Advances in surgical technique for total hip replacement: without and with osteotomy of the greater trochanter.

Advances in the surgical technique for total hip replacement demonstrate that in most straightforward cases, osteotomy of the greater trochanter is unnecessary. This point of view requires some consideration of the present controversy about the need for osteotomy of the greater trochanter. If the limb is to be shortened or if a graft is to be added to the ilium, the trochanter must be removed. In complex cases necessitating revision operations or correction of severe deformities, or in hips requiring long stem components, osteotomy of the trochanter can be a distinct asset. There are pitfalls and complications of the techniques, both with and without trochanteric osteotomy, as well as with methods of reattachment of the trochanter. In general, total hip replacement can be performed with wide exposure of the socket without osteotomy of the trochanter, and can be performed without damage to the abductor muscle group. New cementing procedures and more accurate positioning of the femoral component have significantly improved the end results of total hip arthroplasty.