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Chapter 3
Posterior Approach
Morteza Meftah
Amar S. Ranawat
Chitranjan S. Ranawat
History of the Posterior Approach
The posterior approach is the most commonly used approach to the hip, and is widely used in total hip
arthroplasty (THA) (1). In 1874, Bernhard von Langenbeck first described the posterolateral approach in his
treatment of war wounds and infections of the hip (2). Kocher (3), in 1907, modified Langenbeck's approach by
extending the incision in a caudal direction. Since then, 13 other variations of this approach have been described
(4,5,6,7). Another famous variation to the posterior approach was also described by Alexander Gibson in 1950
(5). Gibson improved exposure of the hip by adding the release of two main abductors of the hip, the gluteus
medius and minimus muscles.
The most famous modified version, and most commonly used today, is the approach described by Austin Talley
Moore during his work with femoral prosthesis (6). The incision in this classic, utilitarian, extensile, posterior
approach extends from the posterior-superior iliac spine (PSIS) to the posterior border of the greater trochanter,
and then extends 10 to 13 cm distally along the axis of the femur (8). This approach offers very wide exposure to
the posterior capsule, posterior acetabular wall, ischium, and greater trochanter, and can be extended to include