Transtrochanteric approach is rarely used for primary THR. We use it in revision surgery. Anyway, trochanter fracture can occur in difficult primary cases. In our practice we fix the trochanter back using the Charnley technique with wiring or the Weber technique with 2 K-pins and wiring in the figure of 8 under tension (similar to what is used for fixation of olecranon fractures).

I wonder if you ever had the opportunity to use it as an approach especially in arthrodesed and very stiff ankylosed hips

Usually, we use the Watson-Jones approach also in ankylosed hips. If you resect the femoral neck you have enough room to work on the ankylosed head by direct reaming to ensure a good bed for the cup component. Of course, the lateral approach with trochanteric osteotomy and retracting the tip of trochanter with the abductors proximally seems to give a better space. We use it also sometimes, but sometimes we have had trochanter problems (delayed healing, displacement, failure of fixation, weakness of abductors) that could be serious for the functional result. We must not forget that in anylosed hips the postoperative exercises are very important and should be started soon after surgery.

Dear Murali

The trochanteric osteotomy access also called Charnley approach eventually is used by me in some special situations in revision of total hip arthroplasty. This access can present some disadvantages such as nonunion of the greater trochanter, fatigue cerclage material, trochanteric bursitis, increased incidence of heterotopic ossification and change in lever arm pelvi-trochanteric

Thank you, Dr Nelson and Dr Tanchev

Dear Murali

Sorry for the late reply but now she came to me .

In my service use osteotomy Charnley for more than 10 years in the past , did the recontrução type champagne cork , we observed low nonunion rate , but We could limit the active abduction for 12 weeks.

Thanks Rodrigo