Combined Vertical and Horizontal Cable Fixation of an Extended Trochanteric Osteotomy Site

Background: The use of an extended trochanteric osteotomy facilitates exposure and aids in the removal of a well-fixed femoral implant and cement during revision total hip arthroplasty. Occasionally, nonunion, fracture, and trochanteric migration have been reported following osteotomy. We evaluated the rate of healing of the osteotomy site and of implant stability when fixation was accomplished with use of vertical trochanteric and horizontal metaphyseal cable fixation (combined cable fixation).

Methods: The clinical and radiographic results of revision total hip arthroplasty with use of an extended trochanteric osteotomy followed by implantation of a distally porous-coated component and combined cable fixation of the osteotomy site in forty-two consecutive patients (forty-three hips) were reviewed. Intraoperative fracture at the osteotomy site occurred in five hips (12%).

Results: All osteotomy sites healed by six months, with an average time to union of fifteen weeks. One implant subsided 5 mm in a patient in whom a fracture had occurred at the time of the osteotomy. No trochanteric migration occurred. Two patients required a reoperation: one because of instability, and another because of recurrent infection.

Conclusions: The extended trochanteric osteotomy facilitates revision of a well-fixed femoral component. Despite occasional intraoperative fracture at the osteotomy site, combined vertical trochanteric and horizontal metaphyseal cable fixation resulted in an excellent rate of healing and implant stability.

Levels of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.