Background: The purpose of this study was
to assess the rate of union, time to union, and complications associated with
the extended slide trochanteric osteotomy. We also evaluated how
outcomes were influenced by the preoperative cortical-bone thickness,
the preoperative cancellous-bone quality of the greater trochanter,
the number of cables used to reattach the trochanteric osteotomy
fragment, and the use of cortical strut augmentation.
Methods: We reviewed the results for forty-six
hips in forty-five patients who underwent a revision total hip arthroplasty
with an extended slide trochanteric osteotomy between December 1991
and December 1996. Twenty-three patients were men, and twenty-two
were women; the mean age at the time of the operation was 66.3 years.
Two hips had an isolated acetabular revision, fifteen had an isolated femoral
revision, and twenty-nine had acetabular and femoral revisions.
One patient (one hip) was lost to follow-up.
Results: At a mean of forty-four months after
the operation, the rate of union of the distal osteotomy site was
98 percent (forty-four of forty-five hips), with no change in the
femoral component position. The time to union was not significantly
correlated with the number of cables, the preoperative cortical-bone
thickness, or the preoperative cancellous-bone quality of the greater
trochanter. Interestingly, the time to bridging-callus union was
significantly longer in the hips with a strut allograft than in
the hips without a strut allograft (p = 0.04, t test for independent
samples). Two fractures of the osteotomy fragment occurred, but
neither necessitated another revision.
Conclusions: The extended slide trochanteric
osteotomy allows extensive acetabular and femoral exposure, facilitates
removal of distal cement or a well fixed porous-coated stem, and
allows reliable reattachment and healing of the trochanteric fragment.