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Georgeanu VA, Atasiei T, Predescu V, Gheorghiu N, Feier AM, Russu OM. Transfemoral Approach in Revision Hip Arthroplasty; a Prospective Analysis of 36 Cases: Radiological and Functional Results at a Minimum 2 Years Follow-up. Medicina (B Aires) 2022; 58:medicina58020237. [PMID: 35208559 PMCID: PMC8879778 DOI: 10.3390/medicina58020237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: One of the most difficult aspects of hip revision is to remove the stem from the femoral canal with or without cement while maintaining the maximal amount of bone stock to obtain the best possible press-fit of the revision prosthesis. The transfemoral approach ensures direct access to the medullary canal so that the content removal is completed under direct control, while protecting the bone. This type of approach is particularly efficient for special conditions, such as deformation of the proximal femoral region, broken stems, or the presence of cement over a long distance distal to the prosthesis. The aim of this study was to evaluate the main advantages of transtrochanteric approach in hip revisions. Materials and Methods: Our series included 36 revisions performed using the transfemoral approach. We have analyzed the following postoperative radiological aspects: the length of the fixation zone distal to the osteotomized bone fragment (OBF), the gap between the OBF and the diaphysis, stem subsidence over time, and OBF consolidation. Results: The results were very good, both in terms of the rate of intraoperative complications and postoperative evolution. The fixation zone length was 4.2 cm on average (range: 2 to 5.8 cm). The distal gap between the OBF and the diaphysis was 1.2 cm on average (range: 0 to 2.3 cm). Stem subsidence was noted in four cases (11.1%). In all cases, stem subsidence occurred between three and six months and was 6 to 8 mm without affecting hip stability. OBF consolidation was radiologically confirmed for all cases at one year follow-up. Clinical assessment based on the Harris Hip Score showed an overall improvement from 43.2 preoperatively to 79.7 at 12 months and 83 at two years, respectively. The most important rate of progress was between 6 months and 12 months. Conclusions: The transtrochanteric approach has been shown to be very efficient for hip revisions. Understanding the hip biomechanics, applying a less aggressive surgical technique, and using efficient fixation methods such as cables significantly improved the results.
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Affiliation(s)
- Vlad Alexandru Georgeanu
- Department of General Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (T.A.); (N.G.)
- Clinic of Orthopaedics and Trauma Surgery, “St. Pantelimon” Hospital, 021659 Bucharest, Romania
- Correspondence: ; Tel.: +40-722-821-344
| | - Tudor Atasiei
- Department of General Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (T.A.); (N.G.)
- Clinic of Orthopaedics and Trauma Surgery, “St. Pantelimon” Hospital, 021659 Bucharest, Romania
| | | | - Nicolae Gheorghiu
- Department of General Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (T.A.); (N.G.)
- Department of Orthopaedics and Traumatology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Andrei Marian Feier
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (A.M.F.); (O.M.R.)
- Department of General Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, 540139 Tîrgu Mureș, Romania
| | - Octav Marius Russu
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (A.M.F.); (O.M.R.)
- Department of General Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, 540139 Tîrgu Mureș, Romania
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Malahias MA, Gkiatas I, Selemon NA, De Filippis R, Gu A, Greenberg A, Sculco PK. Outcomes and Risk Factors of Extended Trochanteric Osteotomy in Aseptic Revision Total Hip Arthroplasty: A Systematic Review. J Arthroplasty 2020; 35:3410-3416. [PMID: 32800436 DOI: 10.1016/j.arth.2020.07.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/08/2020] [Accepted: 07/13/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although extended trochanteric osteotomy (ETO) is an effective technique for femoral stem removal and for the concomitant management of proximal femoral deformities, complications including persistent pain, trochanteric nonunion, and painful hardware can occur. METHODS The US National Library of Medicine (PubMed/MEDLINE) and the Cochrane Database of Systematic Reviews were queried for publications utilizing the following keywords: "extended" AND "trochanteric" AND "osteotomy." RESULTS Nineteen articles were included in the present study with 1478 ETOs. The mean overall union rate of the ETO was 93.1% (1377 of 1478 cases), while the overall rate of radiographic femoral stem subsidence >5 mm was 7.1% (25 of 350 cases). ETO union rates and femoral stem subsidence rates were similar between patients with periprosthetic fractures treated with total hip arthroplasty (THA) revision and ETO and patients treated with THA revision and ETO for reasons other than fractures. There was limited evidence that prior femoral cementation and older age might negatively influence ETO union rates. CONCLUSION There was moderate quality evidence to show that the use of ETO in aseptic patients undergoing single-stage revision THA is safe and effective, with a 7% rate of ETO nonunion and subsidence >5 mm in 7%. ETO can be safely used in cases with periprosthetic fractures in which stem fixation is jeopardized and a reimplantation is required. A well-conducted ETO should be preferred in selective THA revision cases to prevent intraoperative femoral fractures which are associated with deteriorated clinical outcomes. The use of trochanteric plate with cables should be considered as the first choice for ETO fixation.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Ioannis Gkiatas
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Nicolas A Selemon
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Roberto De Filippis
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Alex Greenberg
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
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Abstract
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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Affiliation(s)
- Kavin Sundaram
- Cleveland Clinic Foundation, Department of Orthopedics Cleveland, Ohio, USA
| | - Ahmed Siddiqi
- Cleveland Clinic Foundation, Department of Orthopedics Cleveland, Ohio, USA
| | - Atul F Kamath
- Cleveland Clinic Foundation, Department of Orthopedics Cleveland, Ohio, USA
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Wronka KS, Gerard-Wilson M, Peel E, Rolfson O, Cnudde PHJ. Extended trochanteric osteotomy: improving the access and reducing the risk in revision THA. EFORT Open Rev 2020; 5:104-112. [PMID: 32175097 PMCID: PMC7047899 DOI: 10.1302/2058-5241.5.190005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This review article presents a comprehensive literature review regarding extended trochanteric osteotomy (ETO). The history, rationale, biomechanical considerations as well as indications are discussed. The outcomes and complications as reported in the literature are presented, discussed and compared with our own practice. Based on the available evidence, we present our preferred technique for performing ETO, its fixation, as well as post-operative rehabilitation. The ETO aids implant removal and enhanced access. Reported union rate of ETO is high. The complications related to ETO are much less frequent than in cases when accidental intra-operative femoral fracture occurred that required fixation. Based on the literature and our own experience we recommend ETO as a useful adjunct in the arsenal of the revision hip specialist.
Cite this article: EFORT Open Rev 2020;5:104-112. DOI: 10.1302/2058-5241.5.190005
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Affiliation(s)
- Konrad Sebastian Wronka
- Department Of Orthopaedics, Prince Philip Hospital, Hywel Dda University Healthboard, Llanelli, UK
| | - Michell Gerard-Wilson
- Department Of Orthopaedics, Prince Philip Hospital, Hywel Dda University Healthboard, Llanelli, UK
| | - Elizabeth Peel
- Department Of Orthopaedics, Prince Philip Hospital, Hywel Dda University Healthboard, Llanelli, UK
| | - Ola Rolfson
- Department Of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Peter Herman Johan Cnudde
- Department Of Orthopaedics, Prince Philip Hospital, Hywel Dda University Healthboard, Llanelli, UK.,Department Of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
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Mei XY, Bhanot K, Tsvetkov D, Rajgopal R, Safir OA, Kuzyk PR. Current Uses of the Transtrochanteric Approach to the Hip: A Systematic Review. JBJS Rev 2018; 6:e2. [PMID: 29979233 DOI: 10.2106/jbjs.rvw.17.00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The indications and technique for the transtrochanteric approach to the hip have evolved greatly since its initial popularization in the 1960s. The purpose of this systematic review was to assess current uses of this approach on the basis of indications, osteotomy technique, trochanteric fixation method, complications, and functional outcome. METHODS A comprehensive search of MEDLINE and Embase databases from January 2000 to July 2017 was performed in accordance with the PRISMA guidelines. Articles were divided into 3 major categories on the basis of the type of hip surgery performed: (1) primary arthroplasty, (2) revision arthroplasty, and (3) joint-preserving procedures. Patient data were then analyzed according to these 3 categories. RESULTS Seventy-six studies (5,028 hips), mainly of Level-IV evidence, were included. Four types of osteotomy were reported for a variety of indications. Rates of nonunion were 6.0% (303 of 5,028) across all studies, 4.2% (39 of 921) for primary arthroplasty, 6.7% (114 of 1,690) for revision arthroplasty, and 4.4% (56 of 1,278) for joint-preserving procedures. Rates of dislocation were 1.5% (14 of 921) for primary arthroplasty and 4.6% (77 of 1,690) for revision arthroplasty. The rate of osteonecrosis after joint-preserving procedures was 1.1% (14 of 1,278). Rates of deep infection were 1.1% (55 of 5,028) across all studies, 0.1% (1 of 921) for primary arthroplasty, 2.1% (36 of 1,690) for revision arthroplasty, and 0.6% (8 of 1,278) for joint-preserving procedures. CONCLUSIONS The transtrochanteric approach remains useful in cases requiring extensile exposure of the acetabulum or femoral medullary canal. However, trochanteric complications continue to pose a clinical challenge. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Xin Y Mei
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
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Petrie MJ, Harrison TP, Buckley SC, Gordon A, Kerry RM, Hamer AJ. Stay Short or Go Long? Can a Standard Cemented Femoral Prosthesis Be Used at Second-Stage Total Hip Arthroplasty Revision for Infection Following an Extended Trochanteric Osteotomy? J Arthroplasty 2017; 32:2226-2230. [PMID: 28285036 DOI: 10.1016/j.arth.2017.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study was to review the results of the use of a cemented, standard length, taper-slip femoral component at second stage following an extended trochanteric osteotomy (ETO). METHODS We reviewed prospectively collected data from the hospital arthroplasty database, identifying and reviewing all patients who had undergone an ETO at first-stage revision for infection, who had subsequently undergone second-stage reimplantation. RESULTS Over 17 years, 99 patients underwent 102 2-stage procedures with ETO at first stage, with a mean follow-up of 5.5 years; 70 of 102 patients received a standard prosthesis following ETO union and 32 of 102 patients received a long-stem prosthesis at second stage because of deficiencies in proximal femoral bone stock. There was a significant difference in the Paprosky classification between the 2 groups (P < .0001); 77% of the standard group and 52% of the long-stem group had no complications. A significant complication (infection, fracture, or dislocation) was observed in 12% patients in the standard group and 16% patients in the long-stem group. A number of radiographs were independently reviewed to assess for ETO union and complications and an intraclass correlation of 0.84 (P < .0001) was observed. CONCLUSION A standard femoral prosthesis can be implanted at second stage following ETO union for Paprosky type I and some type II femora. There is no greater risk of complications, and distal bone stock is preserved for potential revision surgery in the future.
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Affiliation(s)
- Michael J Petrie
- Lower Limb Arthroplasty Unit, Orthopaedic Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Tim P Harrison
- Lower Limb Arthroplasty Unit, Orthopaedic Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Simon C Buckley
- Lower Limb Arthroplasty Unit, Orthopaedic Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Andrew Gordon
- Lower Limb Arthroplasty Unit, Orthopaedic Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Robert M Kerry
- Lower Limb Arthroplasty Unit, Orthopaedic Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Andrew J Hamer
- Lower Limb Arthroplasty Unit, Orthopaedic Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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Sambandam SN, Duraisamy G, Chandrasekharan J, Mounasamy V. Extended trochanteric osteotomy: current concepts review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:231-45. [DOI: 10.1007/s00590-016-1749-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
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