Trochanteric Osteotomy

Types

 

1.  Standard trochanteric osteotomy

2.  Sliding trochanteric osteotomy

3.  Extended trochanteric osteotomy

 

Standard Trochanteric osteotomy

 

Standard Trochanteric OsteotomyStandard GT Osteotomy Wire Fixation

 

Concept

- detach GT with only abductors attached

 

Indication

- increasing exposure to acetabulum in difficult cases

- retensioning abductors

 

Problem

- difficulty fixation / unstable

- most hip surgeons now use sliding osteotomy

 

Technique

- detach proximal attachment of vastus lateralis

- pass retractor deep to G medius / minimus and superficial to capsule

- saw osteotomy from lateral aspect of GT angled up towards retractor

- detach any short external rotators and reflect superiorly

 

Fixation

- 3 - 4 intraosseous wires

- claw plate

 

GT Osteotomy Plate Fixation

 

Modification / Chevron Osteotomy

- increased stability

- decreased non union

 

Complications

- non union

- migration

- wire breakage / painful hardware

 

GT Osteotomy Broken WiresGT Osteotomy Broken WireGT Osteotomy Failed Plate

 

Trochanteric Slide

 

Concept

- PA osteotomy

- vastus lateralis and G medius left attached to fragment

- fragment retracted anteriorly

 

Advantage

- increased inherent stability

- vastus lateralis prevents proximal migration

 

Technique

- retractor superiorly deep to minimus and superior to capsule

- posterior elevation of vastus lateralis

- retractor under vastus lateralis insertion

- oscillating saw anterior to posterior

 

Fixation

- wires

- grip plate

 

Extended Trochanteric osteotomy

 

Concept

 

Osteotomy lateral 1/3 to 1/2 of trochanter & femur

- posterior to anterior longitudinal cut

- short distal transverse cut

- levers / hinges open anteriorly

- maintains anterior vasculature / muscle attachment

 

Indications


1.  Aid exposure
2.  Removal cement (especially infection)
3.  Removal well fixed uncemented prosthesis
4.  Removal cement plug / bone very poor / risk of perforation high
5.  Abnormalities of the proximal femur


Contraindications / Relative


1.  Impaction bone grafting
2.  Cementing revision prosthesis

 

Technique ETO
 

Length
- measured from tip GT
- 2 – 15 cm long

- determined from preoperative template
- need to preserve diaphysis if using distal press fit uncemented stem


Timing
- usually after implant removal
- may not be possible


Site
- elevate vas lateralis forward
- expose linea aspera
- expose posterior femur


Osteotomy
- use drill holes to mark osteotomy

- drill both cortices
- thin oscillating saw
- cut down through anterior and posterior femur in line with GT
- through both cortices
- transverse cut distally through 1/3 diameter
- lever open


Fixation
- 3 x cerclage cables
- protect sciatic nerve / palpate / pass wires posterior to anterior
- submuscular

 

Results
 

98 – 100% union rate by 6/12