Lateral Approach Hip Replacement

What is Lateral Approach Hip Replacement?

Lateral approach hip replacement is a type of surgical technique used to perform hip replacement surgery. In this technique, your surgeon makes an incision on the side of the hip joint (lateral approach) with the patient in a lateral decubitus position. The lateral approach to the hip is a commonly used approach and involves the splitting of both the gluteus medius (supplied by the superior gluteal nerve) and often the vastus lateralis (supplied by the femoral nerve) muscles to access the damaged hip joint and perform replacement. The lateral approach to the hip has been noted to have a low prosthetic dislocation rate.

Anatomy of the Hip

The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables frictionless movement of the joint. Stability of the hip joint is achieved by the labrum (a strong fibrous cartilage that covers the acetabulum and seals it), ligaments (tissues connecting bone to bone), and tendons (tissues connecting muscle to bone) that encase the hip and support the hip movements. 

Indications for Lateral Approach Hip Replacement

Lateral approach hip replacement is typically indicated for hemiarthroplasty or uncomplicated primary total hip arthroplasty.

Total hip arthroplasty, commonly referred to as total hip replacement, is a surgical procedure in which the worn-out or damaged parts of the hip joint are removed and replaced with artificial hip components called prostheses or implants made of metal, ceramic, or plastic. Hemiarthroplasty is a procedure in which only one half (ball section) of the hip joint or femoral head is substituted by a metal prosthesis.

Your surgeon may recommend hip replacement in individuals with joint disease resulting from degenerative and rheumatoid arthritis, avascular necrosis, fracture of the neck of the femur, or functional deformity of the hip.

Preparation for Lateral Approach Hip Replacement

Preparation for lateral approach hip replacement surgery may involve the following steps:

• A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Diagnostic tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure and to determine the condition of the hip joint to plan the procedure.
• You will be asked if you have allergies to medications, anaesthesia, or latex.
• You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
• You may be asked to stop taking medications such as blood thinners and anti-inflammatories, or other supplements for a week or two prior to surgery.
• You should refrain from alcohol or tobacco at least a few days prior to the surgery and several days after as it can hinder the healing process.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You should arrange for someone to drive you home after surgery.
• A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Lateral Approach Hip Replacement

Lateral approach hip replacement surgery is usually performed under general or regional anaesthesia. You will be positioned on your side or in a lateral decubitus position on the procedure table with the affected side facing upwards. An anterior and posterior support clamp is usually used to ensure your stability. Both hips are flexed to 45 degrees and both knees flexed to 90 degrees. Your operating surgeon stands at the posterior side of the patient, while the assistant on the opposite side. The skin around your hip joint is sterilised with an antiseptic solution, and a longitudinal incision is made on the side of the hip. The surgery requires cutting a portion of the major abductor (side moving) muscles (gluteus medius, gluteus minimus) off the side of the femur bone and then accessing the hip joint below this. The muscles are pushed aside to gain access to the joint, and the femur is separated from the acetabular socket. The acetabular surface is prepared using a special instrument called a reamer. The acetabular component is cemented or fixed with screws into the socket. Then a liner made up of plastic, metal, or ceramic is placed inside the acetabular component. The femoral head that is worn out is cut off and the femur is prepared using special instruments so that the new metal component fits the bone properly. Then, the new femoral component is inserted into the femur either by a press fit or by using special bone cement. The femoral head component made of ceramic or metal is then placed on the femoral stem. Once the artificial components are fixed in place, the hip joint is checked through its range of motion for satisfactory repair. Instruments are then withdrawn, and the incision is closed with sutures and covered with a sterile dressing.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after lateral approach hip replacement may involve the following:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs as you recover. You may need to stay in the hospital for 2 to 3 days before discharge to home.
• You may notice pain, swelling, and discomfort in the hip area. Pain and anti-inflammatory medications are provided as needed to address these. Antibiotics may also be provided to address the risk of surgery-related infections.
• You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent the risk of blood clots.
• Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
• Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities over a period of time is recommended.
• An individualised physical therapy protocol will be designed to help strengthen hip muscles and optimise hip function once you are off assistive devices.
• Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, returning to sports may take at least 6 months or longer.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Lateral approach hip replacement is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Postoperative pain
• Allergic/anaesthetic reactions
• Damage to surrounding soft tissues, such as nerves and vessels
• Implant failure
• Leg length discrepancy
• The need for revision surgery