Our Experience with Modified Lateral Approach for Total Hip Replacement – A Midterm Study

Volume 6 | Issue 2 | May-Aug 2018 | Page:16-20 | Madhuchandra P, Raju K P, Arun K M

Authors: Madhuchandra P [1], Raju K P [1], Arun K.N [1], Pawan Kumar K M [1].

[1] Department of Orthopaedics, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.

Address of Correspondence
Dr. P Madhuchandra,

Department of Orthopaedics,

BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.

Email: drmadhuchandrap@gmail.com


Background: Numerous approaches have been described in the literature for total hip replacement surgeries. Each of the approach has got its own merits and demerits. Modified lateral approach gives the best visualization and orientation of both acetabular cup and femur; furthermore, rates of dislocation are very less. However, damage to abductor mechanism is a major disadvantage. We have evaluated the clinical and functional outcomes of modified lateral approach in this midterm study.

Materials and Methods: The study was conducted in a tertiary institute in a prospective and retrospective manner. The study period was from January 2007 to December 2012 for 6 years. The study sample was 119 patients who underwent total hip replacements for different indications. 7 patients were lost to follow up for reasons unknown, so a total of 112 patients were included in the study who were in regular follow-up. All the patients were evaluated for clinical and functional outcomes using modified Harris hip score, and abductor mechanism was evaluated by electrophysiological studies and Trendelenburg test.

Results: Functional outcome was evaluated using modified Harris hip score. We had excellent results in 44 (39.2%) hips, good in 62 (55.5%) hips, and fair in 6 (5.5%) hips. There were no cases with poor outcomes. 92 patients (82.2%) had negative modified Trendelenburg test, whereas 20 patients (17.8%) had positive modified Trendelenburg test. Electrophysiological studies were done in 58 patients, which showed that there were no injuries to superior gluteal nerve in any of our cases.

Conclusion: Modified direct lateral approach is a wonderful approach for the total hip replacement surgeries. It gives better visualization and orientation of the components with lesser incidence of dislocations and good abductor strength is retained provided careful dissection is done taking care not to injure superior gluteal nerve.

Keywords: Lateral approach, total hip replacement, Harris hip score, Trendelenburg test.


1. LöDall D. Exposure of the hip by anterior osteotomy of the greater trochanter. A modified anterolateral approach. J Bone Joint Surg Br 1986;68:382-6.

2. Thompson RC Jr., Culver JE. The role of trochanteric osteotomy in total hip replacement. Clin Orthop Relat Res 1975;106:102-6.

3. Gore DR, Murray MP, Sepic SB, Gardner GM. Anterolateral compared to posterior approach in total hip arthroplasty: Differences in component positioning, hip strength, and hip motion. Clin Orthop Relat Res 1982;165:180-7.

4. Hungerford DS. Surgical approach in THA: The direct lateral approach is more practical and appealing. J Arthroplast 2000;15:867-70.

5. Ritter MA, Harty LD, Keating ME, Faris PM, Meding JB. A clinical comparison of the anterolateral and posterolateral approaches to the hip. Clin Orthop Relat Res 2001;385:95-9.

6. Learmonth ID, Allen PE. The omega lateral approach to the hip. J Bone Joint Surg 1996;78(B):559-61.

7. Harris WH. Harris hip score. J Orthop Trauma 2006;20:78-9.

8. Hardcastle P, Nade S. The significance of the trendelenburg test. J Bone Joint Surg 1985;67B:741.

9. Berry M. Traumatic peripheral nerve lesions. In: Brown WF, Bolton C, editors. Clinical Electromyography. 2nd ed. Boston, etc: Butterworth-Heinmann; 1993. p. 323-68.

10. Weale AE, Newman P, Ferguson IT, Bannister GC. Nerve injury after posterior and direct lateral approaches for hip replacement: A clinical and electrophysiological study. J Bone Joint Surg [Br] 1996;78-B:899-902.

11. Brooker AF, Bowerman JW, Robinson RA, Riley LM. Ectopic ossification following THR. J Bone Joint Surg 1973;44:1629-35.

12. Kelmanovich D, Parks ML. Surgical approaches to total hip arthroplasty. J South Orthop Assoc 2003;12:90-4.

13. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br 1982;64:17-9.

14. Mulliken BD, Rorabeck CH, Bourne RB, Nayak N. A modified direct lateral approach in total hip arthroplasty. J Arthroplast 1998;13:737-47.

15. Harkess JW, Crockarell JR Jr. Arthroplasty of the Hip. Philadelphia, PA: Mosby; 2008. p. 312-482.

16. Charnley J. Total hip replacement by low friction arthroplasty. Clin Orthop 1970;72:7-21.

17. Pai VS. A modified direct lateral approach in total hip. Arthroplast J Orthop Surg 2002;10:35-9.

18. Baker AS, Bitounis VC. Abductor function after total hip replacement. An electromyographic and clinical review. J Bone Joint Surg Br 1989;71:47-50.

19. Dudda M, Gueleryuez A, Gautier E, Busato A, Roeder C. Risk factors for early dislocation after total hip arthroplasty: A matched case-control study. J Orthop Surg (Hong Kong) 2010;18:179-83.

20. Downing ND, Clark DI, Hutchinson JW, Colclough K, Howard PW. Hip abductor strength following total hip arthroplasty: A prospective comparison of the posterior and lateral approach in 100 patients. Acta Orthop Scand 2001;72:215-20.

21. Minns RJ, Crawford RJ, Porter ML, Hardinge K. Muscle strength following total hip arthroplasty. A comparison of trochanteric osteotomy and the direct lateral approach. J Arthroplasty 1993;8:625-7.

How to Cite this article: Madhuchandra P, Raju K P, Arun K.N, Pawankumar K M. Our Experience with Modified Lateral Approach for Total Hip Replacement – A Midterm Study. J Kar Orth Assoc. MayAug 2018; 6(2):16-20.

                                          (Abstract    Full Text HTML)      (Download PDF)

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *