A comparison of three lateral approaches in primary total hip replacement

Three different lateral approaches for a Charnley total hip replacement were studied in 264 operations. The transtrochanteric approach was used in 94, the Liverpool in 88 and the Hardinge in 82. The mean follow up was 2.6 years (range 2 to 3 years). The clinical result was the same in each group. Radiographs showed that alignment of the femoral stem was significantly better in the transtrochanteric group. Grade III socket demarcation was more frequent with the Liverpool approach. There was no difference in cement distribution between the 3 groups, except the acetabular cement distribution was poor with the Hardinge approach. There was no increase in Trendelenburg gait after the Hardinge or Liverpool approach compared with the transtrochanteric approach. Dislocation was a problem after the transtrochanteric approach and risk factors were retroversion of the acetabular cup and detachment of the trochanter. Severe heterotopic bone formation was 5 times more common after the Liverpool, compared with the other two, approaches.