Revision of total hip arthroplasty: clinical outcome of extended trochanteric osteotomy and intraoperative femoral fracture

In femoral revision arthroplasty the orthopaedic surgeon frequently has to decide between performing an extended trochanteric osteotomy or trying to remove the femoral stem without an osteotomy and taking the risk of an intraoperative fracture. As this decision is often hard to make this study compared intraoperative femoral fractures during stem removal with extended trochanteric osteotomies in femoral revision arthroplasties. Twenty-eight femoral revision arthroplasties with an extended trochanteric osteotomy were compared with forty-five intraoperative fractures during revision hip arthroplasty. Preoperatively and after a follow-up of 2.8 years the patients were examined clinically and radiologically. We found no osteosynthesis related complication in the extended trochanteric osteotomy group, but six in the fracture group. Furthermore fewer re-revisions were observed in the osteotomy group. Additionally, a significant better clinical and radiological outcome can be found in the extended trochanteric osteotomy group compared to the fracture group. The results of this study suggest that a well conducted extended femoral osteotomy should be discussed in special cases to prevent femoral fractures during stem and cement removal which would probably lead to a poor postoperative outcome.