Anterolateral (modified Hardinge approach)
The modified Hardinge anterior approach to total hip replacement allows the surgeon access the hip joint by passing through the side of the hip in front of the femur.
Reported benefits of the modified hardinge approach to total hip replacement include
- Less pain
- No hip restrictions
- Fewer implant dislocations
- Hospital stays are shorter
An important feature of the modified Hardinge 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 traditional posterior approach hip replacement.
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.
As part of preoperative planning your surgeon will order a series of radiographs or other imaging studies to help with precise placement of the implants. The modified Hardinge approach to total hip replacement can be performed with the patient in the lateral position. A surgical incision is made to the lateral side of the thigh to gain access to the hip joint. 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 thigh bone) 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 thigh bone 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.
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 2 days. Most patients can be discharged home if you can safely get in and out of bed, walk with the assistance of crutches, and use the stairs safely.
The outcome of the modified Hardinge approach total hip replacement is outstanding in terms of improved function and pain relief. Research studies have shown a very low dislocation rate following the procedure.
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 6 to 12 weeks.
The prognosis following modified Hardinge 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.
Following hip replacement surgery, patients 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 of total hip replacements include but are not limited to infection, blood loss, nerve damage, continued pain, dislocation, fracture, need for additional procedures and early failure of implant.