Modified Direct Lateral Approach Total Hip Arthroplasty With Good Functional Outcomes and Low Complication Rates: A Prospective Study of 450 Patients for 6 Years of Follow up

Abstract

Total hip replacement is commonly performed surgeries for all types of Hip arthritis and intracapsular fracture neck femur in more than 50 years of age group patients worldwide. Three main surgical approaches, which have been widely studied in literature for THA have their own risks and complications per and postoperatively. We conducted a prospective study for our primary total hip arthroplasty operated by modified direct lateral approach. We randomly followed our 450 Total Hip Replacement patients from 2013- 2019. We utilized direct lateral small incision modified minimal Vastusgluteal split approach in lateral position. Our results showed excellent outcomes on HHS and VAS scale. We had one post op hip dislocation, managed with closed reduction and skin traction for 1 week with gradual weight bearing over 3 weeks. We encountered one septic complication which needed liner exchange with thorough soft tissue debridement and vacuum dressing with suppressive antibiotics for 6 weeks.Our 3rd patient complained of painful limping with Trendelenburgh gait. There was no superior gluteal nerve injury on MRI. He was diagnosed with severe degenerative lumbar spinal stenosis with L4-S1 nerve roots compression. There were 2 intra-operative incomplete stable trochanteric fractures, which were successfully managed with encirclage cable wiring without any adverse effects on outcome. Length of hospital stay ranged from 2-5 days. Cup positioning were moderately accurate according to Lewinnek safe zone. All patients received Tranexamic acid intraoperatively to minimize bleeding and 8 patients required blood transfusion.