Video Gallery

Video Gallery

To View the Video

Posterior Oblique Trochanteric Osteotomy for Revision Total Hip Arthroplasty

March 01, 2017

Contributors: Amos Dai, BS; Daniel James Kaplan, BA; Steven Andrew Stuchin, MD; Steven Andrew Stuchin, MD

Purpose: Polytethylene failure accounts for an increasing number of problems in patients who undergo total hip arthroplasty (THA). Bearing exchange often requires generous exposure of the joint with extensive dissection of stabilizing soft-tissue structures. This may lead to chronic instability despite well-aligned components. Therefore, the ideal approach to the hip provides adequate exposure and maintains stabilizing structures. Greater trochanteric osteotomy was first described as an approach to the hip by Iyer in 1981. Since then, several modifications and variations have been made to this approach. This video describes a modification that involves the use of heavy nonabsorbable sutures rather than screws for fixation of the osteotomy. Methods: This video discusses the case presentation of a 73-year-old man who underwent THA 21 years ago. He sustained a recent dislocation, and eccentricity of the femoral head in the socket and osteolysis with failing polyethylene were observed on imaging studies. The patient elected to undergo revision THA via the posterior oblique trochanteric osteotomy approach. An oblique osteotomy beginning just below the most posterior insertion of the abductors was carried distally and anteriorly to the insertion of the vastus, where it was completed transversely. The posterior soft tissues were attached to the osteotomy fragment. The osteotomy can be reaffixed with the use of heavy suture, affording the opportunity for bone-to-bone healing, a watertight closure, and restoration of stability. Postoperatively, hyperflexion and internal rotation beyond 5° to 10° should be avoided for 4 weeks. Results: This approach also can be used for more extensive revisions, including those that require revision of the acetabular component of the hip implant. The author’s clinical results associated with this approach are promising. Thirty-five patients (12 men and 23 women) with diagnoses including osteoarthritis (20 patients), dysplasia (four patients), rheumatoid arthritis (eight patients), and femoral neck fracture (four patients), underwent revision of a polyethylene and modular head (16 patients), a socket and modular head (17 patients), a femoral component (one patient), all components (seven patients), staged with interval Girdlestone (five patients), or Girdlestone (one patient). No dislocations, nonunions, or medical sequelae occurred. Conclusion: Osteotomy of the greater trochanter provides adequate exposure to the hip joint during revision THA and preserves the posterior soft-tissue structures that stabilize the joint. The variation described in this video is especially useful for patients with some degree of osteolysis.

Results for "Revision Hip Arthroplasty"

1 of 2
1 of 2

X