Anatomy and osteotomy of the greater trochanter.

Eleven human cadaver hips were dissected to define exactly the musculofascial anatomy of the greater trochanter and the supportive structures around it. A readily identifiable plane was defined that permitted osteotomy of the greater trochanter from an anterior approach leaving the vastus lateralis attached to it so that the trochanter could be folded posteriorly and then replaced securely. The osteotomy has been used in difficult total hip replacements at Waterbury (Conn) Hospital and found to be very satisfactory with no wire or bolt fixation necessary to maintain trochanter stability after surgery. Until a large series of these osteotomies has been reviewed, however, additional fixation may be advisable.