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Osteotomy in artificial femoral component revision with severe greater trochanter osteolysis

Objective: This retrospective study was aimed to evaluate the radiographic and clinical results of polyaxial locking compression osteosynthesis system and bone grafting for the Extended Trochanteric Osteotomy (ETO) in artificial femoral component revision with severe osteolysis of greater trochanter.

Methods: 38 consecutive patients were operated on for the ETO in artificial femoral component revision, with a mean follow-up of 48 months (range, 24-84 months). The trochanteric fixation was achieved with polyaxial locking compression osteosynthesis system on the lateral surface of the severe ostelyic greater trochanter. The bone graft was subsequently performed at the osteolytic site.

Results: Trochanteric union was achieved in all patients (100%). All the osteotomies were not displaced. The preoperative Harris hip score was 40.18 ± 6.23, at final follow-up, the Harris hip score was 81.45 ± 10.68, showing significant difference when compared with preoperative score (P=0.001). The muscle strength of the gluteus medius and gait were respectively evaluated in accordance with the standards of five classes and Trendelenburg sign, showing significant difference before and after operation (P<0.05). No cases needed painful hardware removal. Bony regeneration was an early and significant finding in most cases. We identified no evidence of breakage, bone obsorption or other complications directly attributable to the locking compression plate.

Conclusion: The severe ostelyic greater trochanter can be successfully fixed with polyaxial locking plates for the extended trochanteric osteotomy during total Hip Arthroplasty (THA) revision. We did not observe any complications directly related to the polyaxial locking compression osteosynthesis system.

Author(s): Xiao-hui Gu, Jun-ying Sun