, average 3.6 years). Two prosthet ic dislocations occurred in the follow-up period, for a prevalence of instability of 0.3%. A moderate or severe limp was present in 10% of a ll patients at 2-year follow-up and in 4% of a subgroup of patients wi th only unilateral osteoarthritis of the hip (Charnley A). Severe hete rotopic ossification (Brooker grade III or IV) developed in fewer than 3% of hips and was functionally limiting in only seven patients. Four sciatic nerve palsies occurred. Surgical exposure has been excellent through this approach, without the need for extensile measures, such a s a trochanteric osteotomy. The duration of surgery has been considere d acceptable, and the position of the components considered excellent while using this approach. From this review it was concluded that this modified direct lateral approach has greatly diminished the potential ly devastating complication of postoperative instability and is associ ated with an acceptable level and severity of limp and heterotopic oss ification. The approach provides excellent exposure in primary total h ip arthroplasty to allow accurate placement of components in an effici ent manner.