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. 2008 Feb;466(2):294-9.
doi: 10.1007/s11999-007-0056-8. Epub 2008 Jan 10.

Modified posterior approach to total hip arthroplasty to enhance joint stability

Yong Sik Kim  1 , Soon Yong Kwon, Doo Hoon Sun, Suk Ku Han, William J Maloney
Affiliations

Modified posterior approach to total hip arthroplasty to enhance joint stability

Yong Sik Kim et al. Clin Orthop Relat Res. 2008 Feb.

Abstract

We modified the posterior approach by preserving the external rotator muscles to enhance joint stability after primary THA. We asked whether this modified posterior approach would have a lower dislocation rate than the conventional posterior approach, with and without a repair of external rotator muscles. We retrospectively divided 557 patients (670 hips) who had undergone primary THA into three groups based on how the external rotator muscles had been treated during surgery: (1) not repaired after sectioning, (2) repaired after sectioning, or (3) not sectioned and preserved. The minimum followup was 1 year. In the group with preserved external rotator muscles, we observed no dislocations; in comparison, the dislocation rates for the repaired rotator group and the no-repair group were 3.9% and 5.3%, respectively. This modified posterior approach, which preserves the short external rotator muscles, seemed effective in preventing early dislocation after primary THA.

Level of evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1
Fig. 1
The obturator internus (OI), superior gemelli (SG), and piriformis (P) were retracted proximally with a Hohmann retractor (arrow), and the quadratus femoris muscle was retracted inferiorly to expose the posterior capsule (PC). Rt. GT = right greater trochanter; GM = gluteus medius.
Fig. 2
Fig. 2
The acetabulum (A) is well-exposed after the complete capsulectomy. The tip of a Hohmann retractor is placed on the anterior wall of the acetabulum (white arrow); the proximal femur is retracted anteriorly (black arrow). The obturator internus (OI), superior gemelli (SG), and piriformis (P) are well-preserved.
Fig. 3
Fig. 3
The acetabular component (AC) is successfully implanted without damaging the obturator internus (OI), superior gemelli (SG), and piriformis (P).
See this image and copyright information in PMC

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