Hardinge Approach to Hip Joint (Direct Lateral Approach)
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Hardinge Approach to Hip Joint (Direct Lateral Approach) allows excellent exposure of the hip joint for joint replacement. It avoids the need for trochanteric osteotomy.
- The approach does not give as wide an exposure as the anterolateral approach to hip joint with trochanteric osteotomy.
- Hardinge Approach to Hip Joint (Direct Lateral Approach) is used for:
- Total hip arthroplasty.
- Has lower rate of total hip prosthetic dislocations.
- Proximal femur fracture.
- Total hip arthroplasty.
- Lateral position.
- Supine position with the greater trochanter at the edge of the table.
- Landmarks:
- Anterior superior iliac spine.
- The lateral aspect of the greater trochanter.
- The line of the femur bone.
- Incision:
- Begin 5cm proximal to tip of greater trochanter.
- Longitudinal incision centered over tip of greater trochanter and extends down the line of the femur about 8 cm.
- There is no true internervous plane for hardinge approach to hip joint (direct lateral approach).
- Intermuscular plane:
- Splits gluteus medius distal to innervation (innervated by superior gluteal nerve)
- Vastus lateralis is also split lateral to innervation (innervated by femoral nerve)
- Split fascia lata and retract it anteriorly to expose tendon of gluteus medius.
- Detach fibers of gluteus medius that attach to fascia lata using sharp dissection.
- Split fibers of gluteus medius longitudinally starting at middle of greater trochanter:
- do not extend more than 3-5 cm above greater trochanter to prevent injury to superior gluteal nerve.
- Extend incision inferior through the fibers of vastus lateralis.
- Develop anterior flap.
- Anterior aspect of gluteus medius from anterior greater trochanter with its underlying gluteus minimus.
- Anterior part of vastus lateralis muscle.
- Requires sharp dissection of muscles off bone or lifting small fleck of bone.
- Expose anterior joint capsule:
- Follow dissection anteriorly along greater trochanter and onto femoral neck which leads to capsule.
- Gluteus minimus needs to be released from anterior greater trochanter.
- Distal Extension:
- Hardinge Approach to Hip Joint (Direct Lateral Approach) can easily be extended distally:
- To expose the shaft of the femur, split the vastus lateralis muscle in the direction of its fibers (Lateral Approach to femur).
- Proximal Extension:
- The incision cannot be extended proximally.
- The structures at risk during hardinge approach to hip joint (direct lateral approach) includes:
- Superior gluteal nerve:
- Runs between gluteus medius and minimus muscles 3-5 cm above greater trochanter.
- Can be protected by:
- limiting proximal incision of gluteus medius muscle.
- putting a stay suture at the apex of gluteal split.
- Its injury leads to Trendelenburg gait pattern.
- Femoral nerve:
- Most lateral structure in neurovascular bundle of anterior thigh.
- Keep retractors on bone with no soft tissue under to prevent iatrogenic injury.
- Superior gluteal nerve:
- Surgical Exposures in Orthopaedics book - 4th Edition
- Campbel's Operative Orthopaedics book 12th
Orthopedic Approaches App
