The University of Southampton
University of Southampton Institutional Repository

The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach

The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach
The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach
INTRODUCTION: Minimally invasive total hip arthroplasty has been successfully introduced in the past decade. Nevertheless, standard approaches such as the direct lateral approach are still commonly used in orthopaedic surgery due to easy handling, good intra-operative overview and low complication rates. However, a frequent occurrence of fatty atrophy within the anterior third of the gluteus medius muscle has been demonstrated when using the modified direct-lateral approach (mDL), which may be associated with a reduction in function, limitation of internal leg rotation, gait disorders and pain. The question addressed in this study is whether mDL-approach leads to unfavourable changes in foot progression angle (FPA), gait and to more postoperative pain compared with a minimally invasive anterolateral approach (ALMI). METHODS: Thirty patients with primary osteoarthritis of the hip were recruited for this study. All subjects received an uncemented THA (Alloclassic((R))-Zweymuller stem, Allofit((R)) Cup, FA Zimmer((R))), 15 through an ALMI-approach and 15 via the mDL-approach. Gait analyses were performed both preoperatively and 3 months after surgery to measure FPA, step length, stance duration, cadence and walking speed. Additionally, the Harris-Hip Score, pain according to the visual analogue scale and the Trendelenburg sign were evaluated. RESULTS: No influence of the surgical approach could be observed on the gait patterns or FPA. Furthermore, neither increased external rotation of the limb nor restriction of internal rotation during walking could be established. Pain and Harris-Hip Score did not differ significantly between the two groups. CONCLUSION: In comparison with an ALMI approach, the mDL approach did not lead to a change in FPA postoperatively. No detrimental effect could be found on the gait pattern or pain after surgery. Based on these measurements, the minimally invasive anterolateral approach did not appear to provide functional benefits in outcome over the mDL approach. Consequently, both surgical approaches seem to be equally applicable approaches with good to very good functional results.
total hip arthroplasty, direct lateral approach, minimally invasive anterolateral approach, gait analysis, foot progression angle
0936-8051
725-731
Müller, Michael
731566e0-9b1f-46b7-a645-cc7b1ae78161
Schwachmeyer, Verena
9876d4d7-1826-49ca-bd85-cd8d5fa8c6aa
Tohtz, Stephen
85c99cb2-a078-4864-994c-8768d3e10f5d
Taylor, William R.
1ed48ef6-e396-40f5-8434-6c0628c9d3ca
Duda, Georg N.
ac4e207b-3e2e-4c84-a6c4-cb67531f890b
Perka, Carsten
50eac0cf-e710-45df-a04b-b8af775eace1
Heller, Markus O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Müller, Michael
731566e0-9b1f-46b7-a645-cc7b1ae78161
Schwachmeyer, Verena
9876d4d7-1826-49ca-bd85-cd8d5fa8c6aa
Tohtz, Stephen
85c99cb2-a078-4864-994c-8768d3e10f5d
Taylor, William R.
1ed48ef6-e396-40f5-8434-6c0628c9d3ca
Duda, Georg N.
ac4e207b-3e2e-4c84-a6c4-cb67531f890b
Perka, Carsten
50eac0cf-e710-45df-a04b-b8af775eace1
Heller, Markus O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829

Müller, Michael, Schwachmeyer, Verena, Tohtz, Stephen, Taylor, William R., Duda, Georg N., Perka, Carsten and Heller, Markus O. (2012) The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach. Archives of Orthopaedic and Trauma Surgery, 132 (5), 725-731. (doi:10.1007/s00402-012-1467-x). (PMID:22294091)

Record type: Article

Abstract

INTRODUCTION: Minimally invasive total hip arthroplasty has been successfully introduced in the past decade. Nevertheless, standard approaches such as the direct lateral approach are still commonly used in orthopaedic surgery due to easy handling, good intra-operative overview and low complication rates. However, a frequent occurrence of fatty atrophy within the anterior third of the gluteus medius muscle has been demonstrated when using the modified direct-lateral approach (mDL), which may be associated with a reduction in function, limitation of internal leg rotation, gait disorders and pain. The question addressed in this study is whether mDL-approach leads to unfavourable changes in foot progression angle (FPA), gait and to more postoperative pain compared with a minimally invasive anterolateral approach (ALMI). METHODS: Thirty patients with primary osteoarthritis of the hip were recruited for this study. All subjects received an uncemented THA (Alloclassic((R))-Zweymuller stem, Allofit((R)) Cup, FA Zimmer((R))), 15 through an ALMI-approach and 15 via the mDL-approach. Gait analyses were performed both preoperatively and 3 months after surgery to measure FPA, step length, stance duration, cadence and walking speed. Additionally, the Harris-Hip Score, pain according to the visual analogue scale and the Trendelenburg sign were evaluated. RESULTS: No influence of the surgical approach could be observed on the gait patterns or FPA. Furthermore, neither increased external rotation of the limb nor restriction of internal rotation during walking could be established. Pain and Harris-Hip Score did not differ significantly between the two groups. CONCLUSION: In comparison with an ALMI approach, the mDL approach did not lead to a change in FPA postoperatively. No detrimental effect could be found on the gait pattern or pain after surgery. Based on these measurements, the minimally invasive anterolateral approach did not appear to provide functional benefits in outcome over the mDL approach. Consequently, both surgical approaches seem to be equally applicable approaches with good to very good functional results.

Full text not available from this repository.

More information

Published date: 2012
Keywords: total hip arthroplasty, direct lateral approach, minimally invasive anterolateral approach, gait analysis, foot progression angle
Organisations: Bioengineering Group

Identifiers

Local EPrints ID: 348538
URI: https://eprints.soton.ac.uk/id/eprint/348538
ISSN: 0936-8051
PURE UUID: f072dea6-c39c-4e20-b337-a5db80d41e14
ORCID for Markus O. Heller: ORCID iD orcid.org/0000-0002-7879-1135

Catalogue record

Date deposited: 14 Feb 2013 14:54
Last modified: 20 Jul 2019 00:41

Export record

Altmetrics

Contributors

Author: Michael Müller
Author: Verena Schwachmeyer
Author: Stephen Tohtz
Author: William R. Taylor
Author: Georg N. Duda
Author: Carsten Perka

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×