The intraoperative photographs showed a primary total hip arthroplasty performed through a posterolateral approach with U-shape capsulotomy and capsular repair. (A) The posterior capsule was exposed following the separation of the piriformis tendon and short external rotator muscles. The U-shaped capsular incision was made along the superior border of the femoral neck, the acetabular rim and then the inferior border of the femoral neck. (B) The capsular flap was carefully protected during the operation and meticulously repaired and relocated back to the original position. The posterior capsule was repaired without the need of capsular plication (arrow). (C) The posterior capsule was repaired. Five stitches with 1-0 Dexon suture were used for this case (arrows). (D) The short external rotator muscles and the piriformis tendon were repaired with the piriformis tendon being repaired first (arrow). T = greater trochanter; Cap= posterior capsule; P= piriformis muscle tendon.