MORBIDITY ASSOCIATED WITH TROCHANTERIC OSTEOTOMY IN RESURFACING

Abstract

The Ganz trochanteric flip osteotomy has gained popularity in recent years as a surgical approach that can be used when performing debridement surgery and hip resurfacing. The advantages include preservation of blood supply to the femoral head, maintenance of abductor strength and exposure. Morbidity associated with the trochanteric osteotomy is however a problem.

We reviewed the complications associated with the trochanteric flip in 367 patients that had undergone hip resurfacing arthroplasty. Pain, either felt deep within the groin or from prominent screws heads laterally was a significant problem for 96 patients (26.1%) and necessitated screw removal under general anaesthesia at a mean time of 16 months postop. Of these, 14 patients (14.5%) continued to have pain, with 8 patients proceeding to revision surgery; 5 for refractory pain, 1 for aseptic loosening, 1 for aseptic lymphocyte dominated vasculitis associated lesion (ALVAL) and 1 for acetabular soft tissue impingement.

Trochanteric non-union, leading to further surgery, was diagnosed in 24 patients (6.5%) whom underwent reattachment at a mean time of 6 months postop. Within this group the majority of patients were male (16), with a mean age of 53.5 years (range 35 to 65). Trochanteric non-union was associated with smoking, diabetes, obesity, age and non-compliance. Following reattachment surgery, all patients went on to union.

In total 120 patients experienced complications associated with the trochanteric osteotomy that resulted in a need for further surgery, a re-operation rate of 32.6%. Pain from trochanteric screws appears to be the over whelming issue. Surgeons using the trochanteric flip should be aware of the morbidity associated with the approach and counsel patients accordingly pre-operatively. Patients presenting with ongoing pain following screw removal should be investigated extensively for serious underlying problems.