Scientific Article   |    
Reattachment of the Ununited Greater Trochanter Following Total Hip Arthroplasty The Use of a Trochanteric Claw Plate
Moussa Hamadouche, MD, PhD; Boubker Zniber, MD; Valerie Dumaine, MD; Marcel Kerboull, MD; Jean Pierre Courpied, MD
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Investigation performed at the Department of Orthopaedic and Reconstructive Surgery (Service A), Centre Hospitalo-Universitaire Cochin-Port Royal, Paris, France

Moussa Hamadouche, MD, PhD
Boubker Zniber, MD
Valerie Dumaine, MD
Marcel Kerboull, MD
Jean Pierre Courpied, MD
Department of Orthopaedic and Reconstructive Surgery, Service A, Centre Hospitalo-Universitaire Cochin-Port Royal, 27 Rue du Faubourg St. Jacques, 75014, Paris, France. E-mail address for M. Hamadouche: moussah@club-internet.fr

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2003 Jul 01;85(7):1330-1337
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Background: The purpose of this retrospective study was to analyze the utility of a trochanteric claw plate in the treatment of an ununited greater trochanter following total hip arthroplasty.

Methods: From 1986 through 1999, seventy-two consecutive procedures to reattach an ununited greater trochanter were performed in seventy-one patients. The average age at the time of the index arthroplasty was 66.2 years. The arthroplasty that resulted in the nonunion of the greater trochanter was primary in fifty-four hips, a first revision in sixteen hips, and a second and third revision in one hip each. The mean duration between the hip replacement and the treatment of the nonunion was 8.1 months. The greater trochanter was fixed with the trochanteric plate alone in forty-eight hips and with the plate in conjunction with vertical wires in the remaining twenty-four hips. The average duration of follow-up was 5.1 years.

Results: Osseous union occurred in fifty-one of the seventy-two hips. There was a persistent nonunion in twelve hips and fibrous consolidation in the remaining nine hips. The mean time to osseous consolidation was 3.7 ± 2.1 months (range, two to twelve months). The mean Merle d'Aubigné hip score was 16.1 ± 2.4 points at the time of the latest follow-up. A highly significant improvement in function was achieved only in the group with osseous consolidation (p < 0.0001). The highest rate of osseous union was achieved when vertical wires had been used in conjunction with the claw plate. Union occurred in twenty-one of the twenty-four hips in that group (p = 0.025).

Conclusions: Nonunion of the greater trochanter following total hip arthroplasty can be successfully treated with a trochanteric claw plate. The use of adjunctive vertical wires results in better osseous contact and union.

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.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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