The evolution of the posterior approach in hip surgery: Back to Langenbeck

The posterior approach is a proven approach in hip surgery. Over the past 150 years, we have seen many variations of posterior approaches arising from predecessors, with Dr. Bernhard von Langenbeck (1810–1887) as the founder of the modern posterior approach. The aim of this historical review is to understand the evolution of the posterior approach from its ‘birth’ with von Langenbeck to modern approaches in hip surgery. We analysed von Langenbeck’s original manuscript, as well as literature of subsequent approaches. Over the past two centuries, surgical approaches to the hip joint have adapted to the changing needs and goals of surgeons and patients. Von Langenbeck developed a minimal invasive posterior approach in 1868 for femoral head resection of injured soldiers. According to subsequent surgeons, the perioperative view on the hip joint and surrounding structures was too minimal to reduce the number of complications, implement the first prostheses and fix fractures. As a result, surgical approaches became more invasive. Around 1900, Kocher and Moore further developed von Langenbeck’s approach more distally into the iliotibial band. After World War II, the Judet brothers extended their incision proximally to the pelvis to fix acetabular fractures. With the changing western society in the early 2000s, the demand for minimally invasive approaches in total hip arthroplasty grew. Superior approaches were developed and show many similarities to von Langenbeck’s approach 150 years earlier. With the advent of minimally invasive superior approaches, the evolution of posterior approaches in hip surgery is Back to Langenbeck!