Total hip replacement: a comparison between the transtrochanteric and posterior surgical approaches.

It can be argued with good justification, that the trochanteric complications which stimulated this study could have been avoided by strict adherence to Charnley's technique regarding trochanteric advancement and re-attachment. Should trochanteric reattachment be required, it should be done with strict attention to the details outlined by Charnley, or by use of some other device such as the Volz bolt. Trochanteric removal is usually unnecessary. The transtrochanteric approach to total hip replacement has inherent technical problems that increase the potential for complications. These problems include: painful trochanteric bursitis, displacement of trochanter, non-union of trochanter, broken wires and, an increase in dislocation rate (12% as compared to 4%). The posterior approach reduces operative time, blood loss, hospitalization, and shortens the period of time to unprotected weight bearing. Should certain conditions such as external rotation contracture, acetabular protrusion, or relative lengthening of the operated limb indicate trochanteric osteotomy, it can be accomplished readily by way of the posterior exposure.