Whiteside LA, et al. - Researchers reviewed a total of 519 patients (525 hips) who underwent primary total hip arthroplasty (THA) using the posterior approach, preoperatively and at two and five years postoperatively, with the aim to assess the exposure and preservation of the abductor mechanism during primary THA using the posterior approach. In addition, they appraised gluteus maximus transfer to restore abductor function of chronically avulsed gluteus medius and minimus. Mild chronic damage to the tendon (not caused by exposure) was reported in 54 patients, which was repaired with sutures through drill holes in the greater trochanter. Severe damage with major avulsion of the gluteus medius and minimus muscles was reported in 41 patients, which was repaired with sutures through bone and a gluteus maximus flap transfer to the greater trochanter. The normal hips maintained the abductor strength, but there was a significant progression of lateral hip pain, five years postoperatively. They noted excellent exposure and preservation of the abductor mechanism with the posterior approach during primary THA. Stable reconstruction of the abductor muscles and restoration of function in the hips with functioning muscles were achieved with augmentation of the repair with a gluteus maximus flap.