What is the lateral approach surgical technique for hip arthroplasty (hip replacement)?

From the Guidelines

The lateral approach to hip arthroplasty is recommended as it provides excellent exposure of both the acetabulum and femur while preserving the posterior soft tissues, despite the risk of postoperative abductor weakness if muscle repair is inadequate. When considering the surgical technique for hip arthroplasty, several approaches can be taken, including the lateral approach. According to a systematic review and meta-analysis published in 2021 1, the choice of surgical approach should depend on surgeon and patient preference due to inconclusive evidence in terms of postoperative pain. Some key points to consider when performing a lateral approach to hip arthroplasty include:

• Positioning the patient in the lateral decubitus position with the affected hip facing upward
• Making a straight lateral incision centered over the greater trochanter, extending approximately 10-15 cm
• Identifying and partially detaching the gluteus medius and minimus muscles from their insertion on the greater trochanter
• Dislocating the hip anteriorly by flexing, adducting, and externally rotating the femur
• Preparing the acetabulum and femoral canal for implantation of the prosthetic components
• Closing the wound by reattaching the gluteus medius and minimus to the greater trochanter, followed by closure of the fascia lata, subcutaneous tissue, and skin. It is essential to note that while the lateral approach may provide excellent exposure, it carries some risk of postoperative abductor weakness if muscle repair is inadequate, as reported by Putananon et al. in their study comparing surgical complications with different approaches 1.

From the Research

Hip Arthroplasty Surgical Technique Lateral

• The lateral approach for total hip arthroplasty (THA) is one of the most common approaches used worldwide, along with the posterior and direct anterior approaches 2.
• A study comparing the postero-lateral and anterior approaches for THA found that the anterior approach had shorter operative time, less pain, and less bleeding, but also had more iatrogenic fractures of the proximal femur 3.
• The direct lateral approach facilitates cup positioning, which may decrease rates of hip dislocation and diminishes the risk of injury to the sciatic nerve, but also has an increased risk of limp 4.
• A review of outcomes and complications for the lateral approach found that it had a higher risk of nerve palsy or injury compared to the posterior approach, but no significant difference in terms of dislocation or postoperative Trendelenburg gait 4.
• A matched cohort study found that patients who underwent THA with the posterior approach reported greater improvement in health-related quality-of-life (HRQoL) with lower residual pain, postoperative muscle damage, and Trendelenburg signs compared to those who underwent the lateral approach 5.

Comparison of Surgical Approaches

• The choice of surgical approach for THA depends on the patient's characteristics and the surgeon's experience and preferences 2, 3.
• Current data do not demonstrate superiority of one approach over another in primary THA, and the choice of approach should be based on individual patient needs and surgeon expertise 3, 4.
• The lateral approach may have advantages in terms of cup positioning and reduced risk of dislocation, but also has a higher risk of nerve palsy and limp 4, 5.

Outcomes and Complications

• The lateral approach has been associated with a higher risk of nerve palsy or injury, but no significant difference in terms of dislocation or postoperative Trendelenburg gait 4.
• A study found that the posterior approach had better outcomes in terms of HRQoL, residual pain, and postoperative muscle damage compared to the lateral approach 5.
• The choice of surgical approach should be based on a careful consideration of the potential risks and benefits for each individual patient 2, 3, 4, 5.