Complications of trochanteric osteotomy

Trochanteric osteotomy continues to have an important role in total hip replacement, but more so as a useful adjunct in selected instances rather than as a necessary and integral part of every arthroplasty. Improved exposure is the most important benefit of and indication for trochanteric osteotomy. Trochanteric nonunion per se has little adverse effect on the final result, but most clinically significant complications of trochanteric osteotomy are a consequence of nonunion. Migration or total separation of the greater trochanter is usually preceded by nonunion. Either can result in impaired abductor function manifested as impaired gait and, occasionally, as subluxation or dislocation. Limp and decreased walking endurance are often mild and generally do not warrant specific treatment. However, when they are severe and accompanied by either pain or instability, trochanteric reattachment is indicated. Trochanteric bursitis may or may not be directly related to the presence of prominent fixation devices and, therefore, may not resolve with their removal. Likewise, pain localized to the trochanteric region may in fact be due to other causes, such as component loosening or the presence of infection. Pain unresponsive to a local anesthetic agent warrants a thorough search for alternative causes. Careful patient selection optimizes the benefits and minimizes the risks of trochanteric osteotomy. The procedure is technically demanding, and meticulous attention to detail is essential to avoid complications. We prefer a sliding trochanteric osteotomy for its versatility and for the resistance to trochanteric migration it provides.