Abstract
Aim: To study the complications of an extended lateral femoral osteotomy (after Paprosky) of the femur utilised for exposure in revision total hip replacement.
Method: A retrospective audit was performed of the senior author’s revision hip patients who had, at the time of surgery, an extended lateral femoral osteotomy for both deformity correction and to facilitate cement removal. No attempt was made to correlate the use of an osteotomy and operating time or overall results as no unbiased control group was available. The time to radiological union and complications of the procedure was reviewed to assess the safety of an osteotomy in one surgeon’s practice.
Results: Thirty patients with 31 osteotomies were reviewed, all with long-stem fully porous coated femoral stems. It was the senior author’s anecdotal opinion that osteotomy facilitated cement removal without canal perforation and was necessary for varus deformity correction in many patients. All osteotomies united without further procedures after an average of 22 weeks (range: 12 to 38 weeks). There was one fatigue fracture of the osteotomised fragment, one non-union of the greater trochanter and two cable failures; all without significant sequelae. There was one fracture of the medial proximal femur that required a period of four weeks of bed-rest; otherwise all patients were mobilised full weight bearing as tolerated. One patient had deep infection and a loose femoral component. Two patients had instability of the hip in the post-operative period.
Conclusion: We have shown that the osteotomy reliably united and was safe even with early full weight bearing, with few complications. Extended femoral osteotomy for deformity correction and cement removal in revision hip replacement is a safe and easy technique that reliably facilitates revision.
The abstracts were prepared by Professor Alan Thurston. Correspondence should be addressed to him at the New Zealand Orthopaedic Association, PO Box 7451, Wellington, New Zealand.
