Principles and History of Total Hip Arthroplasty

Abstract

In 1982 Hardinge published a new surgical approach to total hip arthroplasty [1]. The benefit of this new approach was that it offered improved conditions for implant orientation as well as the correction of leg-length discrepancy. It also avoided the pitfalls of trochanteric osteotomy with its inherent risk of nonunion and wire breakage. Technically, the approach was challenged as providing only limited surgical visualization while damaging the nerve supply to the hip abductors as well as placing other neurovascular structures at risk. These criticisms were countered by well-performed studies in the orthopedic literature which established the utility of the approach [2–5]. Despite initial strong criticisms, the Hardinge surgical approach to total hip arthroplasty - and various modifications thereof - has certainly withstood the test of time and is now used routinely for both primary and revision hip arthroplasty.

“I think the exposure of the acetabulum never gets anything like mine and there have been catastrophic results on the femur … I absolutely am opposed to its use by beginners but even with experts it is nothing like as good as the lateral exposure.” (Professor Sir John Charnley, personal correspondence in reference to the Hardinge approach to Richard H. Rothman)