Lateral approach to hip (Hardinge, transgluteal)

longitudinal incision centered over tip of greater trochanter

split fascia lata to expose tendon of gluteus medius

longitudinal incision in fibers of gluteus medius

do not extend more than 5 cm above greater trochanter to prevent injury to superior gluteal nerve

extend incison inferior through the fibers of vastus lateralis

detach origin of gluteus minimus from anterior greater trochanter

expose anterior joint capsule and perform capsulotomy

Superior gluteal nerve

runs between gluteus medius and minimus 5 cm above greater trochanter

protect by limiting proximal incision of gluteus medius

Femoral nerve

Superior gluteal nerve

The superior gluteal nerve enters the deep surface of the gluteus medius approximately 5 cm proximal to the tip of the greater trochanter. Splitting the muscle, as in the Hardinge approach, has been reported to cause injury to this nerve if the split is carried above 5 cm. A simple tag suture can be placed at this level to prevent propogation of the split inadvertently during surgery.

No true internervous plane as the dissection splits a muscle innervated by the superior gluteal nerve

The direct lateral approach (Hardinge) splits the fibers of the gluteus medius which is innervated by the superior gluteal nerve. The anterior approach employs the interval between the sartorius/rectus femoris (femoral nerve) and TFL/gluteus medius (superior gluteal nerve). The posterior approach utilizes the interval between the gluteus maximus (inferior gluteal nerve) and the gluteus medius (superior gluteal nerve).