Clinical experience with a triradiate exposure of the hip for difficult total hip arthroplasty

A triradiate exposure of the hip was developed to facilitate the performance of certain difficult primary and revision total hip arthroplasties. Using this triradiate skin and fascial incision, complete anterior and posterior exposure of the hip capsule can be performed with relative ease. Between October 1980 and January 1985, this exposure was used 50 times in selected cases, including 9 of 320 (3%) primary total hip arthroplasties. All of these cases involved obesity, acetabular protrusion, and/or fragile femoral bone, conditions that would have made safe, adequate exposure without trochanteric osteotomy considerably more difficult through a routine anterolateral or posterior approach. Over this period, the majority of revision hip arthroplasties were performed using triradiate exposure; trochanteric osteotomy was routinely performed in these revision cases. Excellent wound healing was observed in every case, despite unfavorable factors such as advanced age, prednisone therapy, and the presence of prior incisional scars. The triradiate incision offers safe, controlled, and improved exposure in selected primary and revision total hip arthroplasties. It has become nearly the routine incision for the senior author for revision cases.