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Wednesday, March 15, 2000

Extended trochanteric osteotomy combined with coated prosthesis increases success rate

A union rate of 98 percent and excellent improvement in clinical function was achieved in 45 hips where extended trochanteric osteotomy was combined with a proximally coated medial load-bearing coated hip replacement prosthesis during total hip revision surgery. Additionally, 25 of 45 hips were followed for a minimum of two years (average follow-up 2 to 8 years) and had an osteotomy union rate of 100 percent, said co-author Michael E. Brend, MD, Center for Hip and Knee Surgery, Orthopaedics Indianapolis, who presented the results of his study in poster exhibits 62.

"Without the use of an extensively coated prothesis, an acceptable incidence of subsidence and trochanteric migration was seen early in the postoperative course and did not affect trochanteric union or restoration of function," said Dr. Brend. "The mean preoperative HHS was 48, which improved to 91 at most recent follow-up."

The preoperative diagnoses were: loose cemented stem, 11; loose uncemented stem, 7; broken stem, 2; periprosthetic fracture, 3; chronic dislocations, 1; and hip fracture nonunion, 1. The mean time to union was 3.8 months (range: 2-10 months) and the average osteotomy length was 12.5 cm from the tip of the greater trochanter (range: 8 to 9 cm). A combination of cortical and/or cancellous allograft bone graft was used in 23 hips and no femoral component was radiographically loose. Subsidence of the prosthesis, all less than 2 mm, was noted in three hips. Trochanteric migration was found in two hips: 1 and 3 mm respectively, prior to union.

A mild postoperative limp was seen in 24 percent, being severe in one case. Complications included three postoperative dislocations and two periprosthetic fractures.

Co-authors of the study with Dr. Berend are Merrill A. Ritter, MD, E. Michael Keating, MD, Philip M. Faris, MD, John B. Meding, MD and Brian M. Crites, MD, all from the Center for Hip and Knee Surgery, Orthopaedics Indianapolis.

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2000 Academy News March 15 Index B

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