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.
Keywords
Hip Arthroplasty - revision - posterior approach - approach ischium - extended approach
