Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-05-2012 | Hip Arthroplasty

Trochanteric osteotomy in primary and revision total hip arthroplasty: risk factors for non-union

Authors: Karl Wieser, Patrick Zingg, Claudio Dora

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 5/2012

Abstract

Background

Trochanteric osteotomies (TO) facilitate exposure and “true hip reconstruction” in complex primary and revision total hip arthroplasty (THA). However, non-union represents a clinically relevant complication. The purpose of the present study was to identify risk factors for trochanteric non-union.

Methods

All cases of THA approached by TO during the past 10 years were analyzed with respect to potential risk factors for non-union.

Results

In 298 cases complete data were available for analysis. Trochanteric union occurred in 80.5%, fibrous union in 5.4% and non-union 14.1%. Risk factor analysis revealed a four times higher risk for non-union in anterior trochanteric slide osteotomies compared to extended trochanteric osteotomies and a three times higher risk in cemented versus non-cemented stems. Multiple logistic regression analysis revealed patient’s age and use of cement to be independent risk factors for non-union.

Conclusions

Femoral cementation and increasing age negatively influence the union of trochanteric osteotomies.

Charnley J (1970) Total hip replacement by low-friction arthroplasty. Clin Orthop Relat Res 72:7–21PubMed

Charnley J (1972) The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br 54(1):61–76PubMed

Wiesman HJ Jr, Simon SR, Ewald FC, Thomas WH, Sledge CB (1978) Total hip replacement with and without osteotomy of the greater trochanter. Clinical and biomechanical comparisons in the same patients. J Bone Joint Surg Am 60(2):203–210PubMed

Mallory TH (1974) Total hip replacement with and without trochanteric osteotomy. Clin Orthop Relat Res 103:133–135PubMedCrossRef

Teanby DN, Monsell FP, Goel R, Faux JC, Hardy SK (1996) Failure of trochanteric osteotomy in total hip replacement: a comparison of two methods of reattachment. Ann R Coll Surg Engl 78(1):43–44PubMed

Amstutz HC, Maki S (1978) Complications of trochanteric osteotomy in total hip replacement. J Bone Joint Surg Am 60(2):214–216PubMed

Harris WH, Crothers OD (1978) Reattachment of the greater trochanter in total hip-replacement arthroplasty. A new technique. J Bone Joint Surg Am 60(2):211–213PubMed

Dall DM, Miles AW (1983) Re-attachment of the greater trochanter. The use of the trochanter cable-grip system. J Bone Joint Surg Br 65(1):55–59PubMed

Ritter MA, Eizember LE, Keating EM, Faris PM (1991) Trochanteric fixation by cable grip in hip replacement. J Bone Joint Surg Br 73(4):580–581PubMed

10.

Wroblewski BM, Shelley P (1985) Reattachment of the greater trochanter after hip replacement. J Bone Joint Surg Br 67(5):736–740PubMed

11.

Gottschalk FA, Morein G, Weber F (1988) Effect of the position of the greater trochanter on the rate of union after trochanteric osteotomy for total hip arthroplasty. J Arthroplast 3(3):235–240CrossRef

12.

Bal BS, Maurer BT, Harris WH (1998) Trochanteric union following revision total hip arthroplasty. J Arthroplast 13(1):29–33CrossRef

13.

English TA (1975) The trochanteric approach to the hip for prosthetic replacement. J Bone Joint Surg Am 57(8):1128–1133PubMed

14.

Glassman AH, Engh CA, Bobyn JD (1987) A technique of extensile exposure for total hip arthroplasty. J Arthroplast 2(1):11–21CrossRef

15.

Peters PC, Head WC, Emerson RH (1993) An extended trochanteric osteotomy for revision total hip replacement. J Bone Joint Surg Br 75(1):158–159PubMed

16.

Younger TI, Bradford MS, Magnus RE, Paprosky WG (1995) Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty. J Arthroplast 10(3):329–338CrossRef

17.

Nicholson P, Mulcahy D, Fenelon G (2001) Trochanteric union in revision hip arthroplasty. J Arthroplast 16(1):65–69CrossRef

18.

Archibeck MJ, Rosenberg AG, Berger RA, Silverton CD (2003) Trochanteric osteotomy and fixation during total hip arthroplasty. J Am Acad Orthop Surg 11(3):163–173PubMed

19.

McGrory BJ, Bal BS, Harris WH (1996) Trochanteric osteotomy for total hip arthroplasty: six variations and indications for their use. J Am Acad Orthop Surg 4(5):258–267PubMed

20.

Plausinis D, Haddad FS, Oxland TR, Duncan CP (2001) Trochanteric slide osteotomy: biomechanical considerations. Instr Course Lect 50:247–252PubMed

21.

Dostal WF, Andrews JG (1981) A three-dimensional biomechanical model of hip musculature. J Biomech 14(11):803–812PubMedCrossRef

22.

Charnley J (1979) Low friction arthroplasty of the hip. Springer, New YorkCrossRef

23.

Lim SJ, Moon YW, Park YS (2011) Is Extended trochanteric osteotomy safe for use in 2-stage revision of periprosthetic hip infection? J Arthroplasty 26(7):1067–1071PubMedCrossRef

24.

Stuchin SA, Millman JS (2011) Oblique posterior trochanteric osteotomy in revision total hip arthroplasty. J Arthroplast 26(3):472–475CrossRef

25.

Lakstein D, Kosashvili Y, Backstein D, Safir O, Gross AE (2010) Modified extended trochanteric osteotomy with preservation of posterior structures. Hip Int 20(1):102–108PubMed

26.

Hartofilakidis G, Babis GC, Georgiades G, Kourlaba G (2011) Trochanteric osteotomy in total hip replacement for congenital hip disease. J Bone Joint Surg Br 93(5):601–607PubMedCrossRef

27.

Van der Grinten M, Reijman M, Van Biezen FC, Verhaar JA (2011) Trochanteric osteotomy versus posterolateral approach: function the first year post surgery. A pilot study. BMC Musculoskelet Disord 12:138PubMedCrossRef

28.

Lakstein D, Kosashvili Y, Backstein D, Safir O, Gross AE (2010) Trochanteric slide osteotomy on previously osteotomized greater trochanters. Clin Orthop Relat Res 468(6):1630–1634PubMedCrossRef

29.

Sloan A, Hussain I, Maqsood M, Eremin O, El-Sheemy M (2010) The effects of smoking on fracture healing. Surgeon 8(2):111–116PubMedCrossRef

30.

Lehnhartz E (1959) Chemische physiologie. Springer, Berlin-Göttingen-Heidelberg

31.

Hupfauer W, Ulatowski L (1975) The temperature evolution of different bone cements during polymerisation. AOTS 72(2):174–184

32.

Hellman EJ, Capello WN, Feinberg JR (1998) Nonunion of extended trochanteric osteotomies in impaction grafting femoral revisions. J Arthroplast 13(8):945–949CrossRef

33.

Bal BS, Kazmier P, Burd T, Aleto T (2006) Anterior trochanteric slide osteotomy for primary total hip arthroplasty. Review of nonunion and complications. J Arthroplast 21(1):59–63CrossRef

34.

Kampshoff J, Stoffel KK, Yates PJ, Erhardt JB, Kuster MS (2009) The treatment of periprosthetic fractures with locking plates: effect of drill and screw type on cement mantles: a biomechanical analysis. AOTS 130(5):627–632

35.

Bowman KF Jr, Fox J, Sekiya JK (2010) A clinically relevant review of hip biomechanics. Arthroscopy 26(8):1118–1129PubMedCrossRef

36.

Charnley J, Cupic Z (1973) The nine and ten year results of low-friction arthroplasty of the hip. Clin Orthop Relat Res 95:9–25PubMed

Title: Trochanteric osteotomy in primary and revision total hip arthroplasty: risk factors for non-union
Authors: Karl Wieser
Patrick Zingg
Claudio Dora
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 5/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-011-1457-4

2024 ASCO Annual Meeting

Springer Medicine

Trochanteric osteotomy in primary and revision total hip arthroplasty: risk factors for non-union

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2012

The posterolateral approach for plating tibial plateau fractures: problems in secondary hardware removal

Primary results of Kienböck’s disease treated using balloon kyphoplasty system

Surgical outcomes and prognostic factors of cervical spondylotic myelopathy in diabetic patients

The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach

Temporary cement tectoplasty: a technique to improve prefabricated hip spacer stability in two-stage surgery for infected hip arthroplasty

Periarticular infiltration in total hip replacement: effect on heterotopic ossification, analgesic requirements and outcome