Abstract
Introduction: Trochanteric osteotomy provides excellent exposure to perform hip replacement surgery. In the UK, 5.9% of primary hip replacements are performed using an osteotomy. Trochanteric non union is one of the complications of this approach. The aim of this study was to investigate the role of release of posterior trochanteric soft tissue release on the incidence of trochanteric non-union.
Method: We present the results of 100 patients who underwent primary cemented total hip replacement at our centre using the biplanar, intracapsular osteotomy. Group A (50 patients) had received a posterior trochanteric soft tissue release as part of the approach and Group B (50 patients) had not. Patients were followed up clinically and radiologically.
Results: In group A the trochanteric non union rate was 12% and in group B 2% (p< 0.05). According to the Hodgkinson’s classification of trochaneric non-union, all the non-unions in group A were grade 3 (> 1.5 cm migration) and group B was grade 2 (< 1.5cm migration).
Discussion: The two different techniques were examined on cadaveric specimens and it was noted that the obturator externus tendon was consistently cut as a part of the posterior soft tissue release. We conclude that this important structure should not be released as part of this approach to hip replacement. Obturator externus is an important adductor of the trochanter and preserving it decreases the incidence of trochanteric non-union.
Correspondence should be addressed to BHS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
