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The Journal of Bone and Joint Surgery 82:1215 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Extended Slide Trochanteric Osteotomy for Revision Total Hip Arthroplasty*

Wei-Ming Chen, M.D.{dagger}, James P. McAuley, M.D.{ddagger}, C. Anderson Engh, Jr., M.D.{ddagger}, Robert H. Hopper, Jr., Ph.D.{ddagger} and Charles A. Engh, M.D.{ddagger}

Investigation performed at the Anderson Orthopaedic Research Institute, Alexandria, Virginia
*One or more of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
{dagger}Department of Orthopaedics and Traumatology, Veterans General Hospital-Taipei, and Department of Surgery, School of Medicine, National Yang-Ming University, 201 Sec. 2 Shih-Pai Road, Taipei 112, Taiwan.
{ddagger}Anderson Orthopaedic Research Institute, 2501 Parkers Lane, Suite 200, Alexandria, Virginia 22306.

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.


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