The direct lateral (Hardinge) approach has been cited to have the lowest associated dislocation rate of the options provided. The metanalysis by Masonis and Bourne found a dislocation rate for 14 studies involving 13000 total hips was 1.27% for the transtrochanteric approach, 3.23% for the posterior approach (3.95% without posterior repair and 2.03% with posterior repair), 2.18% for the anterolateral approach, and 0.55% for the direct lateral approach. Eight studies involving 2455 primary total hip arthroplasties evaluated postoperative limp. However, the article also found that the incidence of postoperative limp was 4% to 20% for patients who had the lateral approach and 0% to 16% for patients who had the posterior approach. The article by Kwon et al found the lowest dislocation rate with direct lateral (0.43%) followed by anteroalateral (0.7%) and posterior with soft tissue repair (1.01%). The article by Farrell et al reviewed 27,004 patients and found the use of a posterior approach (p = 0.032) to be associated with a significantly increased odds ratio for the development of a postoperative motor nerve palsy.
Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002 Dec;(405):46-53. Review.
PMID:12461355 (Link to Abstract)
Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res. 2006 Jun;447:34-8.
PMID:16741471 (Link to Abstract)
Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am. 2005 Dec;87(12):2619-25.
PMID:16322610 (Link to Abstract)