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Primary Total Hip Arthroplasty: Posterolateral Approach and Extensile Methods
The posterolateral approach to the hip is commonly used in total hip arthroplasty (THA) because of its simplicity, the ease of dissection in internervous planes, the preservation of the abductor musculature, the potential to extend the approach, and the ability to accommodate trochanteric osteotomies. In addition to primary THA, the posterolateral approach can be used for revision THA, hemiarthroplasty, resurfacing procedures, resection arthroplasty, drainage of a septic hip, open reduction and internal fixation of fractures of the posterior column or posterior wall of the acetabulum, osteochondral grafting, and removal of loose bodies. In patients requiring arthroplasty, the posterolateral approach is particularly helpful in those with developmental dysplasia of the hip who may require a femoral shortening osteotomy. The posterolateral approach is also used for patients in whom primary THA is difficult and who may require a trochanteric osteotomy, such as patients with ankylosis, protrusion acetabuli, or extensive heterotopic ossification. This chapter reviews the surgical steps for the posterolateral approach, as well as the contraindications, results, and potential complications associated with its use in primary THA.