Enhanced Posterior Approach Articles

Enhanced Posterior Approach Articles:

 The reduction in dislocation rates with the Enhanced Posterior Approach has been well studied for many years. At this point it would be a “non issue” were it not for the distorted perceptions created by marketing and advertising.

Enhanced Posterior Approach.

Author: Dorr. American Academy of Orthopedic Surgeons (AAOS) Annual Meeting 2012

Approach is not important for outcome of THR operation. Technique of the surgeon is more important for soft tissue result. Component positions and biomechanical reconstruction determine the longevity of the operation and quality of the outcome. Soft tissue injury is surgeon-dependent, not approach-dependent. Component positioning is dependent on three-dimensional conceptualization of the surgeon.

*Manual component precision is the same with all techniques: *Dislocation (published results) is currently the same with all techniques: *Gait analysis shows recovery is the same with all techniques

Posterior approach is superior because:

  • Pain for the patient is better with posterior approach:
  • Blood loss is less
  • Fractures are less
  • Marketing budget is less.

Clinical Orthopaedics & Related Research:

December 2001 - Volume 393 - Issue - pp 163-167

SECTION I SYMPOSIUM: Papers Presented at the Twenty-Ninth Open Meeting of the Hip Society and the American Association of Hip and Knee Surgeons

Effect of Posterior Capsular Repair on Early Dislocation in Primary Total Hip Replacement.

White, Richard E. Jr. MD; Forness, Timothy J. MD; Allman, James K. PAC; Junick, Daniel W. MD


Formal repair of the posterior capsule and short external rotator tendons has been described as a surgical approach to reduce the incidence of posterior dislocation after posterolateral surgical approach to primary total hip replacement. The purpose of the current study was to compare the incidence of early posterior dislocation (within the first 6 months after surgery) using a complete posterior capsulectomy versus a formal posterior capsular repair. In patients with a complete posterior capsulectomy, 52 of 1078 primary total hip replacements (4.8%) had an early posterior dislocation. In patients with posterior capsular repair, three of 437 primary total hip replacements (0.7%) had an early posterior dislocation. This difference was statistically significant. The only complication in the capsular repair group was an avulsion fracture of the greater trochanter in four of 437 total hip replacements (0.9%).

© 2001 Lippincott Williams & Wilkins, Inc.

Clinical Orthopaedics & Related Research:

June 2006 - Volume 447 - Issue - pp 34-38

doi: 10.1097/01.blo.0000218746.84494.df

SECTION I: SYMPOSIUM: Total Hip Arthroplasty Dislocation: Prevention and Management

Does Surgical Approach Affect Total Hip Arthroplasty Dislocation Rates?

Kwon, Michael S MD*; Kuskowski, Michael PhD†; Mulhall, Kevin J MD*; Macaulay, William MD‡; Brown, Thomas E MD*; Saleh, Khaled J MD, MSc(Epid), FRCSC, FACS*

Section Editor(s): Macaulay, William MD, Guest Editor; Saleh, Khaled MD, MSc(Epid), FRCSC, FACS, Guest Editor; Parvizi, Javad MD, Guest Editor


Dislocation is a common complication of total hip arthroplasty, but exact effect of surgical approach on dislocation rates remains unclear. Because little randomized prospective data exist in this context, we performed a meta-analysis comparing dislocation rates using the posterior approach with and without soft tissue repair. A systematic literature review resulted in five studies which directly compared the posterior approach with and without soft tissue repair. The dislocation rates with and without repair were 0.49% and 4.46%, respectively. The relative risk for dislocation was determined using a fixed effects model with chi square test for interstudy heterogeneity. The posterior approach without soft tissue repair was found to have an 8.21 times greater relative risk of dislocation than with soft tissue repair (95% confidence interval, 4.05-16.67). A separate systematic review of 11 studies revealed comparable dislocation rates associated with the anterolateral, direct lateral, and posterior approaches with soft tissue repair (0.70%, 0.43%, and 1.01%, respectively). These data demonstrate that adequate soft tissue repair greatly reduces the relative risk of dislocation using the posterior approach, and that the dislocation rates for the three most prevalent approaches are similar. Further prospective randomized trials examining dislocation rates and other clinicalparameters are needed.

Level of evidence: Therapeutic study, level III (systematic review of level III studies). See the Guidelines for Authors for a complete description of levels of evidence.

The Journal of Arthroplasty

Volume 15, Issue 2, February 2000, Pages 194–199

The effect of posterior capsulorrhaphy in primary total hip arthroplasty: A prospective randomized study

MD Fang-Yao Chiu*, MD Chuan-Mu Chen*, MD Tien-Yow Chung, MD Wai-Hee Lo*Tain-Hsiung-Chen, MD*

DOI: 10.1016/S0883-5403(00)90220-1


Between 1994 and 1997, 180 cases of primary total arthroplasty (THA) were performed with the posterior (Moore) approach for a variety of indications and studies prospectively. The cases were separated randomly into 2 groups to evaluate the effect of posterior capsulorrhaphy in the prevention of postoperative dislocation. In group 1 (96 cases), closure of the arthroplasty was performed with a posterior capsulorrhaphy; in group 2 (84 cases), closure was performed without capsulorrhaphy. The follow-up period was 38 months (range, 12–60 months). No dislocations occurred in group 1, whereas 2 dislocations (2.3%) occurred in group 2. Although the factors affecting dislocation in primary THA are many, a posterior capsulorrhaphy may be helpful in the prevention of posterior dislocation of primary THA performed with a posterior approach

No benefits or funds were received in support of this study.

Reprint requests: Fang-Yao Chiu, MD, Department of Orthopedics and Traumatology, Veterans General Hospital—Taipei, No. 201, Sec. 2, Shi-Pai Road, Taipei, Taiwa, ROC. Copyright © 2000 Published by Elsevier Inc.

Clinical Orthopaedics & Related Research:

January 2004 - Volume 418 - Issue - pp 162-167


A Posterior Approach to Primary Total Hip Arthroplasty With Soft Tissue Repair.

Suh, Kuen Tak MD; Park, Byung Guk MD; Choi, Young Jun MD


To determine whether repair of the posterior soft tissue structures affects dislocation rate, a comparison of the posterolateral approach with and without a posterior soft tissue repair in primary total hip arthroplasty was done. Between January 1993 and December 1998, 250 consecutive primary total hip arthroplasties (220 patients) without a posterior soft tissue repair followed by 96 consecutive primary total hip arthroplasties (83 patients) with a posterior soft tissue repair in the posterolateral approach were done. With the exception of a posterior soft tissue repair, all surgical procedures were done in the same manner. A dislocation rate of 6.4% in 250 hips without a posterior soft tissue repair in the posterolateral approach was reduced to 1% in 96 hips with a posterior soft tissue repair. The results were statistically significant. The current results indicate that the posterior structures should be preserved as much as possible and repaired to reduce dislocation in the posterolateral approach.

Clinical Orthopaedics & Related Research:

October 1998 - Volume 355 - Issue - pp 224-228

Symposium: The Papers Presented at The Hip Society Meeting 1998

Posterior Approach to Total Hip Replacement Using Enhanced Posterior Soft Tissue Repair.

Pellicci, Paul M. MD*; Bostrom, Mathias MD*; Poss, Robert MD**

Section Editor(s): Brand, Richard A. MD


The two senior authors (PMP, RP) independently began using an identical enhanced posterior soft tissue repair after total hip replacement through a posterior approach. In the first author's experience, a dislocation rate of 4% in 395 patients before using the enhanced closure was reduced to 0% in 395 patients in whom the enhanced closure was performed. In the second author's experience, 160 total hip replacements had a dislocation rate of 6.2% before the enhanced closure whereas 124 total hip replacements had a dislocation rate of 0.8% after the enhanced closure. These results are highly statistically significant.


The Journal of Arthroplasty

Volume 16, Issue 2, Pages 207–211, February 2001

Enhanced soft tissue repair using locking loop stitch after posterior approach for hip hemiarthroplasty***

C.K. Ko, FRCSEd, FHKAM (Ortho Surg)  S.W. Law, FRCSEd   K.H. Chiu, FRCSEd, FHKAM (Ortho Surg)

Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China

Received: September 29, 1999; Accepted: September 19, 2000;

DOI: http://dx.doi.org/10.1054/arth.2001.20539


Hemiarthroplasty of the hip for displaced fracture of the femoral neck (including Austin-Moore and Thompson arthroplasties) frequently is performed by orthopaedic surgeons. The posterior approach is used despite the slight increase in risk of postoperative dislocation. The outcome after dislocation can be disastrous. We tried to prevent this complication by repairing the posterior capsule and the short external rotators (piriformis, superior and inferior gemellus, obturator internus, and upper part of quadratus femoris) using locking loop stitch as described by Krackow. From January 1998 to April 1999, 205 hips were operated on and followed up for >3 months; no dislocation was found. Using the pastrecords as the comparative group, 28 posterior dislocations (1.9%) were found in 1,483 hip hemiarthroplasties using the posterior approach (P <.05 using exact probability test). Enhanced soft tissue repair with locking loop stitch is an effective way to reduce the incidence of dislocation after hip hemiarthroplasty using the posterior approach.

Hip hemiarthroplasty for displaced fracture of the neck of the femur in the elderly is 1 of the commonest operations done by orthopaedic surgeons. Although there are controversies in some specific situations, the main indications have been established [1, 2, 3]. The Austin-Moore and Thompson prostheses were introduced in the 1950s and still are used commonly today [4, 5].

Different approaches to the hip joint had been developed in the past, but there is no consensus on the best approach. The favored approach should be the one with which the surgeon is most comfortable [3]. The posterior approach is 1 of the commonest approaches used because of its excellent exposure [4]. Muscle and capsule dissection and the difficulty in reattaching these securely are a source of comparative instability in the posterior direction. We present our results in reducing the incidence of postoperative dislocation by enhanced soft tissue repair using the locking loop stitch described by Krackow et al [6, 7].