Posterolateral Approach to the Hip

A 42-year-old man presented with bilateral hip pain 1 year after undergoing staged, bilateral total hip arthroplasties (THAs). The patient had his right hip replaced first, with good early results, followed 6 weeks later by a left THA. Wound healing on the left was delayed, and he underwent superficial irrigation and débridement without complication. On presentation, the patient reported a 3-month history of squeaking, pain, and limited ability to ambulate.

On physical examination, he had bilateral pain and guarding with any motion of his hips. The patient had a history of hypertension and chronic steroid use leading to osteonecrosis of the femoral heads. An anteroposterior radiograph of the pelvis revealed loosening of the bilateral acetabular components ( Fig. 49.1 ). Preoperative infection parameters were negative, including laboratory values for the erythrocyte sedimentation rate, C-reactive protein level, and synovial white blood cell count (<3000 cells/μL).

His original surgery was performed through a posterior approach, and he underwent staged, bilateral acetabular component revisions. Because of the squeaking, the patient’s preoperative metal ion serum levels (chromium, 38.3 ng/mL; cobalt, 24.9 ng/mL; titanium, 19.27 ng/mL), and the position of the components, a posterior approach was used for revision surgery in case a trochanteric osteotomy was required to remove the femoral stem (because of notching of the implant trunnion by the acetabular component). The patient underwent successful staged, isolated acetabular revision surgery without complication ( Fig. 49.2 ).