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Purpose <p>Several modifications of the direct lateral approach to hip have evolved to improve the&#xa0;functional outcome after hip arthroplasty. We evaluated our modified lateral approach to hip, which involves only ‘functional elevation’ of abductors and spares vastus lateralis. The anatomical basis of this modified approach is presented along with a&#xa0;literature review.</p> Materials and methods <p>We prospectively evaluated uncemented total hip arthroplasty (THA) using our modified lateral approach in 50 consecutive patients. They were assessed for intraoperative joint-stability, component placement accuracy, surgery duration, blood loss, any event of hip dislocation, and functional outcome. They were followed for at least 2&#xa0;years.</p> Results <p>The most common indication was hip arthritis secondary to femoral head osteonecrosis (<i>n</i> = 41). The mean age was 38.5&#xa0;years. The mean duration of surgery was 68.5&#xa0;min. None of these cases had demonstrable posterior/ anterior instability. Mean acetabular inclination was 43° (range 40°–50°) and anteversion was 20° (range 15°–25°). The mean femoral anteversion was 13°. Mean deviation of femoral stem axis from femoral shaft axis was 2.4° ± 1.23° in the coronal plane and 4.1° ± 1.74° in the sagittal plane. None of the cases had intraoperative trochanteric avulsion, postoperative prosthetic dislocation, nerve injury, or heterotrophic ossification at 12&#xa0;months. None of the patients had Trendelenburg gait/ sign at 6-month follow-up. Mean Harris hip score improved from 42 (range 36–45) before surgery to 78.5 (range 72–85) at 6&#xa0;months (<i>p</i> &lt; 0.05) and 92.5 (range 85–100) at 12&#xa0;months (<i>p</i> &lt; 0.05) after surgery.</p> Conclusion <p>The described ‘functional’ modification of the&#xa0;lateral approach to the&#xa0;hip enables the surgeon to&#xa0;place components accurately and results in good early functional outcomes.</p>

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A Modified Direct Lateral Hip Approach for Total Hip Arthroplasty Involving 'Functional' Elevation of Abductors and 'Spare' Vastus Lateralis: Description of the Surgical Technique with its Anatomical Basis

  • 期刊论文

  • 发表日期：

    2025年10月28日

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  • Sumit Arora,
  • Prajwal Gupta,
  • Shahrukh Khan,
  • Gouri Asnani,
  • Sumit Sural,
  • Manoj Kumar

摘要

Purpose

Several modifications of the direct lateral approach to hip have evolved to improve the functional outcome after hip arthroplasty. We evaluated our modified lateral approach to hip, which involves only ‘functional elevation’ of abductors and spares vastus lateralis. The anatomical basis of this modified approach is presented along with a literature review.

Materials and methods

We prospectively evaluated uncemented total hip arthroplasty (THA) using our modified lateral approach in 50 consecutive patients. They were assessed for intraoperative joint-stability, component placement accuracy, surgery duration, blood loss, any event of hip dislocation, and functional outcome. They were followed for at least 2 years.

Results

The most common indication was hip arthritis secondary to femoral head osteonecrosis (n = 41). The mean age was 38.5 years. The mean duration of surgery was 68.5 min. None of these cases had demonstrable posterior/ anterior instability. Mean acetabular inclination was 43° (range 40°–50°) and anteversion was 20° (range 15°–25°). The mean femoral anteversion was 13°. Mean deviation of femoral stem axis from femoral shaft axis was 2.4° ± 1.23° in the coronal plane and 4.1° ± 1.74° in the sagittal plane. None of the cases had intraoperative trochanteric avulsion, postoperative prosthetic dislocation, nerve injury, or heterotrophic ossification at 12 months. None of the patients had Trendelenburg gait/ sign at 6-month follow-up. Mean Harris hip score improved from 42 (range 36–45) before surgery to 78.5 (range 72–85) at 6 months (p < 0.05) and 92.5 (range 85–100) at 12 months (p < 0.05) after surgery.

Conclusion

The described ‘functional’ modification of the lateral approach to the hip enables the surgeon to place components accurately and results in good early functional outcomes.