Hardinge (Hip Direct Lateral Transgluteal) approach explainer скачать в хорошем качестве

Hardinge (Hip Direct Lateral Transgluteal) approach explainer

Hardinge approach (Direct Lateral approach) to the hip Indications Primary and revision total hip arthroplasty Hemiarthroplasty Femoral head/neck procedures, intertrochanteric fractures Position Lateral decubitus (most common) or supine Affected limb on top, pelvis well stabilized Skin incision Centered over the greater trochanter Starts ~5–8 cm proximal to the tip of GT Extends ~5–8 cm distal along the femoral shaft Superficial dissection Incise skin and subcutaneous tissue Split fascia lata in line with skin incision Identify interval between gluteus medius and vastus lateralis Muscle approach Gluteus medius: split anterior 1/3 and posterior 2/3 Anterior fibers incised longitudinally from GT Gluteus minimus exposed and incised in line with fibers Preserve posterior 2/3 of gluteus medius to prevent limp ⚠️ Superior gluteal nerve lies ~5 cm proximal to GT → do not extend split beyond this Capsular exposure Retract gluteus medius and minimus anteriorly Expose anterior hip capsule Perform T-shaped or longitudinal capsulotomy Hip dislocation Usually anterior dislocation (flexion + external rotation) Proceed with planned procedure (THA / hemiarthroplasty) Closure Repair capsule (if possible) Meticulous reattachment of gluteus medius and minimus to GT Close fascia lata, subcutaneous tissue, and skin Advantages Excellent exposure of acetabulum and femur Low dislocation rate Suitable for obese patients Disadvantages / Complications Abductor weakness Trendelenburg limp Risk to superior gluteal nerve if incision extended proximally