A fracture of the greater trochanter through an osteolytic lesion may occur
as a late complication after total hip arthroplasty. The optimal treatment for
this difficult complication remains controversial. We have treated this
problem with internal fixation and allogeneic bone-grafting at the time of
revision of a loose acetabular component.
We retrospectively reviewed the results of treatment of a fracture through
an osteolytic lesion of the greater trochanter in nineteen patients seen from
1996 to 2002. All fractures were treated with morselized allogeneic bone
grafts and wire fixation at the time of revision of a failed acetabular
component. Postoperative care included the use of an abduction orthosis and
protected weight-bearing for at least three months. Follow-up of all patients
consisted of radiographic examinations and clinical evaluation with use of the
Harris hip score.
At an average duration of 3.8 years after the revision, eighteen of the
nineteen fractures had healed. The average time to healing was five months.
The one treatment failure occurred in a patient who did not comply with the
use of an abduction orthosis. The average Harris hip score for all patients
improved from 32.5 points preoperatively to 91.2 points at the time of the
latest follow-up. Polyethylene wear and recurrent osteolysis of the greater
trochanter was noted in one hip at the eight-year follow-up examination.
Fractures of the greater trochanter associated with osteolytic lesions can
be effectively treated with open reduction, internal fixation with wire, and