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

Abstract

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.

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