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Posterior Oblique Trochanteric Osteotomy for Revision Total Hip Arthroplasty

March 01, 2017

Contributors: Steven Andrew Stuchin, MD; Amos Dai, BS; Daniel James Kaplan, BA

Purpose: Polytethylene failure accounts for an increasing number of problems in total hip arthroplasty (THA). Bearing exchange often requires generous exposure of the joint, with extensive dissection of stabilizing soft tissue structures. This may lead to chronic instability despite well aligned components. Therefore the ideal approach to the hip provides adequate exposure while maintaining stabilizing structures. Greater trochanteric osteotomy as an approach to the hip was first described by Iyer in 1981. Since then, there have been several modifications and variations of this approach. This video describes one such modification, using heavy non-absorbable sutures rather than screws for fixation of the osteotomy. Methods: In this video, we present a 73-year-old male, 21 years after undergoing a THA. He had a recent dislocation and was found to have eccentricity of the femoral head in the socket and osteolysis with failing polyethylene on imaging. It was decided the patient would undergo a revision THA using the posterior oblique trochanteric osteotomy approach. An oblique osteotomy beginning just below the most posterior insertion of the abductors is carried distally and anteriorly to the insertion of the vastus where it is completed transversely. Attached to the osteotomy fragment are all the posterior soft tissues. The osteotomy may be reaffixed with heavy suture affording the opportunity for bone to bone healing, a watertight closure, and restoration of stability. Other than avoidance of hyperflexion and internal rotation beyond 5-10 degrees for four weeks, there are no activity or positional limitations. Results: This approach may be used in more extensive revisions as well, including those that require revision of the acetabular component of the hip replacement. The author’s clinical outcomes using this approach are promising. Thirty-five patients, 12 men 23 women, with diagnoses including: osteoarthritis 20, dysplasia four, rheumatoid arthritis eight, and femoral neck fracture four, underwent revision of: polyethylene and modular head 16, socket and modular head 17, femoral component one, revision of all components seven, staged with interval Girdlestone five, and Girdlestone one. There were no dislocations nonunions or medical sequelae. Conclusion: Osteotomy of the greater trochanter provides adequate exposure to the hip joint during revision THA while preserving the posterior soft tissue structures that stabilize the joint. The variation described in this video is especially useful for cases in which some degree of osteolysis has occurred.

Results for "Revision Hip Arthroplasty"