Trochanteric excision following persistent nonunion of the greater trochanter

Trochanteric nonunion associated with total hip arthroplasty (THA) may result from 1 of 3 situations: 1) isolated fracture of the greater trochanter; 2) complication of trochanteric osteotomy; or 3) fracture secondary to cystic formation or osteolysis from wear debris post-THA. Isolated fracture of the greater trochanter can occur during primary or revision THA or as a result of trauma in the post-THA patient. It is estimated that approximately 5% of intraoperative femoral fractures involve just the greater trochanter. Perhaps the most common case is subsequent to trochanteric osteotomy. Although trochanteric osteotomy is more often used in revision THA, it may be used in primary THA where there is severe femoral deformity, developmental dysplasia of the hip, or in cases where previous intraosseous hardware is removed. Finally, trochanteric nonunion may be seen in subsequent to late fracture through an osteolytic lesion of the greater trochanter. Regardless of the etiology, nonunion of the greater trochanter can result in significant pain, Trendelenberg gait, and functional limitations, and additional surgery to reattach the trochanter may be required. Reattachment may be accomplished using various techniques, including abductor slide, trochanteric claw plate, Dalls-Miles cable grip system, and various wiring techniques. The nonunion rate following trochanteric osteotomy ranges up to 6%, and persistent nonunion following reattachment ranges up to 39%.