Posterior Preservation
The posterior capsule and external rotator structures are preserved rather than divided as part of the surgical exposure.
A Distinctive Approach to Hip Replacement
The Mayo Modified Anterolateral Approach
Hip replacement can be performed through several different surgical approaches. Each provides a different pathway to the hip joint.
I perform hip replacement using the Mayo Modified Anterolateral Approach, a technique that preserves the posterior soft tissues while providing versatile exposure for reconstruction.
I am currently the only orthopedic surgeon in the St. Louis area performing primary hip replacement using this approach.
Why I Use It
The approach should serve the reconstruction.
My goal is not to perform a hip replacement through the smallest possible incision or to use a particular approach because it has a familiar marketing label.
My goal is to reconstruct the hip accurately while minimizing unnecessary disruption of the tissues around it.
The Mayo Modified Anterolateral Approach fits that philosophy. It preserves the posterior soft tissues, does not require a specialized traction table or intraoperative fluoroscopy, and provides exposure that can be extended when the reconstruction becomes more complex.
What Makes the Approach Different
Four characteristics that shape how I perform hip replacement.
No Specialized Traction Table
The operation is performed on a standard operating table, allowing the leg to be positioned freely throughout the procedure.
No Intraoperative Fluoroscopy
My technique does not depend on fluoroscopic X-ray guidance during the operation, eliminating fluoroscopy-related radiation exposure during the procedure.
Extensile When Needed
The same general exposure used for routine primary hip replacement can be extended when more complex anatomy or reconstruction requires greater access.
Understanding the Difference
How is the Mayo approach different from direct anterior hip replacement?
Direct anterior hip replacement has become increasingly familiar to patients, and excellent outcomes can be achieved through an anterior approach. The Mayo Modified Anterolateral Approach reaches the hip through a different surgical interval.
Both approaches preserve the posterior soft tissues. In my practice, however, the Mayo approach allows me to perform the operation without a specialized traction table and without intraoperative fluoroscopy.
Different Surgical Interval
The Mayo technique approaches the hip from the anterolateral side rather than through the direct anterior interval.
Posterior Structures Preserved
Like direct anterior surgery, the posterior soft tissues are left intact.
No Required Traction Table
My Mayo technique is performed without dependence on a specialized traction-table workflow.
No Required Fluoroscopy
I perform the procedure without routine intraoperative fluoroscopic imaging.
Understanding the Anatomy
Accessing the hip while respecting the surrounding tissues.
The Mayo modified anterolateral approach reaches the hip from the anterolateral side. The exposure is developed in a controlled fashion to visualize the joint while preserving the posterior capsule and external rotator structures.
Those posterior structures are important contributors to native hip stability. Preserving them is one reason I favor this approach for primary hip replacement.
That does not make the operation entirely free of soft-tissue disruption. Hip replacement remains a major reconstructive procedure, and careful handling of all tissues is essential regardless of the chosen approach.
Built for Reconstruction
A straightforward approach that does not box the surgeon in.
Most primary hip replacements are straightforward. But anatomy, deformity, retained hardware, prior surgery, fracture, or unexpected findings can occasionally require greater exposure.
One reason I value the Mayo approach is that it can be extended when necessary rather than becoming a limitation of the reconstruction.
That same versatility is why I also use the approach in selected complex revision hip procedures.
The Surgical Process
A good result begins before the incision is made.
The approach provides access to the joint. The quality of the operation depends on what is done through that access.
Confirm the Diagnosis
The first priority is determining whether the hip joint is truly responsible for the patient’s symptoms.
Understand the Anatomy
Preoperative imaging helps identify deformity, bone quality, leg-length differences, and features that may affect reconstruction.
Plan the Reconstruction
Component size, position, fixation, hip center, offset, and leg length are considered before entering the operating room.
Use the Approach Thoughtfully
The incision and exposure are tools for completing the reconstruction. They are not the goal of the operation.
More Than an Incision
The implant must function as part of the whole person.
Hip replacement changes the relationship between the pelvis, femur, muscles, and spine. Restoring those mechanics requires more than placing components within acceptable ranges.
I consider hip center, leg length, offset, component orientation, bone quality, fixation, and soft-tissue tension as parts of one reconstruction.
The surgical approach must provide enough visualization to make those decisions accurately and execute the plan safely.
Learn about hip replacement
Recovery
Recovery depends on much more than the approach.
It is natural to ask whether one approach will make recovery faster or easier. The operative exposure can influence early symptoms, but it is only one variable.
01
Severity of arthritis
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Bone quality and anatomy
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Muscle strength and conditioning
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Medical health
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Prior hip or spine surgery
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Complexity of the reconstruction
Keeping the Approach in Perspective
The incision is not the operation.
Surgical approach matters, but it is only one part of a successful hip replacement. Component position, restoration of leg length and offset, implant fixation, soft-tissue handling, stability, medical optimization, and postoperative recovery all contribute to the result.
Several established surgical approaches can produce excellent hip replacement outcomes. I use the Mayo Modified Anterolateral Approach because its combination of posterior preservation and versatile exposure fits the way I perform hip reconstruction.
“The best approach is the one that allows the surgeon to perform a safe, accurate, and stable reconstruction consistently.”
Common Questions
What patients often ask about the approach.
Is this the same as the direct anterior approach?
No. Both approaches access the hip from the front or side rather than through a traditional posterior exposure, but the operative intervals, patient positioning, visualization, and surgical technique are different.
Is the approach muscle-sparing?
The approach uses an anterolateral exposure while preserving the posterior soft tissues. However, terms such as “muscle-sparing” can oversimplify what occurs during surgery. Every hip replacement requires careful handling of muscles, tendons, capsule, and bone.
Does the approach guarantee a faster recovery?
No surgical approach can guarantee a particular recovery. Early progress is influenced by baseline strength, medical health, the severity of the arthritis, surgical complexity, pain response, and patient participation in recovery.
Will I need hip precautions?
Postoperative recommendations are individualized. They depend on implant stability, bone quality, soft-tissue condition, anatomy, and anything unusual encountered during surgery.
Does this approach prevent dislocation?
Preserving the posterior soft tissues may contribute to stability, but no approach eliminates the possibility of dislocation. Component positioning, soft-tissue tension, anatomy, patient factors, and postoperative behavior all matter.
Why do surgeons use different approaches?
Surgeons choose approaches based on their training, experience, patient population, and the technique they can perform most reliably. Excellent hip replacements can be performed through several established approaches.
Who performs the Mayo hip approach in St. Louis?
I am currently the only orthopedic surgeon in the St. Louis area performing primary hip replacement using the Mayo Modified Anterolateral Approach. I use the approach for routine primary hip replacement, and its extensile capabilities can also be useful in more complex hip reconstruction.
A Unique Option in St. Louis
A different option for patients considering hip replacement.
I am currently the only orthopedic surgeon in the St. Louis area performing primary hip replacement using the Mayo Modified Anterolateral Approach.
The goal is not simply to choose the name of an approach. It is to understand how your surgeon plans to reconstruct your hip, why they use the technique they do, and whether that philosophy makes sense for you.
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