VIDEO TECHNIQUES: Hardinge Approach for THA

    Dr. Antonia Chen offers surgical pearls for an approach taught by The Rothman Institute’s founder, Dr. Richard Rothman.

    Proponents of the Hardinge approach for total hip arthroplasty (THA) – including The Rothman Institute’s founder, Richard H. Rothman, MD – use this technique because they say it provides excellent exposure and direct visualization of the orientation of the acetabular cup.

    In a presentation at ICJR’s Instructional Course at the 9th Congress of the Chinese Association of Orthopaedic Surgeons, Antonia F. Chen, MD, MBA, from The Rothman Institute in Philadelphia, Pennsylvania, reviewed the Hardinge approach as taught by Dr. Rothman. She offered these tips for using the approach:

    • Placing the patient in the supine position makes it easy to see the orientation of the acetabular component during the procedure.
    • The anterior gluteus is detached as a single sleeve while retaining a good cuff to facilitate closure and solid reattachment of the adductor muscles.
    • After the initial exposure, the leg is crossed to the opposite side, which exposes the femoral neck. This makes it easy to perform the femoral neck osteotomy without risk to the surrounding soft tissues.
    • After the neck cut is performed and the femoral head is removed, the acetabulum is easily exposed by putting the leg in a “figure-4” position.
    • The acetabulum is reamed medially first. Then the “reaming hand” is dropped into the correct orientation of the acetabular cup to finish reaming.
    • The capsule is closed as a single sleeve, making sure the adductors are brought down and firmly reattached.

    Click the image above to watch Dr. Chen’s presentation at the 9th Congress of the Chinese Association of Orthopaedic Surgeons.