Lateral Approach

This is much less frequently used incision used in total hip replacement. Like the posterior approach, the patient is also placed on the side. The body is held with vertical posts and supports. The skin is cut open on the side of the body. The muscle (gluteus medius) just below the skin is split. Then the vastus lateralus muscle fibers are split. The hip is slightly flexed. The muscle (gluteus minimus) below is seen and the fibers are split. Muscles from the side of the femur (greater trochanter) are detached along the neck of the femur. The gluteus minimus tendon insertion is detached. Then the front of the hip capsule is seen and cut open. The leg is then crossed over to the front of the table. The hip is dislocated.

From this point on, the procedure to install the artificial hip implant is similar to that in the Posterior Approach. The bone and socket of the hip joint is exposed and replaced. Afterwards, the length of the operated leg is checked against the good leg by feeling the knee caps to make sure they are even. A tube (drain) is placed inside the wound so that any bleeding afterwards will exit the body. The split and detached muscles and soft tissue are repaired with sutures. The surface skin is closed up with metal staples. Bandages (dressings) are placed over the wound. A wedged shaped pillow is then placed between the legs to keep the legs apart. The patient is turned from the side to a face up position. The patient is moved from the operating room table and wheeled to the recovery room. Usually, an x-ray is taken in the recovery room to ensure that the implants are placed in the appropriate positions.

While this is a less common approach, the advantage is that it allows the surgeon to place the components, especially the ball and stem part (femoral component) more precisely under direct vision. It is also recommended for patients who may have difficulty in following the cautions in a posterior approach. However, if the repaired muscles and tendons do not heal, the patient may experience ‘residual’ weakness and may affect one’s walking posture (gait).