Outcomes and Risk Factors of Extended Trochanteric Osteotomy in Aseptic Revision Total Hip Arthroplasty: A Systematic Review

AimsTo present a surgically relevant update of trunnionosis.Materials and MethodsSystematic review performed April 2017.ResultsTrunnionosis accounts for approximately 2% of the revision total hip arthroplasty (THA) burden. Thinner (reduced flexural rigidity) and shorter trunnions (reduced contact area at the taper junction) may contribute to mechanically assisted corrosion, exacerbated by high offset implants. The contribution of large heads and mixed metallurgy is discussed.ConclusionIdentifying causative risk factors is challenging due to the multifactorial nature of this problem. Cite this article: Bone Joint J 2018;100-B(1 Supple A):44–9.

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Extended Trochanteric Osteotomy with Intermediate Resection Arthroplasty Is Safe for Use in Two-Stage Revision Total Hip Arthroplasty for Infection

Journal of Clinical Medicine ◽

10.3390/jcm11010036 ◽

2021 ◽

Vol 11 (1) ◽

pp. 36

Author(s):

Sebastian Hardt ◽

Vincent Justus Leopold ◽

Thilo Khakzad ◽

Matthias Pumberger ◽

Carsten Perka ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Femoral Fractures ◽

Revision Total Hip Arthroplasty ◽

Trochanteric Osteotomy ◽

Two Stage ◽

Total Hip ◽

Extended Trochanteric Osteotomy ◽

Revision Tha

Background: This study sought to compare the results of two-stage revision total hip arthroplasty (THA) for periprosthetic infection (PJI) in patients with and without the use of an extended trochanteric osteotomy (ETO) for removal of a well-fixed femoral stem or cement. Methods: Thirty-two patients who had undergone an ETO as part of a two-stage revision without spacer placement were matched 1:2 with a cohort of sixty-four patients of the same sex and age who had stem removal without any osteotomy. Clinical outcomes including interim revision, reinfection and aseptic failure rates were evaluated. Modified Harris hip scores (mHHS) were calculated. Minimum follow-up was two years. Results: Patients undergoing ETO had a significantly lower rate of interim re-debridement compared to non-ETO patients (0% vs. 14.1%, p = 0.026). Reinfection following reimplantation was similar in both groups (12.5% in ETO patients vs. 9.4% in non-ETO patients, p = 0.365). Revision for aseptic reason was necessary in 12.5% in the ETO group and 14.1% in the non-ETO group (p = 0.833). Periprosthetic femoral fractures were seen in three patients (3.1%), of which all occurred in non-ETO patients. Dislocation was the most common complication, which was equally distributed in both groups (12.5%). The mean mHHS was 37.7 in the ETO group and 37.3 in the non-ETO group, and these scores improved significantly in both groups following reimplantation (p < 0.01). Conclusion: ETO without the use of spacer is a safe and effective method to manage patients with well-fixed femoral stems and for thorough cement removal in two-stage revision THA for PJI. While it might reduce the rate of repeated debridement in the interim period, the use of ETO appears to lead to similar reinfection rates following reimplantation.

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Aseptic revision total hip arthroplasty in the elderly

The Bone & Joint Journal ◽

10.1302/0301-620x.100b2.bjj-2017-0895.r1 ◽

2018 ◽

Vol 100-B (2) ◽

pp. 143-151 ◽

Cited By ~ 20

Author(s):

P. Bovonratwet ◽

R. Malpani ◽

T. D. Ottesen ◽

V. Tyagi ◽

N. T. Ondeck ◽

...

Keyword(s):

Risk Factors ◽

Adverse Event ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

National Database ◽

Revision Total Hip Arthroplasty ◽

Serious Adverse Event ◽

Total Hip ◽

Revision Tha ◽

Aseptic Revision

AimsThe aim of this study was to compare the rate of perioperative complications following aseptic revision total hip arthroplasty (THA) in patients aged ≥ 80 years with that in those aged < 80 years, and to identify risk factors for the incidence of serious adverse events in those aged ≥ 80 years using a large validated national database.Patients and MethodsPatients who underwent aseptic revision THA were identified in the 2005 to 2015 National Surgical Quality Improvement Program (NSQIP) database and stratified into two age groups: those aged < 80 years and those aged ≥ 80 years. Preoperative and procedural characteristics were compared. Multivariate regression analysis was used to compare the risk of postoperative complications and readmission. Risk factors for the development of a serious adverse event in those aged ≥ 80 years were characterized.ResultsThe study included 7569 patients aged < 80 years and 1419 were aged ≥ 80 years. Multivariate analysis showed a higher risk of perioperative mortality, pneumonia, urinary tract infection and the requirement for a blood transfusion and an extended length of stay in those aged ≥ 80 years compared with those aged < 80 years. Independent risk factors for the development of a serious adverse event in those aged ≥ 80 years include an American Society of Anesthesiologists score of ≥ 3 and procedures performed under general anaesthesia.ConclusionEven after controlling for patient and procedural characteristics, aseptic revision THA is associated with greater risks in patients aged ≥ 80 years compared with younger patients. This is important for counselling and highlights the need for medical optimization in these vulnerable patients. Cite this article: Bone Joint J 2018;100-B:143–51.

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Trochanteric osteotomy in revision total hip arthroplasty

EFORT Open Reviews ◽

10.1302/2058-5241.5.190063 ◽

2020 ◽

Vol 5 (8) ◽

pp. 477-485

Author(s):

Kavin Sundaram ◽

Ahmed Siddiqi ◽

Atul F. Kamath ◽

Carlos A. Higuera-Rueda

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Vastus Lateralis ◽

Revision Total Hip Arthroplasty ◽

Trochanteric Osteotomy ◽

Transfemoral Approach ◽

Total Hip ◽

Aseptic Revision ◽

Extensile Approach ◽

Trochanteric Slide

Trochanteric osteotomy is a technique that allows expanded exposure and access to the femoral canal and acetabulum for a number of indications. There has been renewed interest in variants of this technique, including the trochanteric slide osteotomy (TSO), extended trochanter osteotomy (ETO), and the transfemoral approach, for both septic and aseptic revision total hip arthroplasty (THA). Osteotomy fixation is crucial for achieving union, and wire and cable-plate systems are the most common techniques. TSO involves the creation of a greater trochanter fragment with preserved abductor attachment proximally and vastus lateralis attachment distally. This technique may be particularly useful in the setting of abductor deficiency or when augmented acetabular exposure is needed. ETO is a posterior-laterally based extensile approach that has been successfully utilized for aseptic and septic indications; most series report a greater than 90% rate of union. The transfemoral approach, as known as the Wagner osteotomy, is an extensile femoral approach and is more anterior-based than the alternate posterior-based ETO. It may be particularly useful for anterior-based approaches and anterior femoral remodelling; rates of union after this approach in most reports have been close to 100%. Cite this article: EFORT Open Rev 2020;5:477-485. DOI: 10.1302/2058-5241.5.190063

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