Extended trochanteric osteotomy (ETO) and fluted tapered modular stems in revision hip arthroplasty. Does ETO integrity or consolidation, really matter?

Garabano, Germán; Gessara, Alan; Pesciallo, César Ángel; Alamino, Leonel Perez; Sel, Hernán Del

doi:10.1016/j.jor.2021.02.001

Cited by 6 publications

(8 citation statements)

References 24 publications

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“…In three studies [ 12 – 14 ] data were detailed on femoral stem subsidence measured in millimetres. The total average rate of femoral stem subsidence in ETO THA reported in these studies was 16.6% (14/84).…”

Section: Results Of Case Seriesmentioning

confidence: 99%

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

Hamad¹,

Konan²

2022

Arthroplasty

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Background Extended 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. Conclusion The 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.

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Section: Results Of Case Seriesmentioning

confidence: 99%

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

Hamad¹,

Konan²

2022

Arthroplasty

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“…Bu osteotomiler, instabiliteye veya erken gevşemeye sebep olmaz. [6,7] Bunlardan standart trokanterik osteotomi, genellikle asetabulumun daha iyi görülmesi için yapılırken, femoral komponentin çıkartılmasında çok yarar sağlamaz. Bunun dışında, ciddi ve sık komplikasyonları dolayısıyla (abduktor yetmezlik, kaynamama, heterotrofik ossifikasyon ve implant irritasyonu) femoral revizyonlarda genellikle kullanılmaz.…”

Section: Ameliyat Sırasında Uygulanabilecek Tekniklerunclassified

“…[1] Genişletilmiş trokanterik ostetomi çimentolu femoral komponent revizyonlarında ileri gevşeme varlığında genellikle gereksiz iken; ileri derecede femoral eğriliği olan ve çimento tıkacının eğriliğin distalinde olduğu olgularda, kırılmış femoral stemlerde, tüm veya tüme yakın tutulumlu çimentosuz komponentlerde ve "double tapered" proksimal tutulumlu stemlerin çıkartılmasında altın standarttır. [7] Ortalama 10-15 cm arası uzunlukta ve abduktor kolun yapışma yüzeyini içine alacak şekilde femur çapının yaklaşık 1/3'ünü içeren geniş bir osteotomidir. Diğer trokanterik osteotomilere benzeyen ama daha nadir görülen komplikasyonlara sahiptir.…”

Section: Ameliyat Sırasında Uygulanabilecek Tekniklerunclassified

Revizyon kalça cerrahisinde femoral sorunlar ve rekonstrüksiyon seçeneklerinin incelenmesi

Uluçay¹,

Özler²,

Mazmanoğlu³

et al. 2021

TOTBID

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“…Extended trochanteric osteotomy (ETO) is often used in revision total hip arthroplasty (rTHA) to remove the prosthesis and protect the femoral cavity, which has the advantages of good exposure, correction of deformity and easy healing [ 1 – 4 ]. As ETO results in diminished proximal femoral support, distally fixed stems are often implanted for femoral reconstruction and to achieve immediate and reliable distal fixation [ 5 – 9 ]. However, distally fixed stems are prone to complications such as femoral stress shielding, periprosthetic fracture, prosthesis subsidence [ 10 , 11 ], nonunion, and fracture or migration of the osteotomy fragment [ 5 , 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…As ETO results in diminished proximal femoral support, distally fixed stems are often implanted for femoral reconstruction and to achieve immediate and reliable distal fixation [ 5 – 9 ]. However, distally fixed stems are prone to complications such as femoral stress shielding, periprosthetic fracture, prosthesis subsidence [ 10 , 11 ], nonunion, and fracture or migration of the osteotomy fragment [ 5 , 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical and radiographic outcomes of long monoblock, hydroxyapatite-coated stem in revision hip arthroplasty with extended trochanteric osteotomy: a multicenter study

Xin,

Yang,

Chen

et al. 2024

J Orthop Surg Res

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Background The distally fixed stem used in revision total hip arthroplasty (rTHA) with extended trochanteric osteotomy (ETO) is subject to periprosthetic fracture, stem subsidence, and stress shielding. The prospective multicentric study aimed to assess the clinical and radiographic outcomes, and complications of using the Corail revision stem in rTHA with ETO. Methods Sixty-four patients undergoing rTHA with ETO using the Corail revision stem between 2019 and 2020 were enrolled in the study. We performed a postoperative follow-up of the patient and obtained radiographs and Harris hip scores (HHSs). These results were used to analyze ETO union, Engh scores, bone remodeling, stem stability and hip function. Results The mean follow-up duration was 34 months (range 23–41). Sixty-two patients who underwent ETOs achieved complete healing at the final follow-up. Fifty-nine hips had bony ingrowth from the osteotomy fragment to the stem without radiolucent lines. The postoperative Engh score was 21.3 ± 3.59 (range 15.5–27.0). Forty-three hips had regeneration in the proximal femur. Two patients had transient thigh pain postoperatively. The postoperative HHS improved from 40.7 ± 16.67 (range 0–67) preoperatively to 82.1 ± 6.83 (range 73–93). Conclusion Corail revision stems are a viable and reliable option in rTHA with ETO. This stem had excellent clinical and radiographic outcomes, resulting in a high rate of ETO union and stem survival. The revision stem enabled restoration of proximal bone stock in femurs with prerevision bone defects, which were prepared for the next revision operation. Level of evidence Level IIb, Prospective self-control study.

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Extended trochanteric osteotomy (ETO) and fluted tapered modular stems in revision hip arthroplasty. Does ETO integrity or consolidation, really matter?

Cited by 6 publications

References 24 publications

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

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

Revizyon kalça cerrahisinde femoral sorunlar ve rekonstrüksiyon seçeneklerinin incelenmesi

Clinical and radiographic outcomes of long monoblock, hydroxyapatite-coated stem in revision hip arthroplasty with extended trochanteric osteotomy: a multicenter study

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