The Journal of Hip Surgery 2018; 02(01): 054-058
DOI: 10.1055/s-0038-1646938
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Access to the Ischium: A Simple Extension of the Posterior Approach in Revision Hip Arthroplasty

Friedrich Boettner
1   Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
,
Kilian Rueckl
1   Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
› Author Affiliations
Further Information

Publication History

19 June 2017

06 February 2018

Publication Date:
25 May 2018 (online)

Abstract

Reconstruction of acetabular defects in revision total hip arthroplasty (THA) requires excellent exposure. Most extensile approaches to the acetabulum were described in the trauma literature and are not beneficial for revision THA. This article describes a modification of the standard posterior surgical approach to improve visualization of the ischium as required for acetabular defect reconstruction, insertion of standard and custom triflange cages as well as posterior column plating. The current surgical technique utilizes an intermuscular plane between the gemellus inferior muscle and the obturator externus muscle. This intermuscular plane leads the surgeon directly to the ischium and facilitates easy extension toward the insertion of the hamstring muscles without compromising the insertion of the external rotator muscles along the ischium. This article describes a novel surgical approach to the posterior column and ischium under special consideration of the sciatic nerve, superior gluteal vessels, and medial femoral circumflex artery. This simple extension of the standard posterior approach optimizes exposure of the posterior column during revision THA using a posterior approach.