One-hundred fifty-six consecutive total hip replacements through a lateral transtrochanteric approach were evaluated and compared to a closely matched group of 160 consecutive similar procedures via a posterior approach. The lateral approach did not have any dislocations and created a greater abductor lever arm. However, a 4.5% complication rate was related to the greater trochanter and degraded the result. The posterior approach provided a shorter operative time, required less blood replacement, and resulted in a shorter hospital stay. However a 4.4% incidence of dislocation decreased the rate of recovery and the final result. Since this early experience, an improved technique of reattaching the short external rotators had mitigated the problem of dislocations. Wound and systemic complications, postoperative results, radiographic findings and prosthetic positioning were not significantly different in comparable patients treated by the 2 surgical approaches.