The trochanteric approach to the hip for prosthetic replacement.

A new lateral operative approach to the hip was used for the insertion of 222 total hip prostheses for arthritis. The trochanter is cut off more deeply and more vertically than hitherto, with all of its muscle attachments, including the vastus lateralis, intact. The inclusion of the vastus lateralis stabilizes the fragment by counteracting the gluteus medius; together they generate an inward-acting muscle force on the fragment. Reattachment was by wire in 120 cases and directly to the femoral implant by bolt and graft in 102 cases. In the bolt attachment operation a new type of femoral component was used in conjunction with a variable-thickness bone graft. The method of trochanteric attachment was thought to contribute to the quality of bone repair by eliminating tensile forces and generating compressive forces. In all patients early mobilization and full weight-bearing were encouraged.