Transtrochanteric Approach for Primary Total Hip Replacement

With less invasive surgical approaches being used in the majority of primary total hip replacement (THR) today, the trochanteric osteotomy remains a very useful technique in selected and often complex cases. The currently most widely used technique follows largely that of the surgical hip dislocation (SHD) (Chap. 7 ), which is mostly used in joint preservation surgery. The initial tenet of the trochanteric osteotomy was leaving the attachments of the gluteus medius and minimus to the trochanter. English later modified it by leaving the vastus lateralis attached to the osteotomized fragment while staying extracapsular. As the abductors are retracted anteriorly, this approach allows for an excellent exposure of both the acetabular and the femoral side even in presence of very contract soft tissues or in cases with extremely narrow pelvic-trochanteric clearance. As perfusion of the femoral head and neck is preserved, it may prevent early femoral bone resorption in hip resurfacings or if neck-preserving stems are used.