| ABSTRACT The posterior approach is the most commonly used surgical approach in hip arthroplasty, of which posterolateral approach is the classic approach for hip arthroplasty. It is clearly revealed and easy to operate. However, it has the defects of large surgical trauma and high rate of postoperative dislocation. In recent years, a number of posterior minimally invasive approaches have emerged, such as SuperPATH (supercapsular percutaneously assisted total hip approach) and DSA (direct superior approach). These approaches are modifications of the traditional posterolateral approach, which can not only shorten the surgical incision and reduce surgical trauma, but also reduce the rate of postoperative dislocation, alleviate postoperative pain, and accelerate postoperative functional recovery. However, the minimally invasive approaches use the muscular gap to perform the operation, which may lead poor exposure and limit the operation space. They may also lead to unsuitable prosthesis position and complications such as femoral fracture, nerve injury, and postoperative dislocation before passing the learning curve. At present, the choice of surgical approach for total hip replacement is still controversial. By reviewing the relevant literature at home and abroad and combining with clinical practice, it is concluded that the traditional posterior-lateral approach is more mature and simple in operation procedure, with the advantages of clear visualization of the operative field, shorter operation time, high rate of postoperative dislocation and bad impact on the function of the hip joint; The SuperPATH approach is a double incision approach which has many advantages such as severing the external rotators, low rate of postoperative dislocation, and less impact on hip function. But it is a complex approach with more steps and a longer learning curve than posterior-lateral approach. And the approach needs to use specific prostheses and surgical instruments; this article summaries the surgical techniques, advantages and disadvantages, and complications of the three hip approaches. The DSA approach is a single-incision approach, which is relatively simple to operate. The pyriformis muscle is severed without damaging the other short external rotators, and the rate of dislocation is lower than that of the posterior-lateral approach. The disadvantage is that it has a greater impact on the function of the hip joint than that of the SuperPATH approach. This article provides a review of commonly used posterior approaches to provide references for the selection of surgical approaches for individualized clinical practice. |
