Skip to main content

The PATH Direct Posterior Approach

  • Living reference work entry
  • First Online:
Minimally Invasive Surgery in Orthopedics
  • 296 Accesses

Abstract

Over the last decade, MIS, or soft tissue sparing, THA has emerged as a viable alternative to “conventional” THA. Much has been published both in the scientific literature as well as lay literature with regard to the advantages of various minimally invasive techniques. Most of the attention has been focused on the anterior approach. However, as more data has become available regarding complication rates, it has become clear there is a price to the adoption of these techniques. We propose an alternative minimally invasive approach, referred to as the “direct posterior approach,” that offers a similar level of preserved anatomic structures with the added benefit of a readily extensile approach that is familiar to most surgeons. As such, it is a viable approach for both primary and revision total hip arthroplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Similar content being viewed by others

References

  1. Spaans AJ, van den Hout JA, Bolder SB. High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop. 2012;83:342–6.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hallert O, Li Y, Brismar H, Lindgren U. The direct anterior approach: initial experience of a minimally invasive technique for total hip arthroplasty. J Orthop Surg Res. 2012;7:17.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Woolson ST, Pouliot MA, Huddleston JI. Primary total hip arthroplasty using an anterior approach and a fracture table: short-term results from a community hospital. J Arthroplasty. 2009;24:999–1005.

    Article  PubMed  Google Scholar 

  4. Jewett BA, Collis DK. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res. 2011;469:503–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bal BS, Lowe JA, E Gietler A, Aleto TJ. Heterotopic ossification after 2-incision total hip arthroplasty. J Arthroplasty. 2010;25:538–40.

    Article  PubMed  Google Scholar 

  6. Bal SB. Bal versus sculco over anterior THA: orthopedics this week; 2013.

    Google Scholar 

  7. Martin CT, Pugely AJ, Gao Y, Clark CR. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty. 2013;28:849–54.

    Article  PubMed  Google Scholar 

  8. Leunig M, Faas M, von Knoch F, Naal FD. Skin crease “bikini” incision for anterior approach total hip arthroplasty: surgical technique and preliminary results. Clin Orthop Relat Res. 2013;471(7):2245–52.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bhargava T, Goytia RN, Jones LC, Hungerford MW. Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty. Orthopedics. 2010;33:472.

    PubMed  Google Scholar 

  10. Goulding K, Beaulé PE, Kim PR, Fazekas A. Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res. 2010;468:2397–404.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Myers SR, Leahy M. Anterior approach total hip arthroplasty: the Heuter interval. Semin Arthroplasty. 2008;19:201–4.

    Article  Google Scholar 

  12. Yi C, Agudelo JF, Dayton MR, Morgan SJ. Early complications of anterior supine intermuscular total hip arthroplasty. Orthopedics. 2013;36:e276–81.

    Article  PubMed  Google Scholar 

  13. Rodriguez JA, Walters BL, Cooper HJ. SE 32 – applied anatomy. AAOS 2013 [Poster]. 472.

    Google Scholar 

  14. Ito Y, Matsushita I, Watanabe H, Kimura T. Anatomic mapping of short external rotators shows the limit of their preservation during total hip arthroplasty. Clin Orthop Relat Res. 2012;470(6):1690–5.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ. Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach. Clin Orthop Relat Res. 2006;453(000):293–8.

    Article  PubMed  Google Scholar 

  16. Grob K, Monahan R, Gilbey H, Yap F, Filgueira L, Kuster M. Distal extension of the direct anterior approach to the hip poses risk to neurovascular structures. J Bone Joint Surg Am. 2015;97:126–32.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brad L. Penenberg .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this entry

Cite this entry

Penenberg, B.L., Campbell, J., Zapf, M., Woehnl, A. (2015). The PATH Direct Posterior Approach. In: Scuderi, G., Tria, A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, Cham. https://doi.org/10.1007/978-3-319-15206-6_48-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-15206-6_48-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-15206-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics