Autogeneic cancellous bone grafting following transtrochanteric hip arthroplasty. An attempt to facilitate union of the greater trochanter

A technique involving the use of autogeneic cancellous bone to facilitate union of the greater trochanter following hip arthroplasty via a transtrochanteric approach is presented. This technique has not been previously reported for a large series of patients. Two hundred thirty-five patients were treated with 286 hip arthroplasty procedures via a transtrochanteric approach. All trochanters were advanced 1-2 cm distally and reattached using a three-wire technique. In 111 procedures, cancellous bone taken from the excised femoral head or neck was placed at the inferior aspect of the osteotomy site. In the remaining 175 procedures, no bone grafting was performed. Retrospectively, the incidences of trochanteric nonunion at two-year follow-up evaluation for the nongrafted versus the grafted groups were as follows: 5.7% (10 of 175) versus 2.7% (3 of 111) overall incidence, 4.3% (6 of 139) versus 1.2% (1 of 85) in patients with no previous hip surgery, 8.7% (2 of 23) versus 0% (0 of 10) in patients with previous hip surgery (excluding previous hip arthroplasty), and 15.4% (2 of 13) versus 12.5% (2 of 16) in patients following revision arthroplasty. There was no significant difference in incidence of nonunion between the grafted versus nongrafted groups in any of these categories (chi-square analysis). However, a lower incidence of trochanteric nonunion was found for the patients with autografts in each category, which may indicate a beneficial effect of cancellous bone grafting following trochanteric osteotomy.