A “Modern” posterior approach: “The Back Is Back”

© 2016 Elsevier Inc. In recent years the direct anterior approach (DAA) to total hip arthroplasty has gained in popularity. This increased interest in the DAA took place at a time when surgeons using a traditional posterior approach were struggling with dislocation risks and slowed recovery due to now outdated, and largely abandoned, techniques combined with older style implants. However, at the same time that the DAA gained in popularity, the standard posterior approach was also being modified. It has been adapted to work with newer instrumentation and modern cementless implants which also offer an expanded array of sizing and dimensioning versatility. We present a contemporary, iliotibial band sparing, minimally invasive posterior approach that we believe achieves the same degree of soft tissue preservation, with similar early recovery benefits as compared to the DAA. This highly modified posterior approach offers a lower risk profile and the potential for stepwise adoption and a surgeon controlled learning curve

The mini anterior approach: Optimizes total hip arthroplasty outcomes-Opposes

© 2015 Elsevier Inc.. Much has been written and talked about in both the lay press as well as orthopaedic journals regarding the potential for enhanced recovery in anterior total hip arthroplasty. It is our feeling that the evidence regarding this claim is weak at best, and that the approach has a high complication rate in many surgeon\u27s hands. We propose the elements of leading to enhance recovery as it applies to all approaches to total hip arthroplasty and propose alternative means to achieve them

A transgluteal approach—Back to the future

© 2016 Elsevier Inc. Minimally invasive approaches to total hip arthroplasty have received much attention from both the lay press as well as the orthopaedic community. The potential for enhanced recovery and improved pain control in the perioperative period are in high demand from patients. We present a transgluteal approach to total hip arthroplasty as an alternative to the direct anterior approach that has the potential to maintain all of the possible benefits of a soft tissue sparing approach with a lower risk profile

The PATH direct posterior approach

© Springer Science+Business Media, LLC 2010 and Springer International Publishing Switzerland 2016. 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

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of “micro-posterior” approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a “micro” (external rotator sparing) posterior approach, to a “mini” (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author’s experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions