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Posterior Approach to Hip

 Posterior Approach to Hip

Posterior Approach to Hip Joint indications:

The posterior approach to hip joint (also known as Southern Moore Approach) is the most common and practical of those used in total hip replacement surgery.

It was first popularized by Moore, and 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.

All posterior approaches allow easy, safe, and quick access to the joint and can be performed with only one assistant. Because they do not interfere with the abductor mechanism of the hip, they avoid the loss of abductor power in the immediate postoperative period.

Hip Posterior approach allow excellent visualization of the femoral shaft, thus are popular for revision joint replacement surgery in cases in which the femoral component needs to be replaced.

See Also: Pelvic Anatomy

Position of the Patient

Posterior Approach to Hip Joint (Moore Approach)

Landmarks and Incision



Make 10 to 15 cm curved incision one inch posterior to posterior edge of greater trochanter (GT):

Mini-incision approach shows no long-term benefits to hip function.

Internervous plane

See Also: Hip Muscles Anatomy

Superficial dissection

Deep dissection

Approach Extension

Proximal extension:

The posterior approach to hip joint may be extended proximally towards iliac crest for exposure of ilium.

Distal extension:

The posterior approach to hip joint may be extended 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: it can be damaged if it is compressed by the posterior blade of a self-retaining retractor used to split the gluteus maximus. Extend the hip and flex the knee to prevent injury to sciatic nerve.
  2. Inferior gluteal artery.
  3. First perforating branch of profunda femoris.
  4. Femoral vessels.
  5. Superior gluteal artery and nerve.

Related Anatomy

Gluteus Maximus Muscle:

Greater Trochanter

The following five muscles insert into it:

  1. The gluteus medius attaches by a broad insertion into its lateral aspect. Below this insertion, the bone is covered by the beginnings of the iliotibial tract.
  2. The gluteus minimus is attached to the anterior aspect of the trochanter, where its tendon is divided in the anterolateral approach.
  3. The piriformis inserts via a tendon into the middle of the upper border of the greater trochanter. Its insertion forms a surgical landmark for the insertion of certain types of intramedullary rods into the femur.
  4. Obturator externus tendon: Immediately below the insertion of the piriformis lies the trochanteric fossa, a deep pit that marks the attachment of the obturator externus tendon.
  5. The obturator internus tendon inserts with the two gemelli into the upper border of the trochanter, posterior to the insertion of the piriformis


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