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Total hip replacement after intertrochanteric osteotomy
S Suominen1, I Antti-Poika, S Santavirta
1Orthopedic Hospital of the Invalid Foundation, Helsinki, Finland.
Insights
Previous intertrochanteric osteotomies can complicate total hip replacements (THR), potentially impairing outcomes. Narrowing of the medullary canal was noted in some cases, affecting prosthesis insertion and long-term results.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Intertrochanteric osteotomy is a surgical procedure used to correct hip deformities.
- Total hip replacement (THR) is a common treatment for severe hip arthritis.
Purpose of the Study:
- To evaluate the long-term outcomes of total hip replacement (THR) in patients with a history of intertrochanteric osteotomy.
- To identify potential complications and factors affecting THR success after prior osteotomy.
Main Methods:
- Analysis of 45 hips in 42 patients who underwent THR after intertrochanteric osteotomy.
- Assessment of patient demographics, interval between surgeries, and intraoperative findings.
- Evaluation of postoperative outcomes using the Mayo score and failure rate.
Main Results:
- A mean of 11.9 years elapsed between osteotomy and THR.
- Medullary canal narrowing complicated prosthesis stem insertion in 10 cases.
- The mean Mayo score at 6-year follow-up was 81, with a 6.7% failure rate. Overweight patients showed poorer outcomes.
Conclusions:
- Prior intertrochanteric osteotomy may negatively impact the results of subsequent total hip replacement.
- Medullary canal narrowing is a potential complication that can hinder prosthesis implantation.
- Weight management is important for optimizing outcomes after THR in this patient cohort.
Abstract:
Forty-five hips were analyzed in 42 patients treated with total hip replacements (THR) after earlier intertrochanteric osteotomies. At time of osteotomy, the patients' mean age was 50 years (range: 14 to 65). Total hip replacement was performed at a mean interval of 11.9 years later (standard deviation: 7.7). Narrowing or closure of the medullary canal made insertion of the prosthesis stem difficult in 10 cases. After THR, the patients were followed for a mean of 6 years (range: 3 to 11). At follow up, the hips had a mean Mayo score of 81 (SD = 13) points (17 excellent, 12 good, 7 fair, 9 poor). The failure rate was 6.7%. Being overweight had an adverse effect on outcome. Intertrochanteric osteotomy may impair results after subsequent THR.