Conjoined Tendon-Preserving Posterior (CPP) Approach

The conjoined tendon-preserving posterior (CPP) approach preserves the short external rotators, including the piriformis and the conjoined tendon composed of the superior gemellus, obturator internus, and inferior gemellus, as well as the underlying joint capsule, all of which are completely dissected in the conventional posterior approach. However, the obturator externus and the proximal part of the quadratus femoris muscle are resected. The CPP approach is considered a “capsular ligament-preserving” posterior approach because it preserves all three primary capsular ligaments: the iliofemoral ligament, ischiofemoral ligament, and pubofemoral ligament, which are largely transected in the conventional posterior approach. This approach may not only maintain joint tension without lengthening the leg and enhance early recovery, but also preserve the obturator internus, one of the pelvic floor muscles, thereby potentially avoiding urinary and sexual dysfunction.