Background: The extended trochanteric osteotomy has been a useful
approach for patients undergoing revision total hip arthroplasty; however, it
has not been well described as an approach for those undergoing complex
primary total hip arthroplasty. The purpose of the present report is to
describe our experience with the use of an extended trochanteric osteotomy for
patients undergoing complex primary total hip arthroplasty.
Methods: Six patients underwent primary total hip arthroplasty with
use of an extended trochanteric osteotomy. The reasons for the use of this
technique included severe femoral deformity, removal of intraosseous hardware,
and high-riding developmental hip dysplasia. A fully porous-coated femoral
component with diaphyseal fixation was used for all reconstructions. The mean
age of the patients at the time of surgery was fifty-six years. Clinical and
radiographic evaluation was performed at a minimum of two years.
Results: After a mean duration of follow-up of fifty months, all
patients had an osseointegrated, stable femoral component. The site of the
extended trochanteric osteotomy healed in five of the six patients. One
patient had nonunion at the osteotomy site and a fracture at the base of the
greater trochanter, with a subsequent fracture of the femoral component. The
mean Merle D'Aubigné and Postel pain and walking scores improved from
2.2 and 2.3 preoperatively to 5.3 and 4.7 at the time of the final follow-up
(p < 0.001).
Conclusions: The extended trochanteric osteotomy is useful for the
correction of femoral deformity and facilitates the removal of intraosseous
hardware in carefully selected patients undergoing complex primary total hip
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.