Total hip arthroplasty (THA) and hemiarthroplasty can be performed successfully through a variety of approaches. The choice of approach depends largely on the training and preference of the surgeon, whose comfort with the exposure and familiarity with any approach are the most important factors in achieving a successful clinical result and avoiding complications. The posterior approach to the hip remains a very commonly performed technique despite having been shunned by some surgeons, who cited a higher risk of posterior dislocation. The balance of the literature has determined that this risk of dislocation is obviated, however, when the posterior soft tissues are formally repaired in a way that reconstructs the native soft-tissue anatomy.¹ In this chapter, we review our preferred approach and outline a small-incision² version of the enhanced posterior soft-tissue repair technique.³ This is an evolution from the standard posterior, posterolateral Moore, or Southern approach. The small-incision enhanced posterior soft-tissue repair (SIEPSTR) technique has also been modified for use in metal-on-metal hip resurfacing.⁴ Although we do not favor the term “minimally invasive,” we do strive to make our well-placed incision small so that excessive prolonged retraction pressure on the soft tissues is unnecessary.

VIDEO 55.1 Noncemented Total Hip Arthroplasty via a Posterior Approach Using Enhanced Posterior Soft-Tissue Repair. William Macaulay, MD (16 min)

We routinely obtain low AP pelvis, AP hip, and cross-table lateral hip radiographs with a 25 mm marker. We use the measurement from the lesser trochanter to the center of the femoral head as our guide to reestablishing the appropriate leg lengths. A similar measurement, from the center of the femoral head to the tip of the greater trochanter, can be used to plan offset.