Extended Trochanteric Osteotomy with Intermediate Resection Arthroplasty Is Safe for Use in Two-Stage Revision Total Hip Arthroplasty for Infection

Abstract

Background: This study sought to compare the results of two-stage revision total hip arthroplasty (THA) for periprosthetic infection (PJI) in patients with and without the use of an extended trochanteric osteotomy (ETO) for removal of a well-fixed femoral stem or cement. Methods: Thirty-two patients who had undergone an ETO as part of a two-stage revision without spacer placement were matched 1:2 with a cohort of sixty-four patients of the same sex and age who had stem removal without any osteotomy. Clinical outcomes including interim revision, reinfection and aseptic failure rates were evaluated. Modified Harris hip scores (mHHS) were calculated. Minimum follow-up was two years. Results: Patients undergoing ETO had a significantly lower rate of interim re-debridement compared to non-ETO patients (0% vs. 14.1%, p = 0.026). Reinfection following reimplantation was similar in both groups (12.5% in ETO patients vs. 9.4% in non-ETO patients, p = 0.365). Revision for aseptic reason was necessary in 12.5% in the ETO group and 14.1% in the non-ETO group (p = 0.833). Periprosthetic femoral fractures were seen in three patients (3.1%), of which all occurred in non-ETO patients. Dislocation was the most common complication, which was equally distributed in both groups (12.5%). The mean mHHS was 37.7 in the ETO group and 37.3 in the non-ETO group, and these scores improved significantly in both groups following reimplantation (p < 0.01). Conclusion: ETO without the use of spacer is a safe and effective method to manage patients with well-fixed femoral stems and for thorough cement removal in two-stage revision THA for PJI. While it might reduce the rate of repeated debridement in the interim period, the use of ETO appears to lead to similar reinfection rates following reimplantation.

Extended trochanteric osteotomy is a safe procedure in two-stage hip revision: a systematic review of the literature

“…Current literature established that ETO fixed with cerclages may be a safe procedure in patients with a stable and well-fixed femoral stem that underwent two-stage hip revision [18]. Furthermore, other devices, such as trochanteric plates, were discouraged due to potentially increasing infection recurrence risk [7,16]. Another important result was the lower re-debridement rate in patients who underwent the ETO procedure compared to non-ETO [15,16].…”

“…Furthermore, other devices, such as trochanteric plates, were discouraged due to potentially increasing infection recurrence risk [7,16]. Another important result was the lower re-debridement rate in patients who underwent the ETO procedure compared to non-ETO [15,16]. This finding could be related to better femoral canal and acetabulum visualization, ensuring complete and thorough debridement and accurate cement removal [7,8].…”

“…After the exclusion of duplicates, 132 studies were examined. After title and abstract screening, 21 clinical studies were assessed for fulltext evaluation, and nine clinical studies [7][8][9][13][14][15][16][17][18] that met the inclusion criteria were finally included in this systematic review. The bibliography of each article was crosschecked to find other relevant publications for inclusion in the current study.…”

“…A mean ETO union time after a twostage revision for PJI of the hip of 12 (10.6-15.6) weeks was reported. All nine studies [7][8][9][13][14][15][16][17][18] reported the postoperative ETO reinfection rate in the setting of a twostage revision for hip PJI. The overall reinfection rate was 8.9%.…”

“…Five studies included in this systematic review were comparative [9,[15][16][17][18]. Three studies compared a group of patients with ETO PJI with a group of patients with non-ETO PJI.…”