A modified direct lateral approach for primary and revision total hip arthroplasty. A prospective analysis of 453 cases.

A prospective analysis of 453 consecutive primary and revision total hip arthroplasties (THAs) were reviewed. The modified direct lateral approach was used in 306 of 319 (96%) primary THAs and 115 of 134 (86%) revision cases for a total of 421 of 453 (93%) procedures. There were three dislocations in the revision group of patients. All three patients had at least two previous arthroplasties prior to their index surgery and at the time of surgery were noted to have very poor tissue quality, making the repair difficult. There were no postoperative dislocations in the primary THA group, with an overall dislocation rate of 0.7%. The incidence of postoperative limp in the primary THA group was 18%. The overall incidence, including revision surgery, was 27%. The presence of a persistent limp after initial rehabilitation was dependent on the number of previous surgeries, leg-length discrepancy greater than 2.7 cm, revision THA requiring a proximal femoral allograft, and preexisting deformities. Limp was therefore believed not to be related to the use of the modified direct lateral approach.