Hardinge (1982) describes a direct lateral approach to the hip for total hip arthroplasty performed with the patient supine. The technique exploits the crescent-shaped tendinous insertion of the gluteus medius, dividing only its anterior half while leaving the posterior bulk undisturbed. The paper addresses whether a lateral approach can provide adequate THA exposure without trochanteric osteotomy or the positioning drawbacks of lateral decubitus techniques.
When selecting a surgical approach for primary THA, you are choosing between three dominant options: posterior, direct anterior, and direct lateral (Hardinge). Each carries a distinct trade-off profile for dislocation risk, abductor function, and exposure.
The Hardinge approach gives you a supine patient (better landmarks for version and leg length), no trochanteric hardware, and a tendon-to-tendon repair that is mechanically sound enough to mobilize by postoperative day 2.
The key constraint to carry into every case: if you anticipate needing wide distraction — complex primary deformity, revision with extensive acetabular work, or significant femoral preparation. The intact posterior gluteus medius will limit you. Plan for trochanteric osteotomy before you start, not after you are already in.
This paper established the anatomic rationale that subsequent comparative trials (dislocation rates, Trendelenburg gait, abductor EMG studies) have debated for four decades. Understanding Hardinge's original design logic helps you interpret that literature critically.
Hardinge (1982) describes a direct lateral approach to the hip for total hip arthroplasty performed with the patient supine. The technique exploits the crescent-shaped tendinous insertion of the gluteus medius, dividing only its anterior half while leaving the posterior bulk undisturbed. The paper addresses whether a lateral approach can provide adequate THA exposure without trochanteric osteotomy or the positioning drawbacks of lateral decubitus techniques.
When selecting a surgical approach for primary THA, you are choosing between three dominant options: posterior, direct anterior, and direct lateral (Hardinge). Each carries a distinct trade-off profile for dislocation risk, abductor function, and exposure.
The Hardinge approach gives you a supine patient (better landmarks for version and leg length), no trochanteric hardware, and a tendon-to-tendon repair that is mechanically sound enough to mobilize by postoperative day 2.
The key constraint to carry into every case: if you anticipate needing wide distraction — complex primary deformity, revision with extensive acetabular work, or significant femoral preparation. The intact posterior gluteus medius will limit you. Plan for trochanteric osteotomy before you start, not after you are already in.
This paper established the anatomic rationale that subsequent comparative trials (dislocation rates, Trendelenburg gait, abductor EMG studies) have debated for four decades. Understanding Hardinge's original design logic helps you interpret that literature critically.