Surgical Approach to the Hip: Direct Lateral Approach

  • Kim, Dong-Ok (Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center) ;
  • Kim, Wan-Lim (Department of Orthopedic Surgery, Seoul National University Hospital) ;
  • Yoon, Kang-Sup (Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center)
  • Published : 2009.12.31

Abstract

The direct lateral approach was first described and named the transgluteal approach by Bauer in 1979 and was popularized by Hardinge K in 1982. In total hip arthroplasty, the direct lateral approach offers distinct advantages for the orientation of implants, access to both the acetabulum and proximal femur, and the preservation of soft tissue continuity between the gluteus medius and vastus lateralis muscle group. It can also be quite versatile, even in cases requiring extensive exposure, such as revision arthroplasty. The disadvantages include a risk of superior gluteal nerve injury, disruption of the repaired abductor mechanism, and postoperative heterotopic ossification. This review describes the surgical exposure of the direct lateral approach as well as the advantages and potential complications of the direct lateral approach.

Keywords

References

  1. Abitbol JJ, Gendron D, Laurin CA, Beaulieu MA. Gluteal nerve damage following total hip arthroplasty. A prospective analysis. J Arthroplasty, 5: 319-322, 1990. https://doi.org/10.1016/S0883-5403(08)80090-3
  2. Archibeck MJ, Rosenberg AG, Berger RA, Silverton CD. Trochanteric osteotomy and fixation during total hip arthroplasty. J Am Acad Orthop Surg, 11: 163-173, 2003.
  3. Baker AS, Bitounis VC. Abductor function after total hip replacement. An electromyographic and clinical review. J Bone Joint Surg, 71-B: 47-50, 1989.
  4. Bauer R, Kerschgaumer F, Poisel S, Oberthaler W. The transgluteal approach to the hip joint. Arch Orthop Trauma surg, 95: 47-49, 1979. https://doi.org/10.1007/BF00379169
  5. Dall D. Exposure of the hip by anterior osteotomy of the greater trochanter. A modified anterolateral approach. J Bone Joint Surg, 68-B: 382-386, 1986.
  6. Eftekhar NS. Applied surgical approaches. In: Eftekhar NS ed. Total hip arthroplasty. St. Louis, Mosby: 61, 1993.
  7. Frndak PA, Mallory TH, Lombardi AV Jr. Translateral surgical approach to the hip. The abductor muscle “split”. Clin Orthop Relat Res, 295: 135-141, 1993.
  8. Glassman AH, Engh CA, Bobyn JD. A technique of extensile exposure for total hip arthroplasty. J Arthroplasty, 2: 11-21, 1987. https://doi.org/10.1016/S0883-5403(87)80026-8
  9. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg, 64-B: 17-19, 1982.
  10. Hardy AE, Synek V. Hip abductor function after the Hardinge approach: brief report. J Bone Joint Surg, 70-B: 673, 1988.
  11. Head WC, Mallory TH, Berklacich FM, Dennis DA, Emerson RH Jr, Wapner KL. Extensile exposure of the hip for revision arthroplasty. J Arthroplasty, 2: 265-273, 1987. https://doi.org/10.1016/S0883-5403(87)80058-X
  12. Jacobs LG, Buxton RA. The course of the superior gluteal nerve in the lateral approach to the hip. J Bone Joint Surg, 71-A: 1239-1241, 1989.
  13. McFarland B, Osborne G. Approach to the hip. A suggested improvement on Kocher's method. J Bone Joint Surg, 36-B: 364-367, 1954.
  14. Ramesh M, O'Byrne JM, McCarthy N, Jarvis A, Mahalingham K, Cashman WF. Damage to the superior gluteal nerve after the Hardinge approach to the hip. J Bone Joint Surg, 78-B: 903-906, 1996.
  15. Parratte S, Pagnano MW. Muscle damage during minimally invasive total hip arthroplasty: cadaver-based evidence that it is significant. Instr Course Lect, 57: 231- 234, 2008.
  16. Syensson O, Skold S, Blomgren G. Intergrity of the gluteus medius after the transgluteal approach in total hip arthroplasty. J Arthroplasty, 5: 57-60, 1990. https://doi.org/10.1016/S0883-5403(06)80010-0
  17. William A, McGann. Surgical approaches. In: Callaghan JJ, Rosenberg Ag, Rubash HE ed. The adult hip, vol.2. 2nd ed. Philadelphia, Lippincott-William&Wilkins: 683-734, 2007.
  18. Woolson ST, Mow CS, Syquia JF, Lannin JV, Schurman DJ. Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Joint Surg, 86-A: 1353-1358, 2004.
  19. Woolsen ST. In the absence of evidence-why bother? A literature review of minimally invasive total hip replacement surgery. Instr Course Lect, 55: 189-193, 2006.