Modified Anterolateral Hardinge Approach

Overview

The modified Hardinge anterolateral approach to total hip replacement allows the surgeon to access the hip joint by passing through the front of the hip and in between the hip muscles, rather than cutting through them.

Benefits

Reported benefits of the modified Hardinge anterior approach to total hip replacement include:

• Less pain
• More cosmetic incisions
• No muscle detachment
• No muscles split
• Faster rehabilitation
• No hip restrictions
• Fewer implant dislocations
• Shorter hospital stays

Features

An important feature of the modified Hardinge anterior approach to total hip replacement is preservation of the posterior soft tissue structures. There are less restrictions in the first few months after the surgery, unlike the traditional posterior approach to hip replacement.

Preparation

A surgical risk assessment will be done to determine if you are a candidate for the procedure. Your surgeon may recommend some pre-operative physical therapy to help strengthen your hip muscles. Improving upper body strength will also help you move around easier during the first few days after surgery. Your surgeon will give you specific instructions regarding what you can eat and any medications you can take prior to the surgery.

Procedure

As part of preoperative planning, your surgeon will order a series of radiographs or other imaging studies to help with precise placement of the hip. The modified Hardinge anterior approach to total hip replacement is performed with you in the supine position. A surgical incision, approximately 6 cm in size, is made to the anterolateral side of the thigh to gain access to the hip joint. The muscles below the skin are then moved aside without cutting them. The blood vessels and nerves are protected with retractors. An incision is made in the joint capsule and the hip joint is dislocated. The femoral head (upper end of the thighbone) is removed by cutting through the femoral neck. Specialized instruments are used to shape the hip socket to precisely fit the implant. The upper end of the thighbone is then drilled to allow for placement of the implant stem. The ball component of the implant is attached to the stem. The hip is relocated and tested for range-of-motion and stability. The incision is then closed with stitches.

Post-op

You will be encouraged to stand up with full weightbearing on your hip on the same day as the surgery. Physical therapy rehabilitation will be started within 24 hours. The postsurgical hospital stay varies between 1 to 4 days. You may be discharged home if you can safely get in and out of bed, walk with the assistance of crutches, and use the stairs safely.

Outcome

The outcome of the modified Hardinge anterior approach total hip replacement is good in terms of improved function and pain relief. Research studies have shown a very low dislocation rate following the procedure.

Downtime

Most people can return to work after a few weeks. If you have a labor-intensive job, you should be able to return to work within 1-1/2 to 2 months.

Prognosis

The prognosis following modified Hardinge anterior approach total hip replacement surgery is very good. Getting your hip joint moving and staying active is the key to long-term success of the procedure.

Lifestyle recommendations

Following hip replacement surgery, you are recommended to avoid high impact activities such as running and contact sports. Low-impact activities such as walking, biking and swimming are advised.

Risks and complications

Possible risks and complications include infection, blood loss, nerve damage, continued pain, dislocation and early failure of the implant.