This is the Original Research work that I had done in 1981,which is referred to in many Orthopedic Textbooks of international repute.I have also collected References and Citations till todate(22/03/2015)My website is:kmohaniyer.com and my email address is:kmiyer28@hotmail.com for any correspondence.

1. POSTERIOR APPROACH
TO THE HIP JOINT
Dr K Mohan Iyer
This is my original research done on cadavers in 1981.
This is the power point presentation of mine at:
1. The Posterior Approach to the Hip Joint – K. Mohan Iyer, Association of Surgeons of India
Conference, Mumbai - December 1982.
2. Asean Orthopaedic Association Congress, Singapore – October 1984.
This Approach of mine was described in detail in The Year Book of Orthopaedics 1982-Mark
B.Coventry,371-373.It has also been described in the following books of International repute:
1. Campbell’s Operative Orthopaedics (1992), Ninth Edition,Volume-1, S. Terry Canale, Pages
140,387,466.
2. The Adult Hip (Lippincott-Raven) (1998), Volume 1, Callaghan, Rosenberg and Rubash,
Pages:700-701,718.
3. Surgery of the Hip,Elsevier, Mosby/Saunders,Volume 2, by Daniel J.Berry and Jay
R.Lieberman, Page No.269.
4. Campbell’s Textbook of Operative Orthopaedics,12th Edition,by S.Terry Canale and James
H.Beaty,Page No.331
I am also preparing my own website narrating all the original research work done by me for the last
30 years till to date(1/1/2014) -> http://www.kmohaniyer.com
My email address is: kmiyer28@hotmail.com

2. K.Mohan Iyer
POSTERIOR APPROACH TO
THE HIP JOINT
K.MOHAN IYER
M.Ch.Orth(Liverpool, U.K.),M.S.Orth(BOM)
F.C.P.S.Orth(BOM),D’Orth(BOM),
M.B.,B.S.(BOM).

3. K.Mohan Iyer
Approaches to the Hip Joint
 1.Anterior
 2.Anterolateral
 3.Lateral
 4.Medial
 5.Anteromedial
 6.Posterolateral
 7.Posterior

4. K.Mohan Iyer
Posterolateral Approaches to
the Hip Joint
 1.Gibson(1950)
 2.Marcy & Fletcher(1954)

5. K.Mohan Iyer
Anterior Approaches to the
Hip Joint
 1.Smith Peterson(1919)
 2.Somerville(1953)

6. K.Mohan Iyer
Anterolateral Approaches to
the Hip Joint
1.Smith Peterson,Cave & Van Gorder(1949)
2.Desmond Dall(1986)
3.Stephenson & Freeman(1991)

7. K.Mohan Iyer
Lateral Approaches to the Hip
Joint
 1.Watson Jones(1935)
 2.Harris(1967)
 3.McFarland & Osborne(1954)
 4.Hardinge(1982)
 5.McLauchlan(Stracathro Approach-1984)
 6.Itokazu M,Ohno & Itoh Y(1988)
 7.Frndak P.A,Mallory T.H.&Lombardi A.V(1992)

8. K.Mohan Iyer
Lateral Approaches to the Hip
Joint(Contd.)
8.Learmonth & Allen(1996)
9.Mulliken et al(1998)

9. K.Mohan Iyer
Medial Approaches to the Hip
Joint
 1.Ludloff(1908)

10. K.Mohan Iyer
Anteromedial Approaches to
the Hip Joint
 1.Zazepen & Gamidov(1972)

11. K.Mohan Iyer
Posterior Approaches to the
Hip Joint
 1. Osborne(1931)
 2. Moore(1959)
 3. Iyer(1981)
 4. Wayne J.Daum(1985)
 5. Hedley et al(1990)
 6. James A.Shaw(1991)

12. K.Mohan Iyer
Posterior Approach to the Hip
Joint – K.Mohan Iyer
 1.A New Posterior Approach to the Hip Joint –
K.Mohan Iyer,Injury,13,76-80,1981.
 2.Experience with Thompson’s prosthesis using
the New Posterior Approach – K.Mohan
Iyer,M.A.Shatwell & M.A.Elloy,Injury,14,243-
244,1982.
 3.The Year Book of Orthopaedics 1982 – Mark
B.Coventry,371-373

13. K.Mohan Iyer
Posterior Approach to the Hip
joint-K.Mohan Iyer
4.A Posterior Approach to the Hip Joint with
complete posterior capsular and muscular
repair;A.K.Hedley,D.H.Hendren & L.P.
Mead(1990) Journal of Arthroplasty:Vol.5;
Supplement October 1990:S 57 to S 66.

14. K.Mohan Iyer
Posterior Approach to the Hip
Joint – K.Mohan Iyer
5.Clinical Experience with the Iyer
modification of the Posterior Approach to
the Hip – F.H.Beddow & C.Tulloch,J.Bone
Joint Surg,1991,73B,Supp II:164-165.
6.Experience with a Modified Posterior
Approach to the Hip Joint.A technical
 note;Shaw J.A:Journal of Artrhroplasty:
 (1991) Vol.6;No.1:11-18.

15. K.Mohan Iyer
Posterior Approach to the Hip
Joint-K.Mohan Iyer
7.Campbell’s Operative Orthopaedics(1992),
Ninth Edition,Volume One,S.Terry Canale,
Pages:140,387 & 466.
8.The Adult Hip(Lippincott-Raven)(1998),
Volume 1,Callaghan,Rosenberg & Rubash,
Pages 700-701,718.

16. K.Mohan Iyer
Posterior Approach to the Hip
Joint-K.Mohan Iyer
9.Failure of Reinserted Short External
 Rotator Muscles after Total Hip Arthro-
 plasty;Thomas Stahelin,P.Vienne &
 O.Hershe(2002),Journal of Arthroplasty,
 Vol.17,No.5;604-607.

17. K.Mohan Iyer
CADAVERIC STUDY
 AIM:To compare the stability of the Hip
 Joint using this approach,with the
 Southern Approach.
 Apparatus used measures the angles of
 flexion/extension,adduction/abduction
 Int.Rotaion/Ext.Rotation of the Hip Joint,
 with the pelvis fixed.

18. K.Mohan Iyer
Cadaveric Study

19. K.Mohan Iyer
Cadaveric Study

20. K.Mohan Iyer
CADAVERIC STUDY
 Comparison’s made in a single cadaver with
 1.Both Hips exposed by different
 approaches,with hemi-arthroplasty done.
 2.Both Hips exposed by different
 approaches,without any arthroplasty
 done.

21. K.Mohan Iyer
CADAVERIC STUDY
 Standard Dislocation Manoeuvre – Torque
 applied in Internal Rotaion,with the Hip
 Joint held in a fixed angle of flexion and
 adduction.
 Torque required to disrupt trochanteric
 fixation was more as compared to the
 Southern Approach.

22. K.Mohan Iyer
Cadaveric Study

23. K.Mohan Iyer
CADAVERIC STUDY
 CONCLUSION:
 The Torque required to disrupt the
 Trochanteric fixation in this Approach is
 around 68 Nm,as compared to the
 conventional Southern Approach
 where the repair of the short lateral
 rotators,disrupts around 30 Nm to 50 Nm.
 with disruption & dislocation.
 *Hence Greater Stability,by this New Approach.

24. K.Mohan Iyer
POSTERIOR APPROACH TO
THE HIP JOINT
 K.MOHAN IYER
 CADAVERIC DISPLAY

25. K.Mohan Iyer
Skin Incision

26. K.Mohan Iyer
Gluteal Fascia

27. K.Mohan Iyer
Gluteus Maximus

28. K.Mohan Iyer
Short External Rotaters

29. K.Mohan Iyer
Trochanteric Osteotomy

30. K.Mohan Iyer
Hip Joint Opened

31. K.Mohan Iyer
Hip Joint Dislocated

32. K.Mohan Iyer
Head and Neck resected

33. K.Mohan Iyer
Total Hip Prosthesis inserted

34. K.Mohan Iyer
Wiring of Trochanteric
Fragment

35. K.Mohan Iyer
Hip Joint Reconstituted

36. K.Mohan Iyer
Radiograph of Total Hip
Prosthesis

37. K.Mohan Iyer
Radiograph of Bipolar
Prosthesis

38. K.Mohan Iyer
Radiograph of Thompson’s
Hemi-Arthroplasty

39. K.Mohan Iyer
DISCUSSION
 ADVANTAGES:
 1.Bloodless field.
 2.Wider visualisation of the acetabulum.
 3.Markedly increased stability.
 4.Very useful in senile/demented patients.

40. K.Mohan Iyer
DISCUSSION
 DISADVANTAGES:
 1.Trochanteric Osteotomy,wherein bony
union takes twice the time required for soft
tissues to heal.
 2.Problems related to wires.

41. K.Mohan Iyer
Concerns Expressed about
this Posterior Approach
 1.Metal Failure with breakage.
 2.Heterotrophic Ossification.
 3.Non-Union of trochanteric fragment.
 4.Fibrous Union of trochanteric fragment.
 5.Greater Trochanteric Bursitis.