Posterolateral Mini-incision Total Hip Arthroplasty

  • Gregg R. Klein
  • Mark A. Hartzband


The posterior approach to the hip was first popularized by Von Langenbeck in the 1870s and later modified by Moore,1 Gibson,2 and Marcy.3 All of these modifications included release of the posterior soft tissue sleeve posterior to the gluteus medius and minimus muscles. They varied with respect to the precise location of skin incision and the exact description of the soft tissue exposure. All resulted in a posterior dislocation of the femoral head in relationship to the acetabulum.

In the United States today, the posterior approach is one of the most commonly used exposures for total hip arthroplasty. The posterior approach is familiar to most arthroplasty surgeons and is quickly and easily performed. This approach minimizes damage to the abductor musculature and has a low rate of heterotopic ossification. In addition, the posterolateral approach may be readily extended during total hip arthroplasty into a more expansile exposure if necessary. However, dislocation after the posterior approach remains a concern.4–6 More recently, the posterolateral approach for total hip arthroplasty has been modified to include a posterior capsular repair to decrease the incidence of dislocation. With the incorporation of a capsular repair, the incidence of dislocation approaches that of the anterior approaches.7–10


Skin Incision Femoral Component Great Trochanter Gluteus Maximus Femoral Canal 
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  1. 1.
    Moore AT. The self-locking metal hip prosthesis. J Bone Joint Surg Am 1957; 39-A:811–27PubMedGoogle Scholar
  2. 2.
    Gibson A. Posterior exposure of the hip joint. J Bone Joint Surg Br 1950; 32-B:183–6PubMedGoogle Scholar
  3. 3.
    Marcy GH, Fletcher RS. Modification of the posterolateral approach to the hip for insertion of femoral-head prosthesis. J Bone Joint Surg Am 1954; 36-A:142–3PubMedGoogle Scholar
  4. 4.
    Jolles BM, Bogoch ER. Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. Cochrane Database Syst Rev 2006; 3:CD003828PubMedGoogle Scholar
  5. 5.
    Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res 2002; 405:46–53CrossRefPubMedGoogle Scholar
  6. 6.
    Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am 1982; 64:1295–306PubMedGoogle Scholar
  7. 7.
    Pellicci PM, Bostrom M, Poss R. Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res 1998; 355:224–8CrossRefPubMedGoogle Scholar
  8. 8.
    Suh KT, Park BG, Choi YJ. A posterior approach to primary total hip arthroplasty with soft tissue repair. Clin Orthop Relat Res 2004; 418:162–7CrossRefPubMedGoogle Scholar
  9. 9.
    Ko CK, Law SW, Chiu KH. Enhanced soft tissue repair using locking loop stitch after posterior approach for hip hemiarthroplasty. J Arthroplasty 2001; 16:207–11CrossRefPubMedGoogle Scholar
  10. 10.
    Hedley AK, Hendren DH, Mead LP. A posterior approach to the hip joint with complete posterior capsular and muscular repair. J Arthroplasty 1990; 5 Suppl:S57–66CrossRefGoogle Scholar
  11. 11.
    Hartzband MA. Posterolateral minimal incision for total hip replacement: technique and early results. Orthop Clin North Am 2004; 35:119–29CrossRefPubMedGoogle Scholar
  12. 12.
    Hurd JL, Potter HG, Dua V, Ranawat CS. Sciatic nerve palsy after primary total hip arthroplasty: a new perspective. J Arthroplasty 2006; 21:796–802CrossRefPubMedGoogle Scholar
  13. 13.
    Leong G, Wilson J, Charlett A. Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect 2006; 63:255–62CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Hartzband Center for HIP and Knee ReplacementParamusUSA

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