Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Extended Trochanteric Osteotomy for Femoral Revision


CASE STUDY

A 50-year-old man with no significant medical history underwent primary left total hip arthroplasty (THA) 9 years earlier. He returned to the medical office with a new limp and pain in his left hip that had increased during the past month. His postoperative course was previously uncomplicated, and he did not report any constitutional symptoms or recent illnesses.

Radiographs of the hip demonstrated a loose, cementless acetabular component and a well-fixed, fully porous-coated stem ( Fig. 52.1 ). The workup for infection was performed, including laboratory tests and synovial fluid aspiration. Based on the white blood cell count and positive aspirate cultures from the synovial fluid, he was diagnosed with a chronic periprosthetic hip infection.

FIGURE 52.1, A and B, Radiographs of an infected total hip arthroplasty. The cementless acetabular shell appears loose, but the fully porous-coated femoral stem is well fixed and ingrown.

A two-stage revision THA was planned. An extended trochanteric osteotomy was used during the first stage to facilitate removal of a well-fixed, fully porous-coated femoral stem ( Fig. 52.2 ). An articulated, antibiotic-loaded spacer was placed, and the second-stage revision was planned for a later date.

FIGURE 52.2, A and B, Postoperative radiographs obtained after an extended trochanteric osteotomy show placement of an antibiotic-loaded spacer.

Chapter Preview

Chapter Synopsis

The indications, surgical technique, complications, and outcomes are described for an extended trochanteric osteotomy (ETO), which is an invaluable tool in femoral revision surgery.

Important Points

  • Preoperative templating is done to determine the needed ETO length.

  • A shorter osteotomy makes stem removal and adequate fixation of the trochanteric fragment more difficult.

  • Because a longer osteotomy limits diaphyseal fixation of the revision stem, at least 4 to 6 cm of diaphyseal scratch-fit should remain after the ETO is complete.

Clinical/Surgical Pearls

  • The osteotomy fragment should be approximately one third of the circumference of the femur, and soft tissue attachments must not be stripped because of the risk of nonunion from devascularization.

  • The osteotomy can be performed in a controlled manner with a microsagittal saw, sagittal saw, or pencil-tip, high-speed bur.

  • After the posterior and distal portions are completed, the anterior hinge of the osteotomy can be started proximally and distally to ensure proper propagation of the anterior portion. Wide, flat osteotomes help to open this anterior hinge and decrease the risk of fracture of the osteotomy.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here