Hip – Posterior

MRI based illustration of the posterior approach
MRI based illustration of the posterior approach. The lateral incision is centred over the trochanter, gluteus maximus is split near its insertion and the short external rotators are released, leaving gluteus medius and minimus intact. Image from Munoz JP, Espinoza I, Figueroa S. Understanding Hip Surgical Approaches, A Review With Clinical and Imaging Correlation. Cureus. 2025, 17(6), e86724. CC BY 4.0.
Gray’s Anatomy illustration of the gluteal muscles
Muscles of the gluteal region and back of the thigh. The posterior approach splits gluteus maximus and detaches the short external rotators, with the sciatic nerve lying behind them. Image by Henry Vandyke Carter, Gray’s Anatomy (1918), Wikimedia Commons, public domain.

Moore

Southern

Principles

  • do no interfere with abductor mechanism of hip
    • avoid loss of abductor power

Position

  • lateral position
  • protect & pad bony prominences
  • prep & drape limb free

Landmarks

Incision

  • 15 cm curved incision centred on the posterior aspect of greater trochanter
  • Start: begins 8 cm above & posterior to the posterior aspect of the greater trochanter
  • End: down shaft of femur

Internervous Plane

  • No true internervous plane
  • Gluteus maximus split

Superficial Dissection

  • Incise fascia lata on lateral aspect of femur to uncover vastus lateralis
  • Lengthen the fascial incision superiorly in line with skin incision & split the fibres of gluteus maximus by blunt dissection
    • Ligate branches of superior & inferior gluteal arteries that are encountered
  • Retract fibres of gluteus maximus
  • Exposes short external rotators & overlying fatty tissue
    • Obturator internus
    • Two gemelli
    • Quadratus femoris

Deep Dissection

  • Palpate & identify the sciatic nerve
  • IR the hip to put the short IR on stretch & put the operative field farther from the sciatic nerve
  • Stay sutures into piriformis & obturator internus tendons
  • Detach the muscles close to their femoral insertion
    • Reflect them backwards to cover & protect the sciatic nerve
  • If necessary I would extend my dissection to include quadratus femoris
    • But haemostasis of the branches from the lateral circumflex artery can be problematic
  • Exposes hip joint capsule
    • Place stay suture in capsule
    • Incise with a T shaped capsulotomy

Dangers

  • Nerves
    • Sciatic
  • Vessels
    • Inferior gluteal artery
    • Lateral circumflex artery

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.