Extended trochanteric osteotomy: comparison of 3 modes of fixation: metallic wires, cables, plate, about a series of 157 cases

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.

Comparison of Functional and Radiographic Outcomes Between Two Fixation Methods for Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty: A Retrospective Cohort Study

“…Abdel et al [9] evaluated the outcomes of 612 ETOs and found 50% postoperative fractures occurred at the most proximal cable of the GT due to concentrated stress and devitalized bone, which is consistent with the finding in our series, in which two fractures occurred in the cable group. In cases where the bone conditions were poor, the scratch in femoral cortex could occur and solid fixation or union by cables alone were hard to achieve [16,17]. The significant decreased ALA and migrations in cable group suggested the tightened cables could not only increase the risk of fracture but also cause inability of fragment to overcome the pull of the abductors before the union, which, to the best of our knowledge, has never been evaluated in previous studies.…”

The Relationship Between Arthroplasty Surgeons’ Experience Level and Optimal Cable Tensioning in the Fixation of Extended Trochanteric Osteotomy

“…There are many previous studies that have examined ETO in patients who underwent complex total hip arthroplasty or total hip arthroplasty revision following periprosthetic fractures, infection, or aseptic loosening, and that have compared the results of the use of cables, and cable grip and cable plate systems used for fixation after ETO. 1 - 3 , 13 , 14 In a retrospective study by Prudhon et al, 15 ETO was performed on 157 patients due to revision total hip surgery. In the fixation of the osteotomized trochanteric fragment, wires and cables were used with tension applied manually.…”

Outcomes of Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty for Periprosthetic Joint Infection: A Systematic Review

“…As the incidence of total hip arthroplasty (THA) continues to rise, demand for revision THA is also increasing [1][2][3][4]. Instability, aseptic loosening, and periprosthetic joint infection (PJI) are the most common indications for revision hip replacement [2,5].…”

“…facilitates component removal, cement removal, reaming, debridement, and preparation of a new implant insertion while minimizing surgical complications such as canal perforation, trochanteric fracture, and shaft fracture [3,8].…”

“…Though useful in a multitude of revision indications, one of the more common situations for ETO is component removal for chronic periprosthetic joint infection (PJI) [3,5,10,11]. Approximately 1% of primary THAs are complicated by PJI [12].…”