Hip – Anterolateral (Hardinge/Transgluteal)

Position

Gray’s Anatomy illustration of the structures around the hip joint
Structures surrounding the right hip joint. The anterolateral (Hardinge) approach splits gluteus medius and vastus lateralis in continuity. Image by Henry Vandyke Carter, Gray’s Anatomy (1918), Wikimedia Commons, public domain.

Supine (as First Described by Hardinge, K. (1982))

  • buttock over hangs over edge of table
  • tilt table away so patient lies flat
  • prep & drape leg free

Lateral Decubitus

  • Patient centred on table
  • Posterior (Sacral) and anterior (ASIS) pelvic supports
  • Hips and Knees flexed to 30 degrees (gel pads to protect bony protuberances)
  • Prep & drape leg free

Landmarks

  • ASIS
  • Greater trochanter
  • Shaft of femur
  • Vastus lateralis ridge

Incision

  • Flex the hip 30°
  • Incision has the GT at its mid point longitudinally
  • Extends 8cm parallel to the shaft of the femur along its anterior border
  • Proximally it extends in a posterior direction ending at the level of the ASIS

Internervous Plane

  • Intermuscular plane*
  • Tensor fascia lata – Split lateral to innervation
  • Gluteus medius – Split distal to innervation
    • Superior gluteal nerve
  • *No true Internervous plane as muscles share common innervation

Superficial Dissection

  • Continue the incision through subcutaneous fat down to deep fascia
  • The gluteal fascia and iliotibial band are exposed using blunt dissection and divided along the whole length and in the same direction as the skin incision.
  • The tensor fascia lata is retracted anteriorly and the gluteus maximus posteriorly

Deep Dissection

  • Detaching the abductor mechanism – if needed
    • 1. Trochanter Osteotomy
      • starting at Vastus Lateralis Ridge
        • straight
        • Chevron
      • Use
        • Gigli saw
        • Osteotome
        • Saw
    • 2. Detaching Gluteus Medius
      • Place a stay suture in the anterior portion of Gluteus Medius
      • Identify the small prominence that lies at the uppermost end of the ridge of the vastus lateralis.
      • Starting at this point and continuing to the APEX of the GT, the tendon of the Gluteus medius is incised using diathermy.
      • Leave a cuff to be re-attached at closing.
      • Extend the incision proximally between the fibres of gluteus medius.
      • Do not extend more than 3-5 cm above greater trochanter to prevent injury to superior gluteal nerve
      • Dissect off the Gluteus minimus tendon and the ligament of Bigelow
      • Adduct and externally rotate the thigh
  • Exposes Hip Joint Capsule
  • Incise the capsule radially around its circumference

Dangers

  • Nerve
  • Vessels
    • Femoral artery & vein
    • Profunda femoris artery
  • Fracture
    • Femoral shaft
    • Acetabular floor

References

  • HARDINGE K: The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64:17–19.

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.