Hip replacement is an effective procedure for people with persistent hip pain and reduced mobility. Surgeons can access the hip joint through several pathways, and this article focuses on one of the most common: the posterolateral hip replacement.
What is a Posterolateral Hip Replacement?
The term “posterolateral” describes the surgical incision’s location on the back (posterior) and side (lateral) of the hip. The incision measures between 6 and 10 centimeters, allowing the surgeon to access the hip joint by splitting the gluteus maximus muscle along its fibers. This muscle-sparing split is a defining feature of the approach.
To reach the hip joint capsule, the surgeon works around the short external rotator muscles, detaching their tendons from the femur to expose the joint. After the prosthetic components are implanted, these tendons are reattached to the bone with strong sutures. This repair stabilizes the new hip and provides the surgeon with excellent visibility of both the hip socket (acetabulum) and the thigh bone (femur).
When is This Procedure Recommended?
A total hip replacement is considered when joint damage causes significant pain that interferes with daily life and non-surgical treatments are no longer effective. Common conditions leading to surgery include severe osteoarthritis, rheumatoid arthritis, and avascular necrosis. Certain types of hip fractures may also require a replacement.
The posterolateral approach is a well-established technique for these replacements. A surgeon’s preference, based on their training and experience, is a major factor in choosing this method. A patient’s specific anatomy can also make this approach a suitable choice.
The Surgical Process
Before surgery, patients have a medical evaluation to confirm they are fit for the procedure. Anesthesia options include general anesthesia or a regional block, like a spinal or epidural, to numb the lower body. The surgery lasts one to two hours, during which the surgeon removes the damaged femoral head (“ball”) and cartilage from the acetabulum (“socket”).
These damaged surfaces are replaced with durable prosthetic implants: a femoral component (metal stem with a ball) and an acetabular component (metal cup with a liner). Following the procedure, patients are moved to a recovery area for pain management. A hospital stay of one to three days is common, and physical therapy often begins the same day to help the patient stand and walk.
Recovery and Precautions
Recovery progresses over several months, with physical therapy being a primary component. Therapy begins in the hospital and continues after discharge to help regain strength and safe movement. Initially, patients use assistive devices like walkers or crutches, and tools such as raised toilet seats can help with daily activities while the hip heals.
Recovery from this approach involves specific “hip precautions” to prevent the new joint from dislocating. Because muscles at the back of the hip were repaired, certain movements must be avoided for a set period. Patients are instructed not to bend the hip past 90 degrees, cross their legs, or twist on the operated leg. Sleeping with a pillow between the legs is also recommended to maintain proper alignment.
Potential complications can include infection, blood clots, or a difference in leg length. While dislocation was historically a concern with this approach, modern surgical techniques and implant designs have significantly reduced this risk. Most patients return to light daily activities within a few weeks and more strenuous activities over the following months.