Abstract
Implant, surgeon, and patient-related factors all contribute to the risk of revision requiring an ETO. It is shown in the literature that the ETO can be a successful and easy-to-be-performed technique, but it can also lead to a bunch of complications, like peri-prosthetic fracture, loosening of the implant, damage of the isthmus and especially nonunion of the greater trochanter, which could result in an insufficiency limping with positive Trendelenburg Sign.
We do not believe in the necessity of an extended trochanteric osteotomy, which is extremely rarely performed at our institution. In almost all cases, the stem can be removed using an endofemoral approach from the top. Special instruments are necessary, and retrograde slap hammers are helpful. In general, cortical windows may be required to gain access to the bone-implant interface, but only in cases of well-fixed cementless components or if the distal cement is difficult to reach and remove. A full range of narrow and wide osteotomes of various thicknesses should be available. Those are our most important tools. Multiple osteotomes, which are carefully driven between the interfaces from all sides, can be gradually wedged or forced out of their cement mantle, even if stemmed. Generally, cemented and cementless procedures could be considered for reconstruction. We recommend performing the procedure only when the surgeon is proficient. This papers tries to provide such strategies.
