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The long modified extended sliding trochanteric osteotomy.

Dror Lakstein1, Yona Kosashvili, David Backstein

  • 1Orthopedic Department, Division of Arthroplasty, Mount Sinai Hospital, 600 University Ave., Suite 476A, Toronto, ON, M5G 1X5, Canada. drorale@gmail.com

International Orthopaedics
|October 17, 2009
PubMed
Summary

Long extended trochanteric osteotomies (ETOs) of 18 cm and above demonstrate comparable union and revision rates to shorter ETOs. This surgical approach preserves posterior structures, enhancing hip stability with good functional outcomes.

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Area of Science:

  • Orthopedic Surgery
  • Hip Arthroplasty
  • Surgical Techniques

Background:

  • The extended trochanteric osteotomy (ETO) is a surgical approach used in hip arthroplasty.
  • Preserving the posterior capsule and short external rotators is crucial for hip stability.
  • The performance of longer ETOs (≥18 cm) requires further evaluation.

Purpose of the Study:

  • To assess the clinical performance and outcomes of long extended trochanteric osteotomies (ETOs) measuring 18 cm and above.
  • To compare the results of long ETOs with those reported for shorter ETOs.
  • To evaluate the rate of union, subsidence, revision, and complications associated with long ETOs.

Main Methods:

  • Retrospective review of 53 patients who underwent long ETOs (≥18 cm).

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  • Mean osteotomy length was 20.0 cm (range, 18-26 cm).
  • Assessment of Harris hip scores, subsidence, stem stability, osteotomy union, and complications at an average follow-up of 57 months.

    • Main Results:

    • The mean Harris hip score improved significantly from 37 preoperatively to 73 postoperatively.
    • Osteotomy union occurred in 98.1% of cases.
    • Subsidence was observed in 22.6% of cases, with most stems stabilizing within the first year. Revision rates were low (1.9% for subsidence/loosening, 1.9% for fracture). Postoperative dislocations occurred in 3.8% of cases.

    Conclusions:

    • Long extended trochanteric osteotomies (≥18 cm) achieve good functional outcomes and union rates comparable to shorter ETOs.
    • The lateral approach preserves posterior structures, contributing to enhanced hip stability.
    • The failure rate in this series is low, suggesting long ETOs are a viable option in hip arthroplasty.