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Locating the Best Approach for Total Hip Replacement Surgery

There are many ways to insert a total hip replacement. Sometimes doctors go in from the front, called an anterior approach. Other times it's best to enter directly from the side (lateral approach). The posterior approach from behind is the simplest and can often be done with the least trauma to the muscles. But the posterior approach can result in too many hip dislocations later.

In this report doctors from the Brigham and Women's Hospital in Boston describe a new, simple method for the posterior approach. They insert the new hip implant and then repair the capsule around the joint. First a flap is made in the capsule. It's moved over and attached to a nearby tendon from the gluteus maximus muscle. Usually the capsule is reattached to the bone itself. Holes have to be drilled into the bone to do this.

This newer, simpler method avoids drilling holes. The risk of bone fracture is much lower when no drilling is done. The repair site is elastic and has some "give" to it during the healing process. The doctor can check the tension during the operation and get it just right.

The authors describe each step of this operation for other doctors interested in trying the new method. They report that dislocations occurred in only 0.4 percent of their 255 patients. The rate of dislocation reported by this same group of doctors before the new technique was four percent.

References: Michael C. Dixon, MBBS, FRACS, et al. A Simple Capsulorrhaphy in a Posterior Approach for Total Hip Arthroplasty. In The Journal of Arthroplasty. April 2004. Vol. 19. No. 3. Pp. 373-376.

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