A comparison of the anterolateral, transtrochanteric, and posterior surgical approaches in primary total hip arthroplasty.

For evaluation of both the anterolateral and posterior approaches to total hip arthroplasty as alternatives to the transtrochanteric approach, 269 replacement procedures in 237 patients were reviewed. Follow-up periods ranged from 24 to 71 months (average, 38.2 months). The anterolateral approach was used in 91 hips, the transtrochanteric approach in 136, and the posterior approach in 42. Dislocation was four times more common (p less than .05) in the posterior approach (9.5%) than in the other two (2.2% each). Seven of the nine dislocations occurred in patients older than 65 years of age, and all four dislocations in the posterior approach group occurred in patients over 65. Heterotrophic bone was three times more common (p less than .10) in posterior and transtrochanteric approaches than in the anterolateral approach. Trochanteric bursitis was twice as common (p less than .05) in the transtrochanteric approach than in the other two. Roentgenographic evaluation of femoral component positioning, width of medial calcar cement, and acetabular cup orientation showed no significant differences between the three surgical approaches. It is apparent that the anterolateral surgical approach (modified Watson-Jones) provides a satisfactory alternative to trochanteric osteotomy in the elderly patient who requires total hip arthroplasty.