Modified less invasive and bloodless lateral hip approach for total arthroplasty

Abstract

In traditional lateral transgluteal Hardinge approach (HA), if it is extended, injury of superior gluteal nerve branches or lateral circumflex artery at the anterior part of vastus lateralis region may occur. Our modified bloodless “Thomine et al.” R (TA) hip approach is characterized apart from no extension into vastus lateralis by a) skin incision of about 18–20% of subgroin perimeter of the thigh, b) adaptable elevation and reinsertion of the anterior bloodless and mechanically not significant part of gluteus medius muscle, c) use of two 6 mm in diameter external fixator pins over the acetabular rim to protect soft tissue during surgery. The purpose of this study is to present this surgical technique and analyze the results of 64 modified TA approach cases in 55 patients (47women and 8 men) with adaptable skin incision, mean: 12 cm (range, 8–15 cm) in comparison with 97 HA cases in 88 patients (79 women and 9 men) with traditional skin incision, mean: 18 cm (range, 16–24 cm). Harris hip score and peri-operative complications were similar in both groups but peri-operative blood loss was significantly eliminated in TA group. Pre-operative Trendelenburg sign positive in 7 hips of TA group and in 13 hips of HA group was ameliorated in all cases at 3 months post-operative followup except one TA and three HA cases with mal technique in obese patients. The modified Thomine et al. lateral hip approach has the advantages of minimal blood loss and no abduction or permanent limp problems.