Minimally invasive hip and knee replacement surgery joseph gondusky, md virginia, usa 41,381 views. Extended trochanteric osteotomy for the treatment of. Twentythree patients were men, and twentytwo were women. Posterior oblique trochanteric osteotomy for revision total. The purpose of this study was to report the clinical outcome of revision total hip arthroplasty with the use of a modified extended trochanteric osteotomy eto in pff treatment. Dec 01, 2001 read the extended trochanteric osteotomy in revision hip arthroplasty. Fourteen patients were identified having a minimum of 2year followup. The long modified extended sliding trochanteric osteotomy. Optimal fixation for the extended trochanteric osteotomy. Read the extended trochanteric osteotomy in revision hip arthroplasty.
A new technique to reattach an extended trochanteric osteotomy. An invitro testing approach was designed to record the loosening between the. We have been using this technique since 1991 on 157 cases of revision thas. Femoral component revision is the treatment of choice for vancouver type b2b3 periprosthetic femur fractures pffs. The purpose of the study was to describe the technique and the clinical results of the modified extended trochanteric osteotomy eto with a lateral approach to the hip. This osteotomy differs from those previously described, as it preserves the posterior part of the greater trochanter and its attached external rotators, the aim of this. This technique gains access to the femoral medullary canal without compromising the bone stock and aids removal of primary.
Extended trochanteric osteotomy is a safe and very useful technique that can be used in revision hip surgery. Each has unique indications, fixation techniques, and complications. Reclaim revision hip system via posterior eto extended. Pdf trochanteric osteotomy and fixation during total hip. Advantages of the extended trochanteric osteotomy include wide exposure to the acetabulum and femoral diaphysis and creation of increased surface area for fixation and healing of the osteotomy. Removal of wellfixed components in femoral revision. Pdf the extended trochanteric osteotomy eto is widely used for revision total hip arthroplasty tha. An invitro biomechanical study of different fixation. More than 80 publications referring to this technique can be found in pubmed. Modified extended trochanteric osteotomy for the treatment of. Extended trochanteric osteotomy for total hip revision.
Extended trochanteric osteotomy in complex primary total hip arthroplasty. Charnley felt that it was essential to move the trochanter laterally as an integral part of the low friction principle of his procedure. Solution system extended trochanteric osteotomy surgical. This osteotomy allows for a safe, efficient, and accurate method for revision of cemented or cementless femoral components. The goal of this study is to evaluate the efficacy of using an extended trochanteric osteotomy eto as. Extended slide trochanteric osteotomy for revision total. Osteotomy in artificial femoral component revision with. Clinical and radiographic evaluation was performed for all patients. When and how do i perform an extended trochanteric osteotomy. Trochanteric osteotomy and fixation during total hip. It facilitates removal of wellfixed cement mantles with a loose or well fixed.
Aug 01, 2016 posterior oblique trochanteric osteotomy for revision total hip arthroplasty. Whatever the choice, every effort must be made to leave soft tissue attached to the. Extended trochanteric osteotomy wheeless textbook of. The purpose of this study was to report the clinical outcome of revision total hip arthroplasty with the use of a modified extended trochanteric osteotomy eto in. Total hip arthroplasty tha without osteotomy of the greater trochanter is reported to have a shorter operating time 3060 min, less blood loss 12 units of blood, no trochanteric problems e.
Apr 03, 2008 the extended trochanteric osteotomy eto is widely used for revision total hip arthroplasty tha. Removal of solidly fixed implants during revision hip and knee arthroplasty 20 journal of. Extended trochanteric osteotomy eto is one of these solutions proposed to remove femoral implant in order to improve surgical technique as well as the clinical outcomes. Note that the trochanteric slide and the extended trochanteric osteotomy incorporate the origin of the vastus lateralis muscle, but the standard osteotomy does not. The fifth and final explantation technique discussed is an extended trochanteric osteotomy.
Use of the extended trochanteric osteotomy in treating prosthetic hip infection brett r. Results each of the five techniques are discussed in detail. Once used routinely, trochanteric osteotomy in total hip arthroplasty now is usually limited to difficult primary and revision cases. The goal of this study is to evaluate the efficacy of using an extended trochanteric osteotomy eto as part of a 2stage exchange procedure for prosthetic hip infections. The trans femoral osteotomy was initially described by wagner 1 in 1987 and the eto was described by younger et al. Arthroscopic labral repair and open derotational osteotomy for fai. It also provides excellent exposure of the acetabulum and can be employed to correct angular deformities of the proximal femur. Many variations in the technique have evolved recently, including the trochanteric slide and the extended trochanteric osteotomy, which have increased the flexibility and utility of trochanteric. Twentyeight femoral revision arthroplasties with an extended trochanteric osteotomy were compared with fortyfive intraoperative fractures during revision hip arthroplasty. This study examined the effects of the extended trochanteric osteotomy on the torsional strength of the femur with use of cadaver bones. Extended trochanteric osteotomy in its current form was described by.
The extended trochanteric osteotomy eto is widely used for revision total hip arthroplasty tha. Osteotomy eto in artificial femoral component revision with severe osteolysis of greater trochanter. Advantages of this technique are more predictable healing of the osteotomy, a decrease in intraoperative fractures and femoral perforations, direct access to the. The extended trochanteric osteotomy was introduced as a safe and effective exposure technique for revision hip surgery. This article presents the most common trochanteric osteotomy techniques for extension of the surgical approach the classical according to charnley, the trochanter slide, the extended trochanteric, and the stepped osteotomy as well as clinical results and biomechanical experiences. The use of extended trochanteric osteotomy in 2stage. Extended trochanteric osteotomy regardless of the initial approach selected posterior, lateral or anterior, it is obligatory that the approach be made via the transfemoral route wagner technique, with a large flap that includes the greater trochanter figure 1 instead of a simple trochanterotomy which. Revision total hip arthroplasty is a technically demanding procedure which has gained importance for more than two decades. Figure 1 from trochanteric osteotomy and fixation during. Both are modiwcations of charnleys traditional osteotomy, which facilitates excellent exposure of the hip while pre.
Figure 1 the paths of the standard trochanteric osteotomy a, the trochanteric slide b, and the extended trochanteric osteotomy c. The purpose of this study was to assess the rate of union, time to union, and complications associated with the extended slide trochanteric osteotomy. However, the approach requires some sort of fixation of the osteotomy fragment. The extended trochanteric osteotomy through the modified direct lateral approach in revision total hip arthroplasty is a reproducible and reliable technique with a lower dislocation rate but a. A 47yearold male presents with severe left thigh pain 1 year after total hip arthroplasty tha performed for a subtrochanteric femur fracture after a gunshot wound and a cephalomedullary nail was utilized for fixation. Extended trochanteric osteotomy when, how, why since the first description by wagner in 1987 the wagner osteotomy became in 1995 the socalled eto. We also evaluated how outcomes were influenced by the preoperative corticalbone thickness, the preoperative cancellousbone quality of the greater trochanter, the number of cables used to reattach the trochanteric osteotomy. We also evaluated how outcomes were influenced by the preoperative corticalbone thickness, the preoperative cancellousbone.
The extended trochanteric osteotomy in revision hip arthroplasty. Variations of the standard trochanteric osteotomy have been described such as the trochanteric slide35 and extended trochanteric osteotomy. Improved cementing techniques and removal of implants for reasons other than loosening also have added to the problem of femoral revision. Mechanical effects of the extended trochanteric osteotomy. The fourth technique is the performance of an anterior cortical window. The 4wire technique involves 2 vertical wires 1 anterior, 1 posterior. Removal of solidly fixed implants during revision hip and. Modified extended trochanteric osteotomy with preservation. Extended trochanteric osteotomy via the direct lateral. Furthermore, the surgical indications are discussed for each technique depending upon the characteristics of the implanted device cemented or cementless, porous coating location, and osseointegration.
Use of the extended trochanteric osteotomy in revision. An extended trochanteric osteotomy eto is a well established surgical technique to facilitate the. Reclaim revision hip system via posterior eto extended trochanteric osteotomy exposure eto featuring james germano. Shortcomings of the standard single plane trochanteric osteotomy, have lead to many modiwcations, particularly the anterior trochanteric slide osteotomy atso, 14 and the extended trochanteric osteotomy eto 15, 16. May 22, 2016 an extended trochanteric osteotomy eto was planned to assist with bypassing the distal pedestal, facilitate preparation of the femoral canal for the revision stem, and avoid difficulties secondary to the greater trochanter overhanging the shoulder of the femoral component, prohibiting simple extraction. James germano demonstrates how to properly prepare for extended trochanteric osteotomy eto exposure for revision hip replacement. Use of the extended trochanteric osteotomy in revision total. In my singlesurgeon practice, the incidence of trochanteric osteotomy in primary hip replacement is only 0. A new technique to reattach an extended trochanteric. Trochanteric osteotomies in revision arthroplasties, primarily the extended. This technique gains access to the femoral medullary canal without compromising the bone stock and aids removal of primary implant. The extended trochanteric osteotomy is appropriate for a number of surgical indications. The extended trochanteric osteotomy is widely used for revision tha. Use of the extended trochanteric osteotomy in treating.
Modified extended trochanteric osteotomy with preservation of. Trochanteric osteotomy in primary and revision total hip. Modified extended trochanteric osteotomy for the treatment. Oct 16, 2009 the extended trochanteric osteotomy in revision total hip arthroplasty is a well established technique to facilitate removal of cement from the femoral canal and extraction of well fixed cementless femoral stems. Trochanteric osteotomy versus posterolateral approach. The transfemoral osteotomy described by wagner 1 and the extended trochanteric osteotomy eto popularized by younger et al. We describe a novel technique to reattach the extended trochanteric osteotomy using a suture cord. Extended trochanteric osteotomy followed by cemented impaction. The extended trochanteric osteotomy through the modified direct lateral approach in revision total hip arthroplasty is a reproducible and reliable technique with a lower dislocation rate but a higher incidence of trochanteric fracture and escape than previously described with its use in the posterior approach. From the inception of total hip replacement surgery the role of osteotomy of the greater trochanter has been debated. A pilot study comparing 3 cables vs 2 cables, abstract the extended femoral trochanteric osteotomy allows excellent exposure of the proximal femoral canal, which facilitates resection of the canals contents during revision total hip arthroplasty. It was a nightmare for revision surgeons during its initial years of inception before the advent of extended trochanteric osteotomy eto. Based on the available evidence, we present our preferred technique for performing eto, its fixation, as well as post.
Trochanteric osteotomy of the femur in total hip replacement used to be a simple, stereotyped technique and was declining in frequency of use. This is especially true if cement is located beyond the anterior bow of the femur. Several osteotomies have been described in order to help achieve this goal. At this point, based on preoperative findings, surgeon preference and previous experience, an anterior lateral, posterior lateral, transtrochanteric or extended trochanteric osteotomy approach may be chosen. Extended slide trochanteric osteotomy for revision total hip. In certain revision tha situations, however, an extended osteotomy may be suboptimal and other tech. In femoral revision arthroplasty, removal of wellbonded cement can be extremely difficult, time consuming and damaging to the remaining bone.
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