Extended trochanteric osteotomy (ETO) fixation for femoral stem revision in periprosthetic fractures: Dall-Miles plate versus cables.

Abstract

Extended trochanteric osteotomy (ETO) is a well-established surgical technique used for femoral stem retrieval in revision hip arthroplasty procedures. Fixation of ETO is commonly achieved through wire, cable or cable-plate fixation. No evidence exists to date to suggest which method is superior when used in an acute traumatic setting. Thirty cases of acute periprosthetic fracture requiring femoral stem revision with an ETO were identified over a 10-year period. Each case had a loose femoral prosthesis which was revised using an ETO approach. Nineteen of these were fixed using cables only, and 11 were fixed using a cable-plate construct. Radiographic outcomes measured included greater trochanter migration, osteolysis, union, time to union and overall success using the Beals and Tower classification. Clinical outcomes were assessed using the modified Harris Hip Score. Twenty-three Vancouver B/C-type fractures were identified. The remaining seven consisted of other fracture types with a loose femoral stem requiring revision through ETO. Mean follow-up was 32months in the cable group and 12months in the cable-plate group. The cable-plate construct performed better than cables alone. Mean migration rates were 1.7mm lower in the cable-plate group (p<0.05). Beals and Tower classification of radiographic outcomes was significantly better in the cable-plate group (p<0.01). Modified Harris Hip Scores were better in this group also (p<0.05). When utilising an ETO approach for femoral stem revision in acute periprosthetic fractures, superior clinical and radiographic outcomes can be achieved if fixation involves a cable-plate system instead of cables only.