Optimal Fixation for the Extended Trochanteric Osteotomy

Principal Investigator: Robert T. Trousdale, M.D.
Project Coordinator: Qingshan Chen — chen.qingshan@mayo.edu

The number of prosthetic hip replacement surgeries performed in the United States is expected to increase as the population ages. As the number of primary hips increases, a corresponding increase in the number of revision surgeries is expected. Resection of the components and/or cement from a failed primary arthroplasty presents a difficult challenge to the surgeon. An extended trochanteric osteotomy was developed in part to address the problem of component and/or cement removal. The extended trochanteric osteotomy allows excellent exposure of the proximal femoral canal, which facilitates resection of the canal's contents. Once the proximal femoral canal has been evacuated and a new femoral component has been placed, the osteotomy should be fixed in proper position to allow for healing. The purpose of our study was to compare the fixation between 2 versus 3 cables when fixing an extended trochanteric osteotomy in an in-vitro biomechanical model. Paired cadaver femurs were loaded to failure. Movement at the osteotomy site prior to failure was recorded using a motion analysis system. No difference in stiffness or ultimate failure was found between 2 versus 3 cables. No clear advantage was seen by adding a third cable in a vertical position around the calcar.