Lateral approach to the hip

Direct lateral
Transgluteal
Hardinge

Aims

first described by Bauer in 1979 transgluteal approach
popularized by Hardinge in 1982
decreases posterior dislocation rate
↑ abductor dysfunction
can preserve blood supply to femoral head with this approach
superior gluteal nerve runs 4.5cm above superior edge of acetabulum
therefore 5cm above tip of GT is safe
8cm incision ll to anterior border of femur
proximal incision extends 5cm posterior, ending level with ASIS
with hip in extension fibres of Gluteus Medius separated
Gluteus Minimus in is included in the anterior flap

Landmarks

ASIS
Iliac crest
Greater trochanter
Femoral shaft

Incision

15 cm longitudinal incision centered over the tip of the greater trochanter

Internervous Plane

Gluteus Medius Split

Superficial Dissection

Incise fat & underlying deep fascia in line with skin incision
Expose fascia lata
- Divide it longitudinally
Charnley initial skin retractor
Expose vastus lateralis & gluteus medius

Deep Dissection

Identify the anterior & posterior borders of Gluteus medius
- Split its insertion in the middle in line with its fibres
- Being careful not to extend too proximally because of the superior gluteal nerve
- Original Hardinge
  - Junction of middle & posterior thirds
- Most surgeons now perform Frndak modification
Split the fibres of vastus lateralis
Develop an anterior flap consisting of
- Gluteus medius
- Gluteus minimus
- Vastus lateralis
Using sharp dissection & diathermy following the contour of the bone onto the femoral neck
Exposes hip joint capsule
- T shaped capsulotomy

Dangers

Nerves
- Superior gluteal nerve
- Femoral nerve
Vessels
- Femoral artery & vein
- Lateral circumflex artery