Posterolateral approach THA: Definition, Uses, and Clinical Overview

Posted on February 28, 2026 | by drhip

Posterolateral approach THA Introduction (What it is)

Posterolateral approach THA is a surgical way to perform a total hip arthroplasty (hip replacement) through the back-and-side of the hip.
It uses an incision near the buttock to reach the hip joint.
It is commonly used for primary hip replacement and some revision (repeat) hip surgeries.
The goal is to replace the damaged hip joint surfaces with artificial components.

Why Posterolateral approach THA used (Purpose / benefits)

Total hip arthroplasty (THA) is performed to address a hip joint that is no longer functioning well due to cartilage loss, bone damage, or deformity. The Posterolateral approach THA describes how the surgeon accesses the joint to remove the damaged femoral head (ball), prepare the socket (acetabulum), and implant replacement components.

Common goals of Posterolateral approach THA include:

Pain relief when hip arthritis or other joint damage causes persistent symptoms.
Improved mobility and function by restoring smoother joint motion.
Correcting mechanics when the hip’s shape or alignment contributes to impaired movement.
Surgical access and visualization of key structures needed to place implants accurately (how much access is needed varies by clinician and case).
Flexibility for complex anatomy in some patients, including cases where exposure of the femur is particularly important.

In practical terms, “posterolateral” refers to the direction of the approach, not a different implant. The hip replacement components (socket, liner, head, and stem) can be similar across approaches, while the pathway to the joint differs.

Indications (When orthopedic clinicians use it)

Posterolateral approach THA may be considered in situations such as:

Hip osteoarthritis with significant pain and reduced function
Inflammatory arthritis (for example, rheumatoid arthritis) causing hip joint damage
Osteonecrosis (avascular necrosis) of the femoral head
Certain hip fractures in older adults where arthroplasty is chosen (varies by fracture pattern and patient factors)
Post-traumatic arthritis after prior injury to the hip
Hip deformity or dysplasia-related arthritis (case-dependent)
Revision THA needs, such as implant wear, loosening, or instability (varies by clinician and case)

Contraindications / when it’s NOT ideal

No single surgical approach is ideal for every person or every hip problem. Situations where Posterolateral approach THA may be less suitable, or where another approach may be preferred, can include:

Higher concern for postoperative instability in a specific patient (risk depends on many factors, including soft-tissue condition and implant choices)
Severe abductor muscle dysfunction (the abductor muscles help stabilize the pelvis during walking); other approaches may be selected depending on goals and anatomy
Complex revision cases where a different exposure is needed (varies by implant position, bone loss pattern, and surgeon preference)
Prior incisions or scars that make a different approach safer for skin, soft tissue, or blood supply (varies by case)
Certain neuromuscular conditions or cognitive limitations that may affect safe movement patterns after surgery (overall risk assessment varies by clinician and case)
Surgeon experience and institutional protocols, since outcomes can be influenced by how familiar a team is with a given approach

Importantly, these are not universal rules. Surgical planning typically balances anatomy, diagnosis, implant strategy, and surgeon expertise.

How it works (Mechanism / physiology)

Posterolateral approach THA works by providing a pathway to the hip joint through the posterior soft tissues, allowing removal of damaged joint surfaces and implantation of prosthetic components that restore joint mechanics.

Key anatomy and structures involved include:

Hip joint basics: The hip is a ball-and-socket joint. The femoral head (ball) moves inside the acetabulum (socket) of the pelvis.
Cartilage and bone: Arthritis and other conditions damage cartilage and can alter bone shape. THA replaces the bearing surfaces to reduce painful bone-on-bone contact.
Posterior soft tissues: The approach passes through the region near the gluteus maximus (a large buttock muscle) and typically involves working around or releasing and later repairing some short external rotator muscles and the posterior capsule (the joint’s soft-tissue envelope). Exact handling varies by clinician and case.
Stability structures: Hip stability after THA depends on implant position, head/liner mechanics, bone geometry, and soft-tissue tension (including capsule and muscles).

Onset and duration/reversibility:

Posterolateral approach THA is a surgical approach, not a medication or temporary device. There is no “onset time” in the pharmacologic sense.
The implants are intended for long-term function, but longevity varies by material and manufacturer, patient activity, bone quality, and other factors.
Some aspects of the operation are reversible only through revision surgery if problems occur, which is why preoperative planning and postoperative follow-up matter.

Posterolateral approach THA Procedure overview (How it’s applied)

Below is a high-level workflow of how Posterolateral approach THA is commonly performed. Specific steps, tools, and protocols vary by clinician and case.

Evaluation / exam – Review of symptoms, functional limits, and prior treatments – Physical exam focused on hip motion, gait, leg length perception, and surrounding muscle function – Imaging (often X-rays; other imaging may be used depending on the question)
Preparation – Preoperative planning for implant sizing and positioning (planning methods vary) – Review of medical history and risk factors relevant to anesthesia, blood clots, infection risk, and bone quality – Discussion of expected recovery course and postoperative precautions (precautions vary by clinician and case)
Intervention (surgery) – Incision made toward the back/side of the hip – Access to the hip joint through posterior soft tissues – Removal of the damaged femoral head – Preparation of the acetabulum (socket) and placement of the acetabular component – Preparation of the femur and placement of the femoral stem and head – Soft-tissue repair (commonly includes posterior capsule/external rotators, depending on technique)
Immediate checks – Surgeon assesses hip stability, leg length, and range of motion in a controlled setting – Postoperative imaging may be obtained to confirm component position (practice varies)
Follow-up – Wound checks and monitoring for complications – Rehabilitation progression and gait retraining – Later follow-up visits to monitor implant function over time

Types / variations

“Posterolateral” describes the direction of access. Within Posterolateral approach THA, variations commonly relate to incision size, soft-tissue handling, and special exposure needs.

Common variations include:

Standard Posterolateral approach THA
Traditional incision length and exposure.
Often chosen for broad applicability and clear visualization.
“Mini-posterior” or smaller-incision Posterolateral approach THA
Uses a shorter incision and more limited dissection.
May be paired with specialized instruments; suitability varies by clinician and case.
Posterior capsular repair techniques
Many surgeons emphasize repairing the posterior capsule and short external rotators to support stability.
The exact repair method and its role in a given patient varies.
Extended posterior approaches (more exposure)
Sometimes used in revision THA or complex anatomy to gain additional access.
Tradeoffs can include longer operative time and increased soft-tissue disruption (varies by case).

Related (but distinct) variables that may be discussed alongside Posterolateral approach THA include implant fixation (cemented vs uncemented), bearing surfaces (ceramic, metal, polyethylene), and stability-focused designs (such as dual-mobility liners). These choices are not unique to the posterolateral approach, and selection varies by material and manufacturer as well as clinician and case.

Pros and cons

Pros:

Often provides good access to the femur, which can help with femoral preparation and implant placement (case-dependent).
Commonly used and widely taught, which may support consistent team workflows in many centers.
Can be adaptable for primary and revision settings (varies by clinician and case).
Typically allows preservation of key hip abductor muscles compared with some other approaches (details vary by technique).
Can be performed with different patient positions and operating room setups (varies by surgeon preference).
Compatible with many implant systems and fixation strategies.

Cons:

The approach works near posterior soft tissues that contribute to stability, so instability/dislocation risk is an important consideration; risk depends on many factors, including technique, component position, and patient-specific anatomy.
Some techniques involve releasing and repairing the short external rotators and posterior capsule, and soft-tissue healing quality can vary.
Certain patients may require postoperative movement precautions (precautions vary by clinician and case).
Nerve irritation can occur with any hip approach; specific risk patterns differ by approach and anatomy.
Wound healing and infection risks exist with all THA approaches and depend on health factors and surgical conditions.
Comparison of recovery speed versus other approaches is not uniform and varies by clinician, rehab plan, and patient factors.

Aftercare & longevity

Aftercare following Posterolateral approach THA generally focuses on safe healing, restoring walking mechanics, and gradually building strength and endurance. Exact restrictions, therapy timelines, and weight-bearing status can differ between surgeons, implant fixation methods, and individual patient factors.

Factors that can affect outcomes and longevity include:

Underlying diagnosis and severity: Advanced deformity, bone loss, or prior surgery can change technical complexity and recovery trajectory.
Soft-tissue condition: Muscle strength, tendon quality, and capsule integrity influence stability and function.
Rehabilitation participation: Progress often depends on consistent, supervised rehabilitation and appropriate activity progression (programs vary).
Weight-bearing status: Some patients are allowed to bear weight as tolerated, while others may have limits; this depends on implant fixation, bone quality, and intraoperative findings.
General health and comorbidities: Diabetes, smoking status, nutritional status, and immune conditions can influence wound healing and infection risk.
Body weight and activity demands: Higher loads and high-impact activities may increase wear and mechanical stress over time (impact varies).
Implant choices and materials: Wear behavior and longevity vary by material and manufacturer, as well as head size, liner type, and positioning.
Follow-up and monitoring: Periodic assessment can identify issues such as loosening, wear, or osteolysis (bone reaction to wear debris) before symptoms become severe.

Longevity is best viewed as a range rather than a guarantee. Many people do well for years after THA, but long-term performance varies widely based on the factors above.

Alternatives / comparisons

Posterolateral approach THA is one way to perform hip replacement, and hip replacement itself is typically considered after non-surgical options are no longer meeting a person’s needs. High-level alternatives fall into two categories: alternatives to THA and alternative approaches to THA.

Alternatives to THA (depending on diagnosis and severity):

Observation / monitoring: Sometimes used when symptoms are mild or imaging changes are early.
Activity modification and physical therapy: Can help with strength, mobility, and symptom management for some conditions, especially earlier-stage arthritis.
Medications: Options may include anti-inflammatory drugs or pain relievers; selection depends on health status and clinician guidance.
Injections: Corticosteroid or other injections may provide temporary symptom relief in some patients; duration and response vary.
Hip preservation surgery: In select patients (often younger or with specific structural problems), procedures other than replacement may be considered. Suitability is highly case-specific.

Alternative approaches to THA (same operation, different route to the joint):

Direct anterior approach THA: Accesses the hip from the front; may be associated with different muscle intervals and different risk considerations.
Direct lateral (anterolateral) approach THA: Accesses from the side; may involve different interactions with abductor muscles.
Other posterior-based variations: Some surgeons use “posterior” versus “posterolateral” terminology differently; the distinctions can be subtle and technique-specific.

No approach is universally “better.” Comparisons depend on surgeon experience, implant positioning goals, patient anatomy, and risk profile.

Posterolateral approach THA Common questions (FAQ)

Q: Is Posterolateral approach THA the same as a “hip replacement”?
Posterolateral approach THA is a way of performing a total hip arthroplasty, which is a hip replacement. “Posterolateral” describes where the surgeon enters relative to the hip. The implants used can be similar across different approaches.

Q: How painful is recovery after Posterolateral approach THA?
Pain experiences vary widely. Most patients have postoperative discomfort that typically improves as tissues heal and mobility returns, supported by a pain-control plan set by the surgical team. The amount of pain can depend on preoperative function, inflammation, surgical complexity, and individual sensitivity.

Q: How long does a Posterolateral approach THA last?
Implant longevity varies by material and manufacturer, implant positioning, patient activity level, body weight, bone quality, and overall health. Some implants function well for many years, while others may require earlier revision due to wear, loosening, instability, or other issues. A specific lifespan cannot be guaranteed.

Q: Is Posterolateral approach THA considered safe?
THA is a commonly performed operation, but it still carries meaningful risks. Safety depends on patient health factors, surgical technique, implant selection, and postoperative rehabilitation and monitoring. Your surgical team typically reviews risks such as infection, blood clots, fracture, nerve injury, and dislocation.

Q: Is dislocation more likely with Posterolateral approach THA?
Dislocation risk is influenced by multiple factors, including component position, head size, soft-tissue tension, neuromuscular control, and whether posterior soft tissues are repaired. Some discussions note posterior-based approaches can have different instability considerations, but actual risk varies by clinician and case. Modern techniques and implant options may be used to support stability.

Q: Will I have hip precautions after Posterolateral approach THA?
Many surgeons recommend certain movement precautions for a period of time, while others individualize restrictions based on stability assessment and technique. The type and duration of precautions vary by clinician and case. The goal is generally to reduce extreme positions while soft tissues heal.

Q: When can someone drive or return to work after Posterolateral approach THA?
Timelines vary based on which leg was operated on, pain control, mobility, reaction time, job demands, and the clinician’s protocol. Driving also depends on being off sedating medications and being able to operate pedals safely. Return-to-work timing can range from earlier for sedentary roles to longer for physically demanding jobs.

Q: Will I be allowed to put full weight on the leg right away?
Weight-bearing status depends on implant fixation (cemented vs uncemented), bone quality, and intraoperative findings. Some patients are allowed to bear weight as tolerated, while others may have restrictions for a period of time. This is determined by the treating surgical team.

Q: What does the scar look like with Posterolateral approach THA?
The incision is typically located toward the back and side of the hip near the buttock. Scar length and exact placement vary with technique (standard vs smaller-incision methods) and patient anatomy. Scar appearance also depends on individual healing and skin factors.

Q: What affects whether I’ll need a revision surgery later?
Revision risk depends on wear, loosening, infection, instability, fracture, and how the bone and soft tissues respond over time. Patient factors (activity level, body weight, bone quality, comorbidities) and implant-related factors (materials and design) can contribute. Regular follow-up helps detect issues that may not be obvious early on.