The purpose of this study was to evaluate the incidence of lateral trochanteric pain (LTP) following primary total hip arthroplasty (THA) and identify risk factors. From 1993 to 1998, 543 primary THAs were performed for osteoarthritis. Lateral trochanteric pain was identified in 24 (4.4%) of 543 patients. The incidence of LTP with the posterior approach was 1.2% (1/82), and the incidence with the direct lateral approach was 4.9% (23/461). Leg length discrepancy, femoral offset, and heterotopic ossification were not correlated with LTP. No patient required operative treatment. Lateral trochanteric pain after primary THA was significantly more common in females (P < .04) and in patients who had a direct lateral approach (P < .01). Lateral trochanteric pain in this series was effectively treated with nonoperative modalities.