Instability in Primary Total Hip Arthroplasty With the Direct Lateral Approach

Demos, Harry A.; Rorabeck, Cecil H.; Bourne, Robert B.; MacDonald, Steven J.; McCalden, Richard W.

doi:10.1097/00003086-200112000-00020

Cited by 79 publications

(43 citation statements)

References 43 publications

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“…The dislocation rate for direct lateral THA is almost negligible; rates of approximately 0.4% have been reported 11,12 . Superior gluteal nerve damage is evident four weeks following direct lateral THA; however this often resolves spontaneously 13 .…”

Section: Direct Lateral (Modified Hardinge)mentioning

confidence: 97%

“…Trendelenburg gait has been attributed to disruption of the abductor compartment (gluteus medius and minimus) during surgery 11,12,19 . Compared to the anterolateral approach, the gait of people undergoing surgery using a direct lateral approach appears to differ more from control participants one year post-operatively in kinematic variables including hip ROM and pelvic asymmetry timed-up-and-go test.…”

Section: Global Functionmentioning

confidence: 99%

See 1 more Smart Citation

The influence of surgical approach on outcomes of total hip arthroplasty

Tadross¹,

Lunn²,

Redmond³

et al. 2016

Orthopaedics and Trauma

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The vast majority of total hip arthroplasties performed in the UK are undertaken using either a posterior or direct lateral approach. This review describes the functional outcomes of these approaches. Functional outcome can be assessed through motion capture of function, strength testing of muscle groups around the hip and imaging of anatomical structures. Regardless of surgical approach, total hip arthroplasty patients rarely -matched controls. The direct lateral approach is associated with abductor deficiencies whilst the posterior approach may introduce extension and rotation deficits. How long functional differences persist between surgical approaches is unclear. The emergence of improved imaging technologies as well as isokinetic dynamometry (muscle strength testing) and 3D biomechanical modelling provide more comprehensive evaluations than traditional post-operative assessments such as radiology or couch examination. Targeted physiotherapy has been suggested as a possible intervention to counter lasting functional deficits. This review provides a foundation to inform surgeons of the impact of each approach to justify their surgical practice and may inform physical rehabilitation regimens postsurgery.

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Section: Direct Lateral (Modified Hardinge)mentioning

confidence: 97%

Section: Global Functionmentioning

confidence: 99%

The influence of surgical approach on outcomes of total hip arthroplasty

Tadross¹,

Lunn²,

Redmond³

et al. 2016

Orthopaedics and Trauma

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“…The surgical approach may be extended for additional exposure if necessary. The reported dislocation rate with this approach has been reported as 0 to 2% [3,6,7,11,14], with an overall dislocation rate of 0.55% [13]. So-called ''hip precautions'' are not necessary when utilizing this approach for primary arthroplasty [17].…”

Section: Anterolateral Approach (Supine Position)mentioning

confidence: 99%

“…The main purported disadvantage is an increased incidence of abductor dysfunction and limp. The low incidence of dislocation has been clearly demonstrated in several studies [3,6,7,14,15], while the issue of abductor dysfunction and limp has not been convincingly proven [1, 3, 5-8, 10, 14, 19, 22].…”

Section: Introductionmentioning

confidence: 99%

Acetabular Orientation: Anterolateral Approach in the Supine Position

Austin¹,

Rothman²

2009

Clinical Orthopaedics &Amp; Related Research

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The anterolateral approach in the supine position provides excellent visualization of the acetabulum. The main advantage of the approach, a low dislocation rate, has been demonstrated in the literature, while the purported disadvantage of abductor dysfunction has not been clearly delineated in the literature. The technique requires meticulous attention to preservation of the gluteus medius and minimus tendons. Impingement and dislocation are avoided by careful attention to the preparation of acetabulum, critical assessment of the implanted components, and intraoperative trialing. Leg lengths are assessed through direct palpation of the malleoli. Routine use of postoperative hip precautions is not necessary when this approach is utilized. The anterolateral approach in the supine position allows for a reproducible result with a low dislocation rate. Level of Evidence: Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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“…Postoperative dislocation remains a common major complication after total hip arthroplasty (THA) with an overall incidence of 2% to 3%, but approaching less than 1% after primary THA [1][2][3][4][5][6][7][8][9]. Khatod et al [10] reported dislocation rates of 1.7% for primary THA and 5.1% for revision procedures using contemporary techniques and implants with a community-based registry.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of an Abduction Brace in Preventing Initial Dislocation in the Early Postoperative Period after Primary Total Hip Arthroplasty

Ishii¹,

Noguchi²,

Takeda³

et al. 2012

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We hypothesized that a hip brace may prevent the initial dislocation in the early postoperative period after total hip arthroplasty (THA). We performed a prospective evaluation of the efficacy of a brace in preventing dislocation in 54 primary THAs in 43 patients. All of the patients wore braces for 3 weeks postoperatively. The occurrence of dislocation was evaluated six months postoperatively. There were no cases of dislocation while wearing a brace, while two posterior dislocations occurred 8 and 12 days postoperatively while picking something up from the floor without a brace in so-called provocative positions. The results of this study suggest that a hip brace helps patients to recognize careless provocative positions and prevents the initial hip dislocation in this period instead of usual postoperative management for an average of 6 weeks after discharge, such as a high toilet seat, restricted hip flexion in the activities of daily living, use of a reacher or grabber, an abduction pillow, and a high chair.

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Instability in Primary Total Hip Arthroplasty With the Direct Lateral Approach

Cited by 79 publications

References 43 publications

The influence of surgical approach on outcomes of total hip arthroplasty

The influence of surgical approach on outcomes of total hip arthroplasty

Acetabular Orientation: Anterolateral Approach in the Supine Position

Efficacy of an Abduction Brace in Preventing Initial Dislocation in the Early Postoperative Period after Primary Total Hip Arthroplasty

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