Surgical approaches to the hip for total hip arthroplasty include the posterior, direct anterior, and lateral methods. Each window buys exposure by spending something—whether a muscle, a nerve, or a margin of stability. Understanding the anatomical trade-offs, dislocation directions, and nerve risks demystifies the debate over which approach is truly best. ⏱ Chapters 0:00 Intro 0:19 ADULT RECONSTRUCTION · THA 0:41 Every Window Spends Something 1:43 Dislocation Rate By Approach 2:36 Approaches Differ In The Complication They C… 2:55 The Hip In Layers 4:02 Three Windows Onto The Same Joint 4:42 Posterior — Exposure, Honestly Bought 5:54 Sciatic Nerve — Why It Is The Peroneal Divis… 7:09 Repair The Rotators And Capsule. Dislocation… 7:36 Direct Anterior — The Only True Plane 9:00 Is There A True Internervous Plane? 9:56 The Two Structures That Define The Anterior… 11:13 Lateral & Anterolateral 13:01 What The Evidence Shows 14:09 What Level I Evidence And Registries Show 15:27 Surgeon Volume Beats Approach Choice. 15:51 Choosing, In Practice 17:25 Position Decides Stability 18:46 The Lewinnek Zone Is Necessary — Not Suffici… 19:19 Recap & sources 20:23 S28 This video breaks down the posterior, direct anterior, anterolateral, and direct lateral approaches for total hip arthroplasty at a fellowship depth. We explore the anatomical layers, the specific internervous planes, and the exact nerves at risk in each surgical window. We also analyse the trade-off between hip stability, the abductor mechanism, and the surgeon's learning curve, supported by the latest AOANJRR registry data and Level I RCT meta-analyses. 🦴 IN THIS VIDEO YOU'LL LEARN • The three-way trade-off between hip stability, the abductor mechanism, and the surgical learning curve • How posterior capsule and short external rotator repair dramatically reduced historical dislocation rates • The specific internervous or intermuscular planes utilised by the posterior, anterior, and lateral approaches • Identifying and protecting the sciatic, lateral femoral cutaneous, femoral, and superior gluteal nerves • Why the direction of post-operative dislocation directly correlates with the direction the hip was opened • The safe zones for splitting the gluteus medius to prevent permanent Trendelenburg gait • How national registry data proves that revision rates are similar across all approaches when performed by experienced surgeons • The difference in surgical positioning and radiographic imaging requirements for each technique 📌 KEY TAKEAWAYS ✔️ No approach is free; each buys exposure by sacrificing a muscle, a nerve, or a margin of stability. ✔️ Soft tissue repair in the posterior approach reduces dislocation rates from 5% to under 2%. ✔️ The direct anterior approach is the only true internervous plane (superior gluteal vs femoral nerve), offering the lowest dislocation rate but a steep learning curve. ✔️ Protect the superior gluteal nerve by never splitting the gluteus medius more than 5cm proximal to the greater trochanter. ✔️ The approach determines the direction of dislocation: posterior dislocates in flexion/IR, anterior dislocates in extension/ER. 👩⚕️ WHO THIS IS FOR This video is designed for orthopaedic surgical trainees, junior doctors, and medical students seeking a fellowship-level understanding of hip arthroplasty. It is also highly valuable for practicing orthopaedic surgeons, healthcare professionals, and curious patients wanting to understand the surgical options and anatomical realities of total hip replacement. 📚 RELATED TOPICS: Total Hip Arthroplasty Component Positioning and Safe Zones · Sciatic Nerve Anatomy and Posterior Hip Dislocation Mechanisms · Abductor Mechanism Deficiency and Trendelenburg Gait · Smith-Petersen Interval and Hueter Direct Anterior Approach · AOANJRR Registry Data on Primary Hip Replacement Survival · Posterior Soft Tissue Repair Techniques in Hip Arthroplasty 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #orthopaedics #hipreplacement #hiparthroplasty #surgicalapproaches #orthopaedicsurgery #directanteriorapproach #posteriorapproach #hardingeapproach #hipanatomy #adultreconstruction #orthopedicsurgery #medicaleducation