Abstract
Background
An extended trochanteric osteotomy (ETO) is a widely used approach for revision hip arthroplasty. Following an ETO it is common practice to use a long stemmed femoral prosthesis at the second stage to bypass the osteotomy. We propose that at the second stage, if the osteotomy has united, it is appropriate to use a standard length prosthesis, which preserves bone stock for any future revisions.
Methods
We performed a retrospective review of our institution's prospective arthroplasty database, identifying all patients who had undergone an ETO at the first stage revision. A radiograph review was then performed and any subsequent complications recorded. A selection of patients radiographs were individually reviewed by three reviewers and intra-class correlation (ICC) was performed to assess intra-observer reliability.
Results
99 patients underwent 104 second-stage procedures (1 contralateral side, 4 further revisions for subsequent infection) with a mean follow-up of 5.5 years (56 days to 15 years). 72/104 (69%) patients received a standard prosthesis following ETO union and 32/104 (31%) received a long-stem prosthesis at second stage due to concerns regarding ETO union or lateral wall bone loss. Following a radiological review of all cases, 49 (71%) of the short stem group and 17 (52%) of the long stem group had no complications. A significant complication (infection, fracture or dislocation) was observed in 10 (18%) of the short stem group and 5 (16%) of the long stem. 22 patients’ radiographs were reviewed by 3 individual assessors to assess for ETO union and complications and an intra-class correlation (ICC) of 0.84 (p<0.0001) was observed.
Conclusion
We propose that standard length prostheses can be used following an ETO for infection if the osteotomy has united at the second stage with no greater risk of complications. This preserves distal bone stock for any future revision surgery that may be required.
