Gibson, J Bone Joint Surg Br 1950 - Posterior Exposure of the Hip Joint

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Posterior Exposure of the Hip Joint

Gibson·J Bone Joint Surg Br·1950·238 citations·Review article

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Gibson (1950) codifies the posterior hip approach as a modification of Kocher's technique. The paper provides a step-by-step operative description covering positioning, incision landmarks, muscle retraction by nerve territory, capsulotomy, and femoral head dislocation. The central question: what is the optimal posterior route to the hip for a wide range of pathology?

Key Findings

Only two landmarks are needed to draw the incision — the posterior superior iliac spine and the upper anterior angle of the greater trochanter — with the lower limb running 6–7 inches distally along the thigh. This simplicity makes the approach reliably reproducible across surgeons and settings.
Muscle retraction follows Kocher's nerve-interval logic, separating superior from inferior gluteal nerve territories without denervating either:
- Superior gluteal nerve (gluteus medius, minimus) → retracted anteriorly
- Inferior gluteal nerve (gluteus maximus) → retracted posteriorly en bloc
- Tensor fasciae latae → entirely undisturbed
The gluteus maximus is never detached from the ilium — it is retracted posteriorly through the plane of the trochanteric bursa, leaving abductor power and hip stability unimpaired after closure.
Femoral head dislocation is achieved by flexion, adduction, and external rotation following capsulotomy along the femoral neck; the ligamentum teres ruptures in the process and does not require deliberate division.
Gibson identifies cup-arthroplasty as the premier modern indication — a prescient designation that foreshadowed the posterior approach becoming the dominant route for total hip arthroplasty in the latter half of the twentieth century. Additional indications include posterior fracture-dislocations, slipped epiphysis, suppurative arthritis, hip arthrodesis, and sciatic nerve exposure.

Board PearlGibson's posterior hip approach follows the Kocher nerve-interval principle, separating superior from inferior gluteal territories to preserve abductor power and hip stability.

Posterior Exposure of the Hip Joint.

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Boileau, Hovorka, et al.J Shoulder Elbow Surg20061,115 citationsProspective cohort

A System for the Surgical Staging of Musculoskeletal Sarcoma.

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Posterior Exposure of the Hip Joint

Gibson·J Bone Joint Surg Br·1950·238 citations·Review article

|

Gibson (1950) codifies the posterior hip approach as a modification of Kocher's technique. The paper provides a step-by-step operative description covering positioning, incision landmarks, muscle retraction by nerve territory, capsulotomy, and femoral head dislocation. The central question: what is the optimal posterior route to the hip for a wide range of pathology?

Key Findings

Only two landmarks are needed to draw the incision — the posterior superior iliac spine and the upper anterior angle of the greater trochanter — with the lower limb running 6–7 inches distally along the thigh. This simplicity makes the approach reliably reproducible across surgeons and settings.
Muscle retraction follows Kocher's nerve-interval logic, separating superior from inferior gluteal nerve territories without denervating either:
- Superior gluteal nerve (gluteus medius, minimus) → retracted anteriorly
- Inferior gluteal nerve (gluteus maximus) → retracted posteriorly en bloc
- Tensor fasciae latae → entirely undisturbed
The gluteus maximus is never detached from the ilium — it is retracted posteriorly through the plane of the trochanteric bursa, leaving abductor power and hip stability unimpaired after closure.
Femoral head dislocation is achieved by flexion, adduction, and external rotation following capsulotomy along the femoral neck; the ligamentum teres ruptures in the process and does not require deliberate division.
Gibson identifies cup-arthroplasty as the premier modern indication — a prescient designation that foreshadowed the posterior approach becoming the dominant route for total hip arthroplasty in the latter half of the twentieth century. Additional indications include posterior fracture-dislocations, slipped epiphysis, suppurative arthritis, hip arthrodesis, and sciatic nerve exposure.

Board PearlGibson's posterior hip approach follows the Kocher nerve-interval principle, separating superior from inferior gluteal territories to preserve abductor power and hip stability.

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