OBJECTIVE: To investigate whether a small-incision artificial total hip replacement technique without cutting the pear-shaped muscle can increase posterior hip stability and prevent early dislocation. METHODS: From January 2010 to January 2012, the authors performed initial artificial total hip replacement in 89 hips in 80 patients. There were 21 cases of femoral neck fracture, 23 cases of hip osteoarthritis and 26 hips, 25 cases of aseptic ring death of the femoral head and 31 hips, 6 cases of developmental dysplasia of the hip (DDH), all of which were Crowe type I and II, and 5 cases of rheumatoid hip arthritis with a mean age of 56.5 years (46 to 75 years). All patients used a small posterior lateral hip incision with an incision length of 7-250 px (mean 210 px), during which the gluteus medius muscle was retracted without cutting the pear muscle, the superior I muscle, the internal closed foramen muscle, and the inferior I muscle were cut and preserved, the artificial hip prosthesis was placed in a standard position, and the joint capsule and the externally rotated minor muscle were sutured. Postoperatively, a lower limb pressure pump was used and the patient was encouraged to exercise the periprosthetic muscles early. Liu Wei, Department of Orthopaedics, Nantong First People’s Hospital, Nantong, China RESULTS: The operation time ranged from 55 minutes to 150 minutes (average 85 minutes), intraoperative bleeding ranged from 150 ml to 600 ml (average 340 ml), and the postoperative X-ray showed a large acetabular abduction angle of 45-55° in 7 cases and a small anteversion angle of 4°-10° in 10 cases. Most of the patients could walk on the ground with a walker the day after surgery and could go on the pumping toilet in the hip abduction and external rotation position. All patients were followed up for 6 to 30 months, with a mean of 15.7 months, and no patient experienced dislocation during the follow-up period. The hip Harris score was 36.3±6.7 preoperatively and 88.5±9.6 postoperatively, which was statistically different (P=0.03). Conclusion: The incidence of dislocation in initial total artificial hip replacement is 1%-4%. There are various reasons for dislocation after artificial total hip replacement, of which surgical technique is considered to be the most important one, including the protection of periarticular soft tissues such as gluteus medius, external rotator minimus, and joint capsule, the position angle of acetabular and femoral prosthesis placement, and the maintenance of proper eccentric distance. Without replacing the large-headed prosthesis and using the same surgical technique, no patient in this group experienced hip dislocation after surgery. We believe that the use of a small incision, not cutting the pear muscle and suturing the joint capsule may have a positive effect on preventing hip dislocation. Keywords: pear-shaped muscle; small incision; artificial total hip arthroplasty