The Mini-incision Direct Lateral Approach in Primary Total Hip Arthroplasty

Patients are inquiring about mini-incision primary total hip arthroplasty with increasing frequency. There are no published randomized controlled trials to substantiate claims that the mini-incision direct lateral approach is better than a standard approach. The purpose of our study was to review our initial experience with the mini-incision technique through the direct lateral approach, with the intent of implementing a randomized controlled trial if the approach could be shown as safe and effective. Of importance was determining if there is any difference in component positioning and if there is any difference in intraoperative or postoperative complications between the two groups. We retrospectively compared a consecutive series of 87 primary total hip arthroplasties. Thirty-four total hip arthroplasties were done using a mini-incision direct lateral approach. The mean abduction angle was 45° for both groups. The femoral stem alignment was within five degrees of neutral in 97% of the mini group and 94% of the standard group. There were no dislocations, infections, neurologic or wound complications. There were no differences in medical complications or blood transfusions. A significant decrease was found regarding body mass index, which reflects the bias in patient selection and lack of randomization. We conclude that it is safe to continue further study with this approach because as there was no increase in complications or component malpositioning.

Level of Evidence: Therapeutic study, Level III (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.