Hardinge described a direct lateral approach to the hip, done with the patient supine, for total hip replacement.
Surgical technique from the Centre for Hip Surgery, Wrightington Hospital, built on an anatomical observation of the gluteus medius insertion.
Methods
Indication
Total hip replacement
Approach
Direct lateral
Patient supine
Lazy J incision centered on the greater trochanter
Anterior half of the gluteus medius tendon divided
Key Points
Hardinge reported that the supine lateral route gave distinct advantages for orienting the implant, inserting cement and correcting leg‑length discrepancy.
Gluteus medius attaches to the greater trochanter through a strong tendon that is broad in its anterior half and follows a crescent‑shaped insertion.
The femoral shaft axis continues into the anterior half of the trochanter, which is exposed once the anterior gluteus medius tendon is cut.
The femoral shaft axis lies in front of the muscle's main bulk, which the approach leaves undisturbed.
Board pearl
Hardinge operated with the patient supine and the greater trochanter at the table edge, whereas the earlier McFarland and Osborne lateral approach placed the patient on the side.
Direct lateral approach: opening sequenceHardinge, J Bone Joint Surg Br 1982
PositionSupine, with the greater trochanter at the table edge so the buttock muscles hang free of the table.
Skin incisionLazy J with the trochanter at its midpoint. It runs 8 cm along the anterior border of the femoral shaft and curves posteriorly above to end level with the ASIS.
Fascia lataSplit along the same line as the skin cut.
Gluteus mediusDivide the anterior half of its tendon to expose the anterior trochanter. The posterior muscle bulk stays attached.
Authors' conclusion
In total hip replacement, the lateral approach with the patient in the supine position offers distinct advantages for orientation of the implant, insertion of cement and correction of the discrepancy in leg length.
Hardinge described a direct lateral approach to the hip, done with the patient supine, for total hip replacement.
Surgical technique from the Centre for Hip Surgery, Wrightington Hospital, built on an anatomical observation of the gluteus medius insertion.
Methods
Indication
Total hip replacement
Approach
Direct lateral
Patient supine
Lazy J incision centered on the greater trochanter
Anterior half of the gluteus medius tendon divided
Key Points
Hardinge reported that the supine lateral route gave distinct advantages for orienting the implant, inserting cement and correcting leg‑length discrepancy.
Gluteus medius attaches to the greater trochanter through a strong tendon that is broad in its anterior half and follows a crescent‑shaped insertion.
The femoral shaft axis continues into the anterior half of the trochanter, which is exposed once the anterior gluteus medius tendon is cut.
The femoral shaft axis lies in front of the muscle's main bulk, which the approach leaves undisturbed.
Board pearl
Hardinge operated with the patient supine and the greater trochanter at the table edge, whereas the earlier McFarland and Osborne lateral approach placed the patient on the side.
Direct lateral approach: opening sequenceHardinge, J Bone Joint Surg Br 1982
PositionSupine, with the greater trochanter at the table edge so the buttock muscles hang free of the table.
Skin incisionLazy J with the trochanter at its midpoint. It runs 8 cm along the anterior border of the femoral shaft and curves posteriorly above to end level with the ASIS.
Fascia lataSplit along the same line as the skin cut.
Gluteus mediusDivide the anterior half of its tendon to expose the anterior trochanter. The posterior muscle bulk stays attached.
Authors' conclusion
In total hip replacement, the lateral approach with the patient in the supine position offers distinct advantages for orientation of the implant, insertion of cement and correction of the discrepancy in leg length.