Posterior Approach to Hip Joint (Moore Approach)

  • The posterior approach to hip joint is the most common and practical of those used to expose the hip joint. Popularized by Moore it is often called the southern approach.

  • The posterior approach to hip joint is used for:
    1. Total hip replacement, including revision surgery.
    2. Hip hemiarthroplasty.
    3. Open reduction and internal fixation of posterior acetabular fractures.
    4. Open reduction of posterior hip dislocations
    5. Removal of loose bodies.
    6. Dependent drainage of septic hip.
    7. Pedicle bone grafting.

  • Place the patient in the true lateral position, with the affected limb uppermost.

  • Landmarks:
    • Greater trochanter.
  • Incision:
    • Make 10 to 15 cm curved incision one inch posterior to posterior edge of greater trochanter (GT):
      • Begin 7 cm above and posterior to greater trochanter.
      • Curve the Incision  posterior to the greater trochanter and continue down the shaft of femur.
    • Mini-incision approach shows no long-term benefits to hip function.

  • There is No internervous plane for The posterior approach to hip joint.
  • Intermuscular plane:
    • Gluteus maximus:
      • Innervated by inferior gluteal nerve.

  • Incise fascia lata to uncover vastus lateralis distally.
  • Lengthen fascial incision in line with skin incision.
  • Split fibers of gluteus maximus in proximal incision:
    • Cauterize vessels during split to avoid excessive blood loss.

  • Internally rotate the hip to place the short external rotators on stretch.
  • Place stay suture in piriformis and obturator internus tendon (short external rotators).
    • Evidence shows decreased dislocation rate when short external rotators repaired during closure.
  • Detach piriformis and obturator internus close to femoral insertion.
    • Reflect backwards to protect sciatic nerve.
  • Incise capsule with longitudinal or T-shaped incision.
  • Dislocate hip with internal rotation after capsulotomy.

  • Proximal extension:
    • May extend proximal incision towards iliac crest for exposure of ilium.
  • Distal extension:
    • Extend incision distally down line of femur down to level of knee.
    • Vastus lateralis may either be split or elevated from lateral intermuscular septum.

  • The structures at risk during posterior approach to hip joint includes:
    1. Sciatic nerve:
      • Extend hip and flex knee to prevent injury.
    2. Inferior gluteal artery.
    3. First perforating branch of profunda femoris.
    4. Femoral vessels.
    5. Superior gluteal artery and nerve.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
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