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Our experience with extended trochanteric osteotomy: a saviour in revision hip arthroplasty


Introduction: Despite the overwhelming success and long term reliability of total hip arthroplasty (THA), several situations necessitate the revision of femoral component. The use of extended trochanteric osteotomy (ETO) is a method that allows exposure of the proximal femur through the use of controlled cortical fracture. Purpose: This surgical technique is extremely helpful to facilitate the removal of a well fixed femoral implant, to provide increased surgical exposure and to permit concentric placement of a new implant. Familiarity with this surgical technique is crucial for surgeons who frequently perform revision THA. Methods: This was a retrospective study of 31 revision hip arthroplasties with a proximal femur ETO performed from 2014 to 2017 by a single surgeon using posterolateral approach and to describe the radiological and functional outcomes with an emphasis on intra-operative difficulties and surgical time. Results: The mean Harris hip score increased from 40 preoperatively to 90 at the final follow-up. Solid bony union was observed on all post-operative radiographs within 6 months. There was no displacement of osteotomised fragments, positions of fixation cables were unchanged, and there was no metallic wire/ cable loosening or bone reaction around the wires. Complete ETO union was noted in one case where a plate was used because of iatrogenic fracture of the medial wall Conclusion: ETO is a safe and very useful technique that can be used in revision hip surgery. When performed carefully and repaired meticulously using cables or wires and supported by autologous bone graft, it results in reliable union with relatively infrequent complications.