A New Technique to Reattach an Extended Trochanteric Osteotomy in Revision THA Using Suture Cord

Kuruvalli, Renuka Reddy; Landsmeer, Ronald; Debnath, Ujjwal K.; Suresh, S; Thomas, T. L.

doi:10.1007/s11999-008-0233-4

Cited by 28 publications

(18 citation statements)

References 9 publications

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“…The vastus is thought to counteract the pull of the abductors in the coronal plane, thus avoiding proximal migration and promoting osteotomy union [ 10 ]. However, the reported incidence of proximal migration of the ETO fragment is up to 6.6% [ 4 , 8 ] and the incidence of nonunion similarly up to 11% [ 4 , 7 ]. Another important consideration that must be taken into account, when using these trochanteric osteotomies, is that when there is an obvious curvature in the frontal and/or sagittal planes, these osteotomies cannot provide a straight-shot access to the canal, thus increasing the risk of intraoperative perforations of the femoral shaft [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although the osteotomized anterolateral bone flap is folded back, the contralateral interface surfaces remain unexposed. Despite the use of modern removal instruments [ 8 ], the rate of proximal femur fractures has been reported to be between 4% [ 4 , 8 ] and 60% [ 3 ]. What is more important is that these fractures concern the more distal portion of the proximal femur, as this is the usual area of remaining fixation [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…The transfemoral osteotomy described by Wagner [ 1 ] and the extended trochanteric osteotomy (ETO) popularized by Younger et al [ 2 ] are the most commonly used in femoral revision, both when proximal or diaphyseal fixation of the new component has been decided [ 3 , 4 ]. These trochanteric osteotomies involve the creation of a longitudinal bone flap of various dimensions at the anterolateral femur, with the surrounding musculature remaining attached.…”

Section: Introductionmentioning

confidence: 99%

“…They provide increased exposure of the fixation surfaces and adequate access to the canal for reaming and prosthesis insertion, but the overall complication rate has been reported as high as 24% [ 5 ]. Nonunion or proximal migration of the osteotomy fragment can occur [ 6 - 8 ], whereas the dorsal portion particularly of the proximal femur is vulnerable to intraoperative split fractures [ 3 , 4 ]. The latter can eventually compromise the potential for fixation of the revision stem [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Removal of well-fixed components in femoral revision arthroplasty with controlled segmentation of the proximal femur

et al. 2014

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BackgroundThe transfemoral and the extended trochanteric osteotomies are the most common osteotomies used in femoral revision, both when proximal or diaphyseal fixation of the new component has been decided. We present an alternative approach to the trochanteric osteotomies, most frequently used with distally fixated stems, to overcome their shortcomings of osteotomy migration and nonunion, but, most of all, the uncontrollable fragmentation of the femur.MethodsThe procedure includes a complete circular femoral osteotomy just below the stem tip to prevent distal fracture propagation and a subsequent preplanned segmentation of the proximal femur for better exposure and fast removal of the old prosthesis. The bone fragments are reattached with cerclage wires to the revision prosthesis, which is safely anchored distally. A modified posterolateral approach is used, as the preservation of the continuity of the abductors, the greater trochanter, and the vastus lateralis is a prerequisite.ResultsBetween 2006 and 2012, 47 stems (33 women, 14 men, mean age 68 years, range 39–88 years) were revised using this technique. They were 12 (26%) stable and 35 (74%) loose prostheses and were all revised to tapered, fluted, grit-blasted stems. No fracture of the trochanters or the distal femur occurred intraoperatively. Mean follow-up was 28 months (range 6–70 months). No case of trochanteric migration or nonunion of the osteotomies was recorded. Restoration of the preexisting bone defects occurred in 83% of the patients. Three patients required repeat revision due to dislocation and one due to a postoperative periprosthetic fracture. None of the failures was attributed to the procedure itself.ConclusionsThis new osteotomy technique may seem aggressive at first, but, at least in our hands, has effectively increased the speed of the femoral revision, particularly for the most difficult well-fixed components, but not at the expense of safety.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Removal of well-fixed components in femoral revision arthroplasty with controlled segmentation of the proximal femur

et al. 2014

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“…Later the cable fixation system was improved to utilize a claw plate to strengthen the greater trochanter, which was called the cable grip system. The latest fixations were reported, such as using suture cord and nonmetallic cable [2,3]. ETO has many advantages, such as larger exposure during operation, lower risk of the femoral facture, and larger contact area for healing of the osteotomized bone, etc.…”

Section: Introductionmentioning

confidence: 99%

An in-vitro biomechanical study of different fixation techniques for the extended trochanteric osteotomy in revision THA

et al. 2013

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BackgroundThe wire fixation and the cable grip fixation have been developed for the extended trochanteric osteotomy (ETO) in the revision of total hip arthroplasty (THA). Many studies reported the postoperative performance of the patients, but with little quantitative biomechanical comparison of the two fixation systems.MethodsAn in-vitro testing approach was designed to record the loosening between the femoral bed and the greater trochanter after fixations. Ten cadaveric femurs were chosen in this study. Each femur underwent the THA, revision by ETO and fixations. The tension to the greater trochanter was from 0 to 500N in vertical and lateral direction, respectively. The translation and rotation of the greater trochanter with respect to the bony bed were captured by an optical tracking system.ResultsIn the vertical tension tests, the overall translation of the greater trochanter was observed 0.4 mm in the cable fixations and 7.0 mm in the wire fixations. In the lateral tension tests, the overall motion of the greater trochanter was 2.0 mm and 1.2° in the cable fixations, while it was 6.2 mm and 5.3° in the wire fixations. The result was significantly different between the two fixation systems.ConclusionsThe stability of the proximal femur after ETO using different fixations in the revision THA was investigated. The cable grip fixation was significantly more stable than the wire fixation.

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Extended trochanteric osteotomy: current concepts review

Sambandam

Duraisamy

Chandrasekharan

et al. 2016

Eur J Orthop Surg Traumatol

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ETO is an important tool in the revision surgeon's armamentarium and can be used in variety of clinical scenarios and for various intraoperative needs and goals. Awareness about biomechanics of ETO, indications, implants selection, fixation techniques and complications is paramount for good intraoperative and postoperative outcome. ETO by posterior approach continues to be a work horse approach for most revision surgeons all over the world.

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A New Technique to Reattach an Extended Trochanteric Osteotomy in Revision THA Using Suture Cord

Abstract: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 28 publications

References 9 publications

Removal of well-fixed components in femoral revision arthroplasty with controlled segmentation of the proximal femur

Removal of well-fixed components in femoral revision arthroplasty with controlled segmentation of the proximal femur

An in-vitro biomechanical study of different fixation techniques for the extended trochanteric osteotomy in revision THA

Extended trochanteric osteotomy: current concepts review

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