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Related Experiment Video

Updated: Jan 8, 2026

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
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Can External Rotator Preservation Reduce Dislocation Risk Following Posterior Approach Total Hip Arthroplasty in

Seok-Hyung Won1, Yongwon Joh1, Young-Wook Lim2

  • 1Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

The Journal of Arthroplasty
|December 20, 2025
PubMed
Summary

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The external rotator preservation (ERP) approach for total hip arthroplasty (THA) significantly reduces dislocation risk in high-risk patients. This muscle-sparing technique offers comparable long-term outcomes to the standard posterior approach.

Area of Science:

  • Orthopedic Surgery
  • Arthroplasty
  • Hip Reconstruction

Background:

  • Limited data exists on muscle-sparing techniques for posterior approach total hip arthroplasty (THA) in high-risk patients.
  • Previous studies often suffer from small sample sizes and short follow-up periods.
  • This study addresses the need for evidence in high-risk populations, including those with osteonecrosis of the femoral head (ONFH), inflammatory arthritis (IA), or lumbar spinal fusion (LSF).

Purpose of the Study:

  • To compare the overall and 90-day dislocation risks between the external rotator preservation (ERP) and standard posterior approach THA.
  • To evaluate the efficacy of the ERP approach in high-risk patient cohorts.
  • To assess long-term outcomes, including revision rates and functional scores.

Main Methods:

Keywords:
dislocationexternal rotator preservationminimally invasive surgeryposterior approachtotal hip arthroplasty

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  • Retrospective review of 1002 patients (501 per group) undergoing THA between 2008 and 2022.
  • Matching of ERP patients to standard posterior approach controls based on key demographic and clinical factors.
  • Comparison of dislocation rates using binary logistic regression and Kaplan-Meier analysis for revision-free survival.

Main Results:

  • The ERP group demonstrated significantly lower overall (OR, 0.25) and 90-day (OR, 0.20) dislocation risks.
  • Reduced dislocation risk was observed in subgroups with ONFH and IA, but not LSF.
  • 10-year survivorship free from dislocation revision and all-cause revision was similar between groups.

Conclusions:

  • The ERP approach is effective in reducing dislocation rates in high-risk THA patients without compromising long-term outcomes.
  • ERP may be a valuable alternative for posterior approach THA in patients with ONFH and IA.
  • The technique shows promise for improving safety in posterior approach THA.