Abstract
Revision arthroplasty poses many challenges including extensile exposure and difficulty in safe removal of cemented/uncemented femoral component and/or distal cement particularly from a poor bone stock. Extended trochanteric osteotomies are associated with complications including non-union, proximal migration of the trochanter or osteotomised segment, wire breakage and difficulties associated with reattachment of the fragment. We present a technique of trochanter sparing extended anterior femoral osteotomy (AFO) through a modified Hardinge approach in reducing the difficulties associated in conventional and ETO. We assessed the performance of this technique in 23 patients with a maximum follow-up of 10 years. No trochanteric escape or fractures seen in any cases. No proximal migration, subsidence or failure of femoral component seen. Union was seen in all cases. Mean time for union was 3 months. 1 patient developed recurrent dislocations that required constrained liner.
Improvement in Harris Hip scores was noted from 13 (pain) and 9 (function) pre-operatively to 39 (pain) and 22 (function) (p<0.05). Extended trochanter sparing AFO allows extensive exposure similar to traditional ETO. It heals reliably without the use of vertical wires, trochanteric plates or grips. The avoidance of abductor mechanism and osteotomy through weakest anterior non weight bearing area of the proximal femur may be a significant advantage.
