In a study of 225 hip replacements, 126 had trochanteric osteotomy and 99 did not. Trochanteric osteotomy was invaluable in approaching the difficult, previously operated hip. Even though 81 hips without trochanteric osteotomy had no complications directly related to the operative technique, 19 had significant operative problems. Hips with fixed flexion or external rotation contractures preoperatively presented technical difficulties had postoperative problems avoidable only by trochanteric osteotomy. Complications are encountered with and without osteotomy and various indications for osteotomizing the greater trochanter through a lateral approach to the hip are reviewed on the basis of experience with 184 patients with an average age of 61 yr.