A new lateral operative approach to the hip was used for the insertion
of 222 total hip prostheses for arthritis. The trochanter is cut off more
deeply and more vertically than hitherto, with all of its muscle
attachments, including the vastus lateralis, intact. The inclusion of the
vastus lateralis stabilizes the fragment by counteracting the gluteus
medius; together they generate an inward-acting muscle force on the
fragment. Reattachment was by wire in 120 cases and directly to the femoral
implant by bolt and graft in 102 cases. In the bolt attachment operation a
new type of femoral component was used in conjunction with a
variable-thickness bone graft. The method of trochanteric attachment was
thought to contribute to the quality of bone repair by eliminating tensile
forces and generating compressive forces. In all patients early
mobilization and full weight-bearing were encouraged.