Clinical outcomes of modified direct lateral approach of Hardinge for total hip arthroplasty


hip arthritis, total hip arthroplasty, direct lateral approach, outcomes

Published online: Jan 08 2024


1 Orthopaedic Traumatology Department, Emergency Clinical County Hospital, Constanta, Romania
2 Faculty of Medicine, “Ovidius” University of Constanta, Romania
3 Department of Anatomy, Faculty of Medicine, “Ovidius” University of Constanta, Constanta, Romania
4 Romanian Shoulder Institute, Ortopedicum– Orthopaedic Surgery & Sports Clinic, Bucharest, Romania
5 Balneal and Rehabilitation Sanatorium Techirghiol, Romania
6 Clinic of Orthopaedics and Trauma Surgery, “St. Pantelimon” Hospital, Bucharest, Romania
7 University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania


The aim of the study was to evaluate a modified direct lateral approach for total hip arthroplasty in terms of clinical and functional outcomes, rate of complications and hospitalization.

We retrospectively reviewed the data of 526 patients with THA operated in our department between January 2017 and December 2021. Clinical examination, functional outcome and radiographic evaluation were performed during follow-up. Patients were evaluated at the following time points: preoperatively and postoperatively at 3 days, 6 weeks, 12 weeks and 1 year and we registered surgery related data, complications, Visual Analogue Scale pain score, Harris Hip Score, the Western Ontario McMaster Osteoarthritis Index. Low intraoperative blood loss, short operation time, short hospitalization, early mobilization of the patient and good range of motion imposed the modified direct lateral approach as a valuable procedure for the patients with THA. VAS score evaluated at 3 days and 6 weeks indicated a very good overall postoperative experience. The HHS and Womac scores were evaluated at 6 weeks, 12 weeks and 1 year and showed excellent results. Trendelenburg gait and abductor weakness, traditionally related with direct lateral approach, were not significant statistically and complete reversible. We registered a very low complication rates with good functional outcome. The modified direct lateral approach can lead to superior outcomes, improved quality of life, with reduced intra and postoperative complications rate.