Limping Following Primary Total Hip Replacement

Comparison of 3 Surgical Approaches

Pongcharoen, Boonchana, MD1; Chaichubut, Kittisak, MD1

doi: 10.2106/JBJS.OA.18.00043
Scientific Articles: PDF Only

Background: Limping following total hip replacement affects clinical outcome and patient satisfaction. The purpose of the present study was to determine the prevalence of limping following the posterior approach, the direct lateral approach, and the modified anterolateral Watson-Jones approach for primary total hip replacement, performed by 1 surgeon.

Methods: We retrospectively reviewed the records for 152 patients who had undergone unilateral primary total hip replacement and assessed the prevalence of limping ≥2 years after surgery as a function of the surgical approach. Patients were divided into 3 groups, according to the surgical approach: (1) 43 patients, posterior approach; (2) 53 patients, direct lateral approach; and (3) 56 patients, modified anterolateral Watson-Jones approach. The mean duration of follow-up was 65.04 months (range, 24 to 117 months). No patients were lost to follow-up.

Results: There were no significant differences between the groups in terms of the limping rates (6.98%, 7.55%, and 3.57% for the posterior approach, direct lateral approach, and modified anterolateral Watson-Jones approach, respectively; p = 0.64). No patient had severe limping. The Harris hip score, the alignment of the acetabular component, and blood loss were not significantly different between the 3 groups. However, operative time was significantly longer for the modified anterolateral Watson-Jones approach (p = 0.001).

Conclusions: The prevalence of limping was similar ≥2 years after primary total hip replacement, irrespective of the surgical approach.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

1Department of Orthopaedic Surgery, Thammasat University, Pathumthani, Thailand

Email address for B. Pongcharoen:

Investigation performed at the Department of Orthopaedic Surgery, Thammasat University, Pathumthani, Thailand

Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

© 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Journal of Bone and Joint Surgery, Incorporated.