Modified Hardinge Approach for Lesser Complications

Author(s): Sivaprasad Kalyanasundaram1 , Krishanth Krishnathas2

BACKGROUND Fracture Neck of Femur is on the rise in the recent years owing to the increase in the geriatric population. It has a high incidence owing to severe osteoporosis and increased brittleness of the bone with age. It constitutes 20% of osteoporotic fractures. Total hip replacement was mostly used in the initial days but owing to higher chances of dislocations, it became less preferred. Now, bipolar hemiarthroplasty has become one of the main methods of treatment in such patients. Many surgical approaches have been used for a very long time in the field of Orthopaedics and various modifications were tried to obtain optimal results. Posterior approach is the go-to approach used nowadays followed by Hardinge approach. In spite of the different approaches introduced, complications like dislocation, infection and abductor lurch are still common. This study was undertaken to show the functional outcomes of a Modified Hardinge approach which seems to have optimal results out of all the approaches. METHODS A total of 20 patients fulfilling the inclusion and exclusion criteria with fracture neck of femur were taken into consideration and treated with Bipolar Hemiarthroplasty by modified Hardinge approach between April 2018 and October 2019. Each patient was put through the same preoperative and postoperative protocols. They were screened for comorbidities and were taken up for surgery only when the coexisting conditions were under control. The patients were evaluated up to 6 months postoperatively. RESULTS The age of the patients in the study ranged between 58 and 60 yrs. All the patients underwent bipolar hemiarthroplasty through modified Hardinge approach. The mean hip score was 80. Complications like posterior hip dislocation and infection were nil. Abductor lurch was not noted in any of the patients. CONCLUSIONS There were no significant complications in any of the 20 patients who underwent bipolar hemiarthroplasty through modified Hardinge approach. Complications like posterior dislocation and abductor lurch were nil in the study. The only downside of the procedure is a longer learning curve which makes it a less used approach in the field of Orthopaedics when compared to other approaches.