Abstract
Introduction: The trans femoral osteotomy was initially described by Wagner in 1987 and the extended trochanteric osteotomy (ETO) was described by Younger et al. in 1995 and is considered to be the gold standard technique for removal of well-fixed femoral stems in revision total hip arthroplasty (THA). The purpose of this report is: to compare the different types of fixation metallic wires, cables, metallic reinforcement plate (MRP) we have used in revision THA where an ETO was performed;analyse the clinical and radiological outcomes of these devices at 1 year;analyse the complication.Material and method: It is a retrospective continuous monocentric series of 157 patients where an ETO was performed. It was fixed by an MRP in 17 patients, cables in 43, metallic wires in 97. The main outcome was the consolidation of the osteotomized femoral flap (OFF). Secondary outcomes were Postel Merle d’Aubigne score and complications occurred at 1 year follow up. Qualitative variable was presented as percentage, quantitative variables as mean or median, standard deviation and range.Result: 157 patients (73−46, 5% females) were included. Mean age at surgery was 66.7 year (sd = 10.63). Mean interval between index surgery and revision was 11.07 year (sd = 5.67). Causes for revision and bone defects were comparable. At 1 year OFF is healed without displacement in 82% with metallic wires, 70% with cables, 88% with MRP. Not significant.Discussion: Fixation of the femoral flap is a technical issue in ETO. Metallic wires and cables are the most commonly used to secure the fixation. Fixation with a metallic plate is reported in a few number of articles and may be helpful specially when a fracture of the OFF occurred during surgery.
Highlights
As the number of revision total hip arthroplasty (THA) is regularly growing, several technical issues had risen and have been solved by orthopaedic surgeons
The trans femoral osteotomy was initially described by Wagner [1] in 1987 and the Extended trochanteric osteotomy (ETO) was described by Younger et al [2] in 1995 and is considered to be the gold standard technique for removal of well-fixed femoral stems
There are several pitfalls that the surgeon should aim to avoid when performing an ETO: – meticulous haemostasis; – the preservation of the soft tissue attachments of the vastus lateralis and gluteus medius, maintain the blood supply of the osteotomy fragment; – care should be taken to protect the osteotomy fragment from intraoperative fracture, when applying cerclage cables [3]; – even in experienced hands, ETO can still result in complications such as non-union (1.3–1.6%), fracture (2.4–4%), superior migration of osteotomy fragment (1.2–6.7%), and reoperation (2.7–10.2%) [4,5]; – patient status has to be considered in this challenging surgery
Summary
As the number of revision total hip arthroplasty (THA) is regularly growing, several technical issues had risen and have been solved by orthopaedic surgeons. There are several pitfalls that the surgeon should aim to avoid when performing an ETO: – meticulous haemostasis; – the preservation of the soft tissue attachments of the vastus lateralis and gluteus medius (minimize Trendelenburg gait), maintain the blood supply of the osteotomy fragment; – care should be taken to protect the osteotomy fragment from intraoperative fracture, when applying cerclage cables [3]; – even in experienced hands, ETO can still result in complications such as non-union (1.3–1.6%), fracture (2.4–4%), superior migration of osteotomy fragment (1.2–6.7%), and reoperation (2.7–10.2%) [4,5]; – patient status has to be considered in this challenging surgery
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