Posterolateral Mini-incision Total Hip Arthroplasty

Abstract

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