|
Year |
2002 |
|---|---|
|
Question Number |
254(2) |
|
Category |
Hip and Knee Reconstruction |
Question
Which of the following is considered a fundamental advantage when using the extended slide trochanteric osteotomy for revision total hip arthroplasty?
1- Only a small wafer of bone is removed from the greater trochanter
2- The sciatic nerve is more readily exposed and protected
3- The gluteus medius muscle is detached, allowing distal advancement of the greater trochanter
4- The greater trochanter may be reflected proximally, facilitating exposure of the acetabulum
5- The vastus lateralis muscle remains attached
Figures
Answer (click for answer)
Preferred response: 5
The extended slide trochanteric osteotomy is another exposure method available when planning complex revision total hip arthroplasty. It involves removal of a much larger fragment of the greater trochanter than more conventional osteotomies (answer 1 incorrect). The osteotomy extends distally into the lateral femoral diaphysis and preserves the attachment site of the vastus lateralis muscle (the correct answer 5). Thus, when completed, this osteotomy allows elevation and anterior retraction of the greater trochanteric fragment with both the abductor mechanism and vastus lateralis still attached to it (answer 3 incorrect). The greater trochanter cannot be reflected proximally as it is tethered by the preserved vastus (answer 4 incorrect). Sciatic nerve exposure is not improved (answer 2 incorrect). The theoretical advantages of this are extensive exposure of the femoral component, preservation of the blood supply to the trochanteric fragment, and a larger surface area for trochanteric reattachment.
The study sited retrospectively reviewed the results of 46 hip revisions in which an extended trochanteric slide was used. The rate of union of the osteotomy was 98%, which compared favorably with statistics for conventional osteotomies. There was a 24% complication rate (11 of 46), although only three complications directly involved the osteotomy itself (one nonunion and two fragment fractures). The author’s listed indications for the extended slide were (1) osteolysis or osteopenia of the greater trochanter rendering the bone inadequate for wire or cable fixation after conventional osteotomy; (2) proximal-medial bone loss requiring distal cable fixation for trochanteric reattachment; (3) the need to revise a well fixed cemented or extensively porous coated cementless component; or (4) angular deformity or the proximal femur that obstructs cement removal or component reimplantation.
Reference: Chen WM, McAuley JP, Engh CA Jr, Hopper RH Jr, Engh CA: Extended slide trochanteric osteotomy for revision total hip arthroplasty. J Bone Joint Surg Am 2000;82:1215-1219.