Vol 32| Issue 1 | Jan – June 2019 | page: 7-10 | George Jacob, Vinay Jaison Chacko, Jacob Varghese
Authors: George Jacob [¹], Vinay Jaison Chacko [¹], Jacob Varghese [¹]
 Department Of Orthopaedics, VPS Lakeshore Hospital, Kochi, Kerala, India.
Address of Correspondence
Dr. George Jacob,
VPS Lakeshore Hospital, Kochi, Kerala, India.
Objective: Many studies assessing the outcomes of extended trochanteric osteotomy (ETO) and its role in revision
total hip arthroplasty (THA) have shown ETO to be an extremely useful tool in femoral stem explantation and reducing intra-operative fractures. However, the sagittal plane of the osteotomy means detachment of the abductor mechanism insertion and possible muscle injury. The removal of the trochanter also alters the horizontal offset of the affected hip. This can have an effect on hip biomechanics and result in a trendelenburg gait. We studied a small group of patients at our center for the incidence of abductor insufficiency post revision THA when combined with ETO.
Methods: 25 patients scheduled for revision THR with an average age of 55 years were assessed for abductor
insufficiency pre-operatively. Patients underwent revision THA performed by the senior author with use of an ETO for femoral stem explantation. Hip Harris scores, anteroposterior and lateral radiographs of the affected hip were taken pre and postoperatively at 6 weeks, 3 months, 6 months, 1 year and 2 years. Post oprative patients were assessed for abductor weakness, gait pattern and a trendelenburg test.
Results: Four osteotomy segments migrated more than 2mm on post-operative radiographs. The mean Harris Hip
Score improved from 35 to 81.4. A positive trendelenburg’s sign was noted in 14/25 patients. All patients had ≥5mm
decreased horizontal offset.
Conclusion: There is a significant incidence of abductor insufficiency in patients who have undergone ETO. It must
be further evaluated to determine the cause to reduced horizontal offset or muscle injury.
Keywords: Hip Replacement; Extended trochanteric osteotomy; Revision hip replacement; Abductor lurch;
1. Huo MH, Muller MS. What’s new in hip arthroplasty. Journal of Bone and Joint Surgery – Series A. 20042Oct;86(10):2341- 53.
2. Younger TI, Bradford MS, Magnus RE, Paprosky WG. Extended proximal femoral osteotomy: A new technique for
f e m o r a l r e v i s i o n a r t h r o p l a s t y. J A r t h r o p l a s t y. 1995;Jun;10(3):329-38.
3. Schurman D, Maloney W. Segmental cement extraction at revision total hip arthroplasty. Clin Orthop Relat Res
4. Papagelopoulos PJ, Trousdale RT, Lewallen DG. Total hip arthroplasty with femoral osteotomy for proximal femoral deformity. Clin Orthop Relat Res. 1996;Nov;(332):151-62.
5. Jando VT, Greidanus N V, Masri BA, Garbuz DS, Duncan CP. Trochanteric osteotomies in revision total hip arthroplasty: contemporary techniques and results. Instr Course Lect. 2005; ;54:143-55.
6. Paprosky WG, Martin EL. Removal of well-fixed femoral and acetabular components. American journal of orthopedics (Belle Mead, N.J.). 2002.; Aug;31(8):476-8.
7. Mardones R, Gonzalez C, Cabanela ME, Trousdale RT, Berry DJ. Extended femoral osteotomy for revision of hip
arthroplasty: Results and complications. J Arthroplasty. 2005;Jan;20(1):79-83.
8. Wronka KS, Cnudde PHJ. Union rates and midterm results after Extended Trochanteric Osteotomy in Revision Hip Arthroplasty. Useful and safe technique. Acta Orthop Belg. 2017;Mar;83(1):53-56.
9. Lerch M, von Lewinski G, Windhagen H, Thorey F. Revision of total hip arthroplasty: Clinical outcome of extended trochanteric osteotomy and intraoperative femoral fracture. Technology and Health Care. 2008;16(4):293-300.
10. R. M, M. G-W. Outcomes of extended trochanteric osteotomy using a postero-lateral hip approach for revision
total hip arthroplasty. HIP Int. 2012; 22(4): 403 – 485.
11. Noble AR, Branham DB, Willis MC, Owen JR, Cramer BW, Wayne JS, et al. Mechanical effects of the extended
trochanter ic osteotomy. J Bone Jt Surg – Ser A . 2005;Mar;87(3):521-9.
12. Wagner H. [Revision prosthesis for the hip joint in severe bone loss]. Orthopade. 1987;Aug;16(4):295-300.
|How to Cite this Article: Jacob G, Chacko V J, Varghese J. Is Abductor Lurch a certainty after Extended Trochanteric Osteotomy? Kerala Journal of Orthopaedics Jan-June 2019; 32(1): 7-10 .