Extended Trochanteric Osteotomy Combined with Medial Reduction Corticotomy to Correct Femoral Deformity at the Time of Revision Total Hip Arthroplasty

Abstract

Background: An extended trochanteric osteotomy (ETO) is commonly used to improve exposure and facilitate femoral component removal in revision total hip arthroplasty (THA). An additional medial corticotomy may be used in conjunction with an ETO to correct a femoral deformity, particularly varus remodeling in association with a failed femoral component. This study evaluated the outcomes of combining an ETO with a medial corticotomy in revision THA, with emphasis on implant fixation, femoral alignment, bone union, and clinical outcomes.

Methods: Of the 612 ETOs performed between 2003 and 2013, 13 patients (9 men and 4 women) underwent ETO combined with a medial corticotomy to correct varus remodeling, representing 2% of all ETOs during that period. The average follow-up was 8 ± 3.5 years. The mean age at surgery was 67 ± 13.5 years. The mean body mass index was 32 ± 7.7 kg/m². Radiographs were reviewed to measure preoperative and postoperative femoral deformity, time to consolidation, and femoral fixation. Clinical outcomes were evaluated using the Harris Hip Score (HHS).

Results: All patients had preoperative varus femoral deformity (mean 16.3° ± 5.7°). The mean postoperative alignment was 4.3 ± 1.6° varus achieving an average correction of 12° (95% CI -15.7 to -8.3, p < 0.0001). Both the ETO and the medial corticotomy consolidated in 10 of 11 patients (91%) with available 1-year radiographs at a mean of 11 ± 7.7 months. The mean HHS improved significantly from 42 preoperatively to 82 at 5-year follow-up (p = 0.0002). Complications related to the ETO and corticotomy occurred in 4 patients (30%), including 1 intraoperative fracture, 1 postoperative greater trochanteric fracture, 1 nonunion of the medial corticotomy, and 1 postoperative wound-hematoma. All femoral components remained well fixed at final follow-up.

Conclusion: The combination of ETO and medial corticotomy in revision THA effectively corrected femoral alignment in patients with a preoperative varus deformity and was associated with significant functional improvement at the final follow-up.

Level of evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.

Fig. 1

Fig. 1-A Preoperative anteroposterior radiographs, illustrating the anatomical axes of the proximal and distal femur. The preoperative varus angle is 20.1°. Fig. 1-B AP radiograph taken after revision total hip arthroplasty with combined ETO (blue arrow) and medial corticotomy (red arrow) shows a postoperative varus angle of 2°. Fig. 1-C AP radiographs taken 6 years postoperatively demonstrates complete healing of the medial corticotomy and maintained correction of the femoral varus deformity with stable alignment over time. No signs of implant loosening or complications are present, confirming the long-term success of the combined ETO and medial corticotomy technique. AP = anteroposterior, and ETO = extended trochanteric osteotomy.

Fig. 2

Figs. 2-A through 2-E Illustrations of a surgical technique combining a laterally based Paprosky ETO with a medial reduction corticotomy. ETO = extended trochanteric osteotomy.

Fig. 3

A 54-year-old man who underwent an ETO combined with a medial corticotomy for revision THA due to femoral varus deformity. Fig. 3-A Preoperative AP radiograph showing the varus femoral deformity. Fig. 3-B Immediate postoperative AP radiograph showing the revised femoral stem, the ETO (blue arrow), and the medial corticotomy (red arrow), with correction of the femoral varus deformity. Fig. 3-C AP radiograph 4 years postsurgery, demonstrating complete healing of both the ETO and medial corticotomy and sustained correction of the femoral varus deformity with continued alignment stability. No signs of implant loosening or complications are observed, and the femoral alignment remains well maintained, confirming the long-term success of the combined ETO and medial corticotomy procedure. AP = anteroposterior, ETO = extended trochanteric osteotomy, and THA = total hip arthroplasty.

Fig. 4

A 74-year-old man with underlying Paget disease who underwent ETO combined with medial corticotomy for revision THA due to femoral varus deformity. Fig. 4-A Preoperative AP radiograph demonstrating the varus femoral deformity with fracture and displaced right lesser trochanter containing a broken screw. Fig. 4-B One-month postoperative AP radiograph showing the ETO and medial corticotomy with correction of femoral varus deformity. Note the persistent gaps between the trochanteric fragment and the femoral shaft. Fig. 4-C Twelve-year postoperative AP radiograph showing the nonunion of medial corticotomy, ETO, and trochanteric fragments. AP = anteroposterior, ETO = extended trochanteric osteotomy, and THA = total hip arthroplasty.