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Hardinge Approach

 Hardinge Approach

Hardinge Approach to Hip Joint (or Direct Lateral Approach) allows excellent exposure to 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.

See Also: Hip Joint Anatomy

Hardinge Approach to Hip Joint indications

Hardinge Approach to Hip Joint (Direct Lateral Approach) is used for:

  1. Total hip arthroplasty: it has lower rate of total hip prosthetic dislocations.
  2. Proximal femur fracture.

Position of the Patient

  1. Lateral position.
  2. Supine position with the greater trochanter at the edge of the table, this allows the buttock muscles and gluteal fat to fall posteriorly away from the operative plane.

Landmarks and Incision

Hardinge Approach to Hip Joint (Direct Lateral Approach)

Internervous plane

There is no true internervous plane for Hardinge approach to hip joint (direct lateral approach).

The fibers of the gluteus medius muscle are split in their own line distal to the point where the superior gluteal nerve supplies the muscle. The vastus lateralis muscle is also split in its own line lateral to the point where it is supplied by the femoral nerve.

Superficial dissection

Deep dissection

Approach Extension

Distal Extension:

Proximal Extension:

Dangers

The structures at risk during hardinge approach to hip joint (direct lateral approach) include:

  1. Superior gluteal nerve:
    • Superior gluteal nerve runs between gluteus medius and minimus muscles 3-5 cm above greater trochanter.
    • It can be protected by limiting proximal incision of gluteus medius muscle and putting a stay suture at the apex of gluteal split.
    • Its injury leads to Trendelenburg gait pattern.
  2. Femoral nerve:
    • The Femoral nerve is the most lateral structure in neurovascular bundle of anterior thigh.
    • Keep retractors on bone with no soft tissue under to prevent iatrogenic injury.

References

  1. Surgical Exposures in Orthopaedics book – 4th Edition
  2. Campbel’s Operative Orthopaedics book 12th
  3. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br 1982;64B:17–18. Link


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