Clinical Orthopaedics and Related Research

, Volume 466, Issue 2, pp 294–299 | Cite as

Modified Posterior Approach to Total Hip Arthroplasty to Enhance Joint Stability

  • Yong Sik Kim
  • Soon Yong Kwon
  • Doo Hoon Sun
  • Suk Ku Han
  • William J. Maloney
International Hip Society Symposium


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.


  1. 1.
    Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stöckl B. Reducing the risk of dislocation after THA: the effect of orientation of the acetabular component. J Bone Joint Surg Br. 2005;87:762–769.PubMedCrossRefGoogle Scholar
  2. 2.
    Bischoff R, Dunlap J, Carpenter L, DeMouy E, Barrack R. Heterotopic ossification following uncemented THA: effect of the operative approach. J Arthroplasty. 1994;9:641–644.PubMedCrossRefGoogle Scholar
  3. 3.
    Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMedGoogle Scholar
  4. 4.
    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–S66.PubMedGoogle Scholar
  5. 5.
    Hovelius L, Hussenius A, Thorling J. Posterior versus lateral approach for hip arthroplasty. Acta Orthop Scand. 1977;48:47–51.PubMedGoogle Scholar
  6. 6.
    Komeno M, Hasegawa M, Sudo A, Uchida A. Computed tomographic evaluation of component position on dislocation after THA. Orthopedics. 2006;29:1104–1108.PubMedGoogle Scholar
  7. 7.
    Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does surgical approach affect THA dislocation rates?. Clin Orthop Relat Res. 2006;447:34–38.PubMedCrossRefGoogle Scholar
  8. 8.
    Masaoka T, Yamamoto K, Shishido T, Katori Y, Mizoue T, Shirasu H, Nunoda D. Study of hip joint dislocation after THA. Int Orthop. 2006;30:26–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Masonis JL, Bourne RB. Surgical approach, abductor function, and THA dislocation. Clin Orthop Relat Res. 2002;405:46–53.PubMedCrossRefGoogle Scholar
  10. 10.
    Mihalko WM, Whiteside LA. Hip mechanics after posterior structure repair in THA. Clin Orthop Relat Res. 2004;420:194–198.PubMedCrossRefGoogle Scholar
  11. 11.
    Morrey BF, Adams RA, Cabanela ME. Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for THA. Clin Orthop Relat Res. 1984;188:160–167.PubMedGoogle Scholar
  12. 12.
    Nishii T, Sugano N, Miki H, Koyama T, Takao M, Yoshikawa H. Influence of component positions on dislocation: computed tomographic evaluations in a consecutive series of THA. J Arthroplasty. 2004;19:162–166.PubMedCrossRefGoogle Scholar
  13. 13.
    Pätiälä H, Lehto K, Rokkanen P, Paavolainen P. Posterior versus lateral approach for hip arthroplasty. Acta Orthop Scand. 1977;48:47–51.CrossRefGoogle Scholar
  14. 14.
    Pellicci PM, Bostrom M, Poss R. Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res. 1998;355:224–228.PubMedCrossRefGoogle Scholar
  15. 15.
    Roberts JM, Fu FH, McClain EJ, Ferguson AB. A comparison of the posterolateral and anterolateral approaches to THA. Clin Orthop Relat Res. 1984;187:205–210.PubMedGoogle Scholar
  16. 16.
    Sierra RJ, Raposo JM, Trousdale RT, Cabanela ME. Dislocation of primary THA done through a posterolateral approach in the elderly. Clin Orthop Relat Res. 2005;441:262–267.PubMedCrossRefGoogle Scholar
  17. 17.
    Stähelin T, Drittenbass L, Hersche O, Miehlke W, Munzinger U. Failure of capsular enhanced short external rotator repair after total hip replacement. Clin Orthop Relat Res. 2004;420:199–204.PubMedCrossRefGoogle Scholar
  18. 18.
    Stähelin T, Vienne P, Hersche O. Failure of reinserted short external rotator muscles after THA. J Arthroplasty. 2002;17:604–607.PubMedCrossRefGoogle Scholar
  19. 19.
    Suh KT, Park BG, Choi YJ. A posterior approach to primary THA with soft tissue repair. Clin Orthop Relat Res. 2004;418:162–167.PubMedCrossRefGoogle Scholar
  20. 20.
    van Stralen GM, Struben PJ, van Loon CJ. The incidence of dislocation after primary THA using posterior approach with posterior soft-tissue repair. Arch Orthop Trauma Surg. 2003;123:219–222.PubMedGoogle Scholar
  21. 21.
    Vicar AJ, Coleman CR. A comparison of the anterolateral, transtrochanteric, and posterior surgical approaches in primary THA. Clin Orthop Relat Res. 1984;188:152–159.PubMedGoogle Scholar
  22. 22.
    Weeden SH, Paprosky WG, Bowling JW. The early dislocation rate in primary THA following the posterior approach with posterior soft-tissue repair. J Arthroplasty. 2003;18:709–713.PubMedCrossRefGoogle Scholar
  23. 23.
    White RE, Forness TJ, Allman JK, Junick DW. Effect of posterior capsular repair on early dislocation in primary total hip replacement. Clin Orthop Relat Res. 2001;393:163–167.PubMedCrossRefGoogle Scholar
  24. 24.
    Widmer KH. A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty. 2004;19:387–390.PubMedCrossRefGoogle Scholar
  25. 25.
    Yamaguchi T, Naito M, Asayama I, Kambe T, Fujisawa M, Ishiko T. The effect of posterolateral reconstruction on range of motion and muscle strength in THA. J Arthroplasty. 2003;18:347–351.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Yong Sik Kim
    • 1
  • Soon Yong Kwon
    • 2
  • Doo Hoon Sun
    • 3
  • Suk Ku Han
    • 4
  • William J. Maloney
    • 5
  1. 1.Department of Orthopaedic Surgery, Kang-Nam St. Mary’s HospitalThe Catholic University of KoreaSeoulKorea
  2. 2.Department of Orthopaedic Surgery, St. Mary’s HospitalThe Catholic University of KoreaSeoulKorea
  3. 3.Department of Orthopaedic SurgerySun HospitalDaejeonKorea
  4. 4.Department of Orthopaedic Surgery, St. Paul’s HospitalThe Catholic University of KoreaSeoulKorea
  5. 5.Department of Orthopaedic SurgeryStanford Hospital and ClinicsStanfordUSA

Personalised recommendations