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Journal of Bone and Joint Surgery - British Volume, Vol 85-B, Issue 4, 510-516.
doi: 10.1302/0301-620X.85B4.13301  
Copyright © 2003 by British Editorial Society of Bone and Joint Surgery
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Trochanteric slide osteotomy in revision total hip arthroplasty for loosening

F. Langlais, MD, Professor and Chairman; J. C. Lambotte, MD, Orthopaedic Surgeon; Ph. Collin, MD, Orthopaedic Surgeon; F. Langlois, MD, Orthopaedic Surgeon; J. W. Fontaine, MD, Senior Registrar; and H. Thomazeau, MD, Assistant Professor

Orthopaedic Department, University Hospital Sud, 16 Boulevard de Bulgarie, 35203 Rennes, France.

Correspondence should be sent to Professor F. Langlais.

We used a trochanteric slide osteotomy (TSO) in 94 consecutive revision total hip arthroplasties (90 with replacement of both the cup and stem). This technique proved to be adequate for removing the components, with few complications (two minor fractures), and for implanting acetabular allografts (18%) and reinforcement devices (23%). Trochanteric union was obtained in most patients (96%), even in those with septic loosening (18/19), major femoral osteolysis (32/32), or previous trochanteric osteotomy (17/18). TSO is versatile, since it can be extended by a femoral flap (four cases) or a distal femoral window (eight cases). Despite significant bone loss, in 24% of the femora and 57% of the acetabula, favourable midterm results were achieved and only six reoperations were required, including two for trochanteric nonunion and two for loosening. It leaves the lateral femoral cortex intact so that a stem longer than 200 mm was needed in only 25% of patients. This is a considerable advantage compared with the extended trochanteric osteotomy in which the long lateral flap (12 to 14 cm) requires an average length of stem of 220 mm beyond the calcar.

TSO provides an approach similar in size to the standard trochanteric osteotomy but with a rate of nonunion of 4% versus 15%. It reduces the risk of difficulties with removal of the stem, and removes the need for routine distal anchoring of long revision stems. The limited distal femoral compromise is very important in patients with a long life expectancy.






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Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General