Extended trochanteric osteotomy in revision hip arthroplasty: a case series study and systematic literature review.

backgroundExtended trochanteric osteotomy (ETO) in revision hip arthroplasty provides direct access to the femoral medullary canal and facilitates removal of implants and re-implantation. This study looks at objective outcomes of ETO from a systematic review of the literature and a case series of revision total hip arthroplasty (THA) cases with ETOs from the authors' local institution.

methods(1) The National Institutes of Health (NIH) national library of medicine was searched for studies related to ETO and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) technique were followed. (2) Case series of 23 revision THAs with ETOs from University College London Hospital (UCLH) were retrospectively analyzed with a minimum of 2-year follow-up for radiological outcomes.

results(1) The main revision THAs diagnoses were aseptic loosening (880/1,386; 63.4%), prosthetic joint infection (PJI) (301/1,386; 21.7%) and periprosthetic THA fractures (78/1,386; 5.6%). Other diagnoses, including non-specified reasons for THA revision in the chosen studies, accounted for 9.2% (127/1,386). The total mean was a union rate of 95.2%, an infection eradication rate of 91.6%, a femoral stem subsidence rate of 16.6%, with the rate of subsidence more than 5 mm being 10.7%. ETO proximal migration was reported in 7.8% of ETOs; however, it rarely required re-attachment (0.9%). Intraoperative fracture during revision THA with ETO was reported to be at a rate of 5%; while postoperative femoral fracture rate was at 7.8%. (2) All 24 cases had radiographic union at 3 to 6 months and there was no reported femoral stem subsidence.

conclusionThe overall outcome of this literature review provides moderate-quality evidence indicating that ETO provides safe outcome for revision THAs in single and 2-stage revision surgeries with low ETO non-union, femoral stem subsidence, greater trochanter (GT) proximal migration and fracture rates in the different diagnoses groups of revision THA at over 2-year follow up. In the case series group, there was radiographic union of all ETOs with no reported femoral stem subsidence or periprosthetic fractures.