Evidence‑Based Peri‑Operative Care for Lateral (Hardinge) Total Hip Arthroplasty

Pre‑operative Optimization

Implement structured pre‑operative exercise and education programs to promote early postoperative rehabilitation. 1
Administer oral paracetamol together with NSAIDs (or COX‑2 inhibitors) before surgery as part of the basic analgesic regimen. 1

Offer either spinal or general anesthesia; both techniques are considered equally appropriate for this procedure. 1

Give a single intravenous dose of dexamethasone 8–10 mg intra‑operatively for analgesic and anti‑emetic benefit. 1
Consider a fascia iliaca block or local infiltration analgesia in patients who cannot receive standard analgesics or are expected to have high postoperative pain. 1
When spinal anesthesia is selected, intrathecal morphine 0.1 mg may be added, provided the risk‑benefit profile is acceptable. 1

Perform the femoral neck osteotomy at the level predetermined by pre‑operative templating. 3
Elevate the proximal femur with a bone hook or femoral elevator to bring it into the surgical field. 3
Open the femoral canal using a box chisel or awl placed at the piriformis fossa. 3
Sequentially broach the femoral canal to the size indicated by pre‑operative templating. 3
Conduct a trial reduction to evaluate leg‑length equality, offset restoration, and joint stability. 3
After definitive component implantation, reduce the hip and assess stability through a full range of motion. 3

Close the fascia lata and subcutaneous tissues in layered fashion using heavy, non‑absorbable sutures. 1

Continue oral paracetamol and NSAIDs (or COX‑2 inhibitors) as the primary postoperative analgesic strategy. 1
Reserve opioid analgesics for rescue use only, to limit opioid‑related adverse effects. 1
Avoid epidural analgesia, femoral nerve block, lumbar plexus block, and gabapentinoids because their potential harms outweigh benefits in this context. 1