Trochanteric osteotomy versus posterolateral approach: function the first year post surgery. A pilot study

Abstract

BackgroundAlthough no prospective studies have compared functional results of trochanteric osteotomy and a non-trochanteric approach, most surgeons feel that trochanteric osteotomy is outdated in simple hip arthroplasty. Reasons not to perform an osteotomy include the fear of longer rehabilitation and worse (final) functional outcome.MethodThis prospective study examines differences in rehabilitation between posterolateral and trochanteric approach one year post-surgery using questionnaires (WOMAC, SF-36, HHS) and functional tests (walking, climbing stairs, rising from sitting, and strength tests). Of the 109 patients 24 had a trochanteric osteotomy: the selected approach was based on the surgeon's preference. The trochanteric osteotomy group included more patients with developmental dysplasia of the hip. Before the start of the study no power analysis was performed.ResultsData from the questionnaires showed no significant differences between the two groups at 3, 6 and 12-months follow-up. At 3-months follow-up patients in the trochanteric osteotomy group scored lower on the functional tests. This difference had disappeared at 6 and 12-months follow-up, except for abduction force which remained lower in the trochanteric osteotomy group in patients with a non union of the TO.ConclusionFor simple hip arthroplasty an approach without osteotomy seems a logical choice. Although the power of this study is low, in experienced hands trochanteric osteotomy seems to give good functional results at 6-12 months post surgery if trochanteric union is obtained. Therefore, one should not hesitate to perform an osteotomy in difficult cases.

Trochanteric osteotomy in primary and revision total hip arthroplasty: risk factors for non-union

“…Although most orthopedic surgeons nowadays prefer other less invasive approaches in routine primary THAs, the trochanteric osteotomy remains an eVective and safe approach in certain instances, particularly revision surgery [23][24][25], or severe hip dysplasia [26,27].…”

Effects of a Multicomponent Home-Based Physical Rehabilitation Program on Mobility Recovery After Hip Fracture: A Randomized Controlled Trial

“…Hip fractures can be treated surgically in various ways: total hip replacement, hemiarthroplasty (unipolar vs. bipolar, cemented vs. uncemented), screws, pins, sliding hip screw, intramedullary nail or fixed angle plate . The surgical approach varies as well: injury can be approached from the posterior or anterior side of the hip, or in some cases both approaches are required (van der Grinten et al 2011). The treatment decision depends on the fracture itself but also on the practice of the individual surgeon and the operating unit .…”

Trochanteric non-union following revision hip replacement is associated with a poor functional outcome: a matched, case-control study

“…The greater trochanter is the site of attachment of the abductor muscles. A non-union of the greater trochanter results in decreased abductor muscle power (5, 6). Reattachment of the migrated greater trochanter is difficult during revision total hip replacement and non-union rates after internal fixation vary between 9% and 28% (4, 7-9).…”