Trochanteric osteotomy in revision total hip arthroplasty
Kavin Sundaram1, Ahmed Siddiqi1, Atul F Kamath1
1Cleveland Clinic Foundation, Department of Orthopedics Cleveland, Ohio, USA.
EFORT Open Reviews
|September 21, 2020
Summary
Trochanteric osteotomy variants like TSO, ETO, and transfemoral approaches offer expanded access for hip revision surgery. These techniques demonstrate high union rates, crucial for successful total hip arthroplasty outcomes.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Surgical Techniques
Background:
- Trochanteric osteotomy provides enhanced surgical access to the femur and acetabulum.
- Renewed interest exists in trochanteric osteotomy variants for revision total hip arthroplasty (THA).
- Effective osteotomy fixation is critical for successful bone healing.
Purpose of the Study:
- To review and compare trochanteric osteotomy variants for revision total hip arthroplasty.
- To highlight the indications and outcomes of trochanteric slide osteotomy (TSO), extended trochanter osteotomy (ETO), and transfemoral approaches.
- To discuss the importance of fixation methods in achieving osteotomy union.
Main Methods:
- Review of current literature on trochanteric osteotomy techniques for revision THA.
- Description of trochanteric slide osteotomy (TSO), extended trochanter osteotomy (ETO), and transfemoral (Wagner) osteotomy.
- Discussion of osteotomy fixation methods, primarily wire, cable, and plate systems.
Main Results:
- TSO offers advantages in cases of abductor deficiency or when increased acetabular exposure is needed.
- ETO demonstrates high union rates (>90%) for both septic and aseptic revision THA.
- Transfemoral (Wagner) osteotomy shows near 100% union rates, particularly beneficial for anterior approaches.
Conclusions:
- Trochanteric osteotomy variants provide valuable extensile approaches for complex revision total hip arthroplasty.
- The choice of technique depends on specific surgical needs, such as abductor status and approach preference.
- Achieving stable fixation is paramount for successful bone union and long-term implant survival.
