Extended trochanteric osteotomy: current concepts review

Sambandam, Senthil; Duraisamy, Gopinath; Chandrasekharan, Jayadev; Mounasamy, Varatharaj

doi:10.1007/s00590-016-1749-z

Cited by 24 publications

(16 citation statements)

References 66 publications

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“…During osteotomy, the femur is vulnerable to intraoperative fractures. In our study, the incidence of intraoperative femoral fractures was 3.6% (2 / 56), whereas the incidence ranged from 4% to 30% in previous studies of ETO 2530). When making an anterior cortical window, the surgeon should take care not to cause intraoperative fractures especially at the distal end of the anterior cortical window and to avoid extensive removal of the porous-coated stem, such as the AML stem.…”

Section: Discussioncontrasting

confidence: 47%

“…Reportedly, the nonunion rate of standard trochanteric osteotomy (STO) ranged from 5% to 14% 2324). The nonunion rate has been decreased to 1% to 3% since the ETO was introduced 25). In our patients, nonunion occurred in one femur (1.8%) that had an intraoperative fracture.…”

Section: Discussionmentioning

confidence: 71%

“…In ETO, it is not feasible to press-fit the new stem in the proximal femur, and it is necessary to use a distally fitting stem. Distally fitting modular stems with an extensive porous coating were recommended for ETO 25). However, modular stems are associated with fracture at the modular junction 29).…”

Section: Discussionmentioning

confidence: 99%

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Anterior Cortical Window Technique Instead of Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty: A Minimum 10-Year Follow-up

et al. 2019

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BackgroundThe anterior cortical window technique was developed to facilitate stem removal in revision total hip arthroplasty (THA). In this technique, only the anterior cortex of the proximal femur is osteomized; the trochanter, lateral cortex, and medial cortex remain intact. Therefore, a new stem can be press-fitted into the femur and mediolateral stability can be obtained. However, the long-term results of revision THA using this technique are unknown. We report the outcome and survivorship at a minimum of 10-year follow-up.MethodsFrom May 2003 to April 2006, 69 patients (75 hips) underwent revision THA using an anterior cortical window and a cementless distal interlocking stem. Of these, 50 patients (56 hips) were followed up for 10 to 13 years (mean, 11.5 years). There were 26 men (29 hips) and 24 women (27 hips) with a mean age of 51.2 years (range, 29 to 82 years) at the time of revision arthroplasty. We evaluated radiographs, Harris hip score, University of California at Los Angeles (UCLA) activity score, Koval category, and survivorship.ResultsNonunion of the osteotomy occurred in one hip (2%). Five stems (8.9%) subsided 5 mm or more. At the final evaluation, the mean Harris hip score, UCLA activity score, and the Koval category were 82.5, 4.6, and 1.5, respectively. Survivorship with any operations as the end point was 80.4% and that with stem-revision as the end point was 91.1%.ConclusionsWith use of an anterior cortical window, a well-fixed stem can be easily removed, and a new stem can be inserted with firm mediolateral stability in the proximal femur in revision THA. We recommend using this technique instead of the extended trochanteric osteotomy in revision THA.

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Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 71%

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Anterior Cortical Window Technique Instead of Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty: A Minimum 10-Year Follow-up

et al. 2019

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“…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, particularly 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 also to be considered in this challenging surgery. …”

Section: Introductionmentioning

confidence: 99%

“…care should be taken to protect the osteotomy fragment from intraoperative fracture, particularly when applying cerclage cables [ 3 ];…”

Section: Introductionmentioning

confidence: 99%

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

Prudhon¹,

Tardy²

2018

SICOT-J

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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.

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Partial implant retention in two-stage exchange for chronic infected total hip arthroplasty

Shi

Yang

Zhou

et al. 2020

International Orthopaedics (SICOT)

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Extended trochanteric osteotomy: current concepts review

Cited by 24 publications

References 66 publications

Anterior Cortical Window Technique Instead of Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty: A Minimum 10-Year Follow-up

Anterior Cortical Window Technique Instead of Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty: A Minimum 10-Year Follow-up

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

Partial implant retention in two-stage exchange for chronic infected total hip arthroplasty

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