Trochanteric osteotomy for revision total hip arthroplasty. 97% union rate using a comprehensive approach

In current practice most primary total hip arthroplasties (THAs) are performed without trochanteric osteotomy. The superior exposure afforded by trochanteric osteotomy, however, can be valuable in revision total hip surgery. Between 1969 and 1983, 188 revisions in 177 patients were carried out with osteotomy of the greater trochanter. Ninety-one percent were reattached with a three- or four-wire method. Sixty-one percent of the trochanters (N = 114) were advanced to the lateral cortex. Supplemental trochanteric mesh was used in 75% of the revisions (141 hips). Its use is now routine for all revisions. Most patients (N = 137) were permitted to ambulate within five days, using a walker or two crutches, bearing partial weight on the operative hip. Ninety-seven percent (182 of 188) of the trochanters united. Six failed to unite (3%) and eight others had delayed healing (4%). Two trochanters migrated proximally prior to union (1%). Retrospective evaluation of the initial postoperative radiographs for each patient with nonunion identified one or more technical errors in the reattachment technique. While the overall incidence of wire breakage was 27%, most (42 of 51) of these trochanters healed uneventfully. Five of the six patients with trochanteric nonunion, however, had failure of one or both vertical wires by 12 weeks after surgery. The average hip score for the patients with nonunion was 89 points (versus 57 points before surgery), indicating that the average clinical outcome in this group was not substantially comprised by trochanteric complications. In light of the improvement in surgical exposure, high rate of union of the trochanter, and limited number of complications, trochanteric osteotomy is recommended for most revision THA.