Trochanteric fixation in total hip arthroplasty using the S-ROM bolt and washer

We evaluated the S-ROM bolt and washer (DePuy, Inc, Warsaw, IN) for fixation of the greater trochanter after trochanteric osteotomy in 29 hips in 28 consecutive patients. Of 29 cases, 9 (31%) resulted in trochanteric nonunion, with bony union being achieved in only 38% of cases. There was dislocation and subluxation in 7 of 29 (24%) cases with 6 of the 7 dislocations associated with trochanteric nonunion. Revision was necessary in 4 of 8 hips to obtain fixation of the trochanter. The rate of complications in this series suggests that the S-ROM bolt and washer is associated with a high rate of nonunion, particularly in the multiply-revised hip. Avoidance of trochanteric osteotomy whenever possible would be desirable. When an osteotomy is necessary, alternative forms of fixation should be considered. Copyright 2002, Elsevier Science (USA). All rights reserved.