Complications of trochanteric osteotomy. Long-term implications

Area of Science:

• Orthopedic Surgery
• Arthroplasty Research
• Biomechanical Engineering

Background:

• The Charnley transtrochanteric approach for cemented total hip arthroplasty (THA) involves a trochanteric osteotomy.
• Understanding the complications associated with this specific surgical step is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the incidence and impact of trochanteric separations (nonunions) following cemented THA using the Charnley transtrochanteric approach.
• To identify factors influencing nonunion rates and their effect on patient function and revision surgery.

Main Methods:

• Retrospective review of 1162 cemented THA cases performed between 1970 and 1986.
• Analysis of trochanteric separation rates, associated patient demographics, preoperative diagnoses, and prior hip surgeries.
• Comparison of functional outcomes (pain, function scores) and revision rates between united and nonunion groups.

Main Results:

• A 5% rate of trochanteric separation (nonunion) was observed.
• Nonunion rates were associated with gender, preoperative diagnosis, and previous hip procedures.
• Patients with nonunion exhibited lower functional scores and a higher incidence of Trendelenberg gait.
• Revision surgery rates were almost three times higher in patients with nonunion.

Conclusions:

• Trochanteric osteotomy in cemented THA presents a significant, quantifiable risk of nonunion.
• Nonunion negatively impacts patient function, gait, and necessitates more frequent revision surgeries.
• Surgeons should carefully weigh the risks and benefits of the trochanteric osteotomy in the Charnley approach.