Outcomes of Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty for Periprosthetic Joint Infection: A Systematic Review

Salesky Madeleine, Shau David N, Barry Jeffrey
2021 Journal of Orthopedic Surgery and Techniques  
Extended trochanteric osteotomy (ETO) has been popularized as a technique to safely and efficiently remove femoral implants in revision hip arthroplasty [9] . Via a controlled Research Article Abstract Background: Extended trochanteric osteotomy (ETO) is a technique to remove well-fixed femoral stems in revision total hip arthroplasty (THA). ETO is commonly utilized in the setting of chronic periprosthetic joint infection (PJI). This article presents a systematic review concerning outcomes
more » ... ETO in the setting of PJI. Methods: The US National Library of Medicine (Pubmed/MEDLINE) and Embase were searched from 1980 to 2020 for publications using the keywords: ("extended" AND "trochanteric" AND "osteotomy" AND "infection"). The inclusion criteria were the following: (1) Human subjects of any age or gender, (2) Outcomes after two-stage exchange revision THA with ETO in patients with chronic periprosthetic joint infection, (3) Minimum of two years follow-up, (4) Minimum ten subjects, and (5) Included a measurable outcome (PROs, complication rates, functional scores, pain scale, union rate, or stem subsidence rate). Studies that did not delineate outcomes between aseptic vs. septic revision THAs were also excluded. Results: Following the PRISMA guideline for systematic reviews, six papers were analyzed comprising a total of 285 unique ETOs. The cohort included 140 male patients (50%). The average age was 64.9 years. The mean length of followup was 60.4 months. All ETOs were initiated in Stage 1 surgery and 96 required reopening in Stage 2 surgery. The ETO union rate was 94% with a mean time to union of 12.0 weeks. Complications included intraoperative fracture (8.4%), dislocation (7.0%), stem subsidence (6.0%), and aseptic loosening (1.1%). The average improvement in Harris Hip Score was 45.5 points. Reinfection free survival was achieved in 94.1% of cases. Conclusions: There is moderate quality evidence to support that ETO is safe and effective technique for patients undergoing THA revision for chronic PJI. ETO has a high union rate and does not appear to increase risk of infection recurrence or aseptic loosening. ETO is recommended in revision THA cases for PJI involving well-fixed femoral stems. Keywords ETO: Extended trochanteric osteotomy, Total hip arthroplasty, Revision total hip arthroplasty, Periprosthetic joint infection Check for updates opening of the proximal femur, this technique allows the surgeon to access the medullary canal and manipulate the femoral component while minimizing damage to remaining bone stock and the abductor musculature. Wide femoral exposure
doi:10.36959/453/562 fatcat:gq4fidzrd5durdfxouczvdg7uq