Diego J Restrepo, Sergio F Guarin Perez, Ta-Wei Tai, Matthew P Abdel, Daniel J Berry, Rafael J Sierra
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This study evaluated the outcomes of combining an ETO with a medial corticotomy in revision THA, with emphasis on implant fixation, femoral alignment, bone union, and clinical outcomes.</p><p><strong>Methods: </strong>Of the 612 ETOs performed between 2003 and 2013, 13 patients (9 men and 4 women) underwent ETO combined with a medial corticotomy to correct varus remodeling, representing 2% of all ETOs during that period. The average follow-up was 8 ± 3.5 years. The mean age at surgery was 67 ± 13.5 years. The mean body mass index was 32 ± 7.7 kg/m<sup>2</sup>. Radiographs were reviewed to measure preoperative and postoperative femoral deformity, time to consolidation, and femoral fixation. Clinical outcomes were evaluated using the Harris Hip Score (HHS).</p><p><strong>Results: </strong>All patients had preoperative varus femoral deformity (mean 16.3° ± 5.7°). The mean postoperative alignment was 4.3 ± 1.6° varus achieving an average correction of 12° (95% CI -15.7 to -8.3, p < 0.0001). Both the ETO and the medial corticotomy consolidated in 10 of 11 patients (91%) with available 1-year radiographs at a mean of 11 ± 7.7 months. The mean HHS improved significantly from 42 preoperatively to 82 at 5-year follow-up (p = 0.0002). Complications related to the ETO and corticotomy occurred in 4 patients (30%), including 1 intraoperative fracture, 1 postoperative greater trochanteric fracture, 1 nonunion of the medial corticotomy, and 1 postoperative wound-hematoma. All femoral components remained well fixed at final follow-up.</p><p><strong>Conclusion: </strong>The combination of ETO and medial corticotomy in revision THA effectively corrected femoral alignment in patients with a preoperative varus deformity and was associated with significant functional improvement at the final follow-up.</p><p><strong>Level of evidence: </strong>Level IV. 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An additional medial corticotomy may be used in conjunction with an ETO to correct a femoral deformity, particularly varus remodeling in association with a failed femoral component. This study evaluated the outcomes of combining an ETO with a medial corticotomy in revision THA, with emphasis on implant fixation, femoral alignment, bone union, and clinical outcomes.</p><p><strong>Methods: </strong>Of the 612 ETOs performed between 2003 and 2013, 13 patients (9 men and 4 women) underwent ETO combined with a medial corticotomy to correct varus remodeling, representing 2% of all ETOs during that period. The average follow-up was 8 ± 3.5 years. The mean age at surgery was 67 ± 13.5 years. The mean body mass index was 32 ± 7.7 kg/m<sup>2</sup>. Radiographs were reviewed to measure preoperative and postoperative femoral deformity, time to consolidation, and femoral fixation. Clinical outcomes were evaluated using the Harris Hip Score (HHS).</p><p><strong>Results: </strong>All patients had preoperative varus femoral deformity (mean 16.3° ± 5.7°). The mean postoperative alignment was 4.3 ± 1.6° varus achieving an average correction of 12° (95% CI -15.7 to -8.3, p < 0.0001). Both the ETO and the medial corticotomy consolidated in 10 of 11 patients (91%) with available 1-year radiographs at a mean of 11 ± 7.7 months. The mean HHS improved significantly from 42 preoperatively to 82 at 5-year follow-up (p = 0.0002). Complications related to the ETO and corticotomy occurred in 4 patients (30%), including 1 intraoperative fracture, 1 postoperative greater trochanteric fracture, 1 nonunion of the medial corticotomy, and 1 postoperative wound-hematoma. 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引用次数: 0
摘要
背景：在翻修型全髋关节置换术（THA）中，扩大粗隆截骨术（ETO）通常用于改善暴露和促进股骨假体去除。额外的内侧皮质切开术可与ETO联合使用，以纠正股骨畸形，特别是与股骨假体失败相关的内翻重塑。本研究评估了ETO联合内侧皮质切开术在THA翻修术中的效果，重点是植入物固定、股骨对准、骨愈合和临床结果。方法：在2003年至2013年期间进行的612例ETO中，13例患者（9名男性和4名女性）接受了ETO联合内侧皮质切开术来纠正内翻重塑，占该期间所有ETO的2%。平均随访8±3.5年。平均手术年龄为67±13.5岁。平均体重指数为32±7.7 kg/m2。回顾x线片测量术前和术后股骨畸形，巩固时间和股骨固定。临床结果采用Harris髋关节评分（HHS）进行评估。结果：所有患者术前均存在股内翻畸形（平均16.3°±5.7°）。术后平均对准度为4.3±1.6°内翻，平均矫正度为12°（95% CI -15.7至-8.3,p < 0.0001）。11例患者中有10例（91%）的ETO和内侧皮质切开术在平均11±7.7个月的1年x线片中得到巩固。5年随访时HHS平均值由术前42分显著提高至82分（p = 0.0002）。4例（30%）患者发生与ETO和皮质切开术相关的并发症，包括术中骨折1例，术后大转子骨折1例，内侧皮质切开术不愈合1例，术后创面血肿1例。在最后的随访中，所有股骨部件都保持良好的固定。结论：ETO联合内侧皮质切开术翻修THA有效地纠正了术前内翻畸形患者的股骨对齐，并在最终随访时显著改善了功能。证据等级：IV级。参见《作者说明》获得证据等级的完整描述。
Extended Trochanteric Osteotomy Combined with Medial Reduction Corticotomy to Correct Femoral Deformity at the Time of Revision Total Hip Arthroplasty.
Background: An extended trochanteric osteotomy (ETO) is commonly used to improve exposure and facilitate femoral component removal in revision total hip arthroplasty (THA). An additional medial corticotomy may be used in conjunction with an ETO to correct a femoral deformity, particularly varus remodeling in association with a failed femoral component. This study evaluated the outcomes of combining an ETO with a medial corticotomy in revision THA, with emphasis on implant fixation, femoral alignment, bone union, and clinical outcomes.
Methods: Of the 612 ETOs performed between 2003 and 2013, 13 patients (9 men and 4 women) underwent ETO combined with a medial corticotomy to correct varus remodeling, representing 2% of all ETOs during that period. The average follow-up was 8 ± 3.5 years. The mean age at surgery was 67 ± 13.5 years. The mean body mass index was 32 ± 7.7 kg/m2. Radiographs were reviewed to measure preoperative and postoperative femoral deformity, time to consolidation, and femoral fixation. Clinical outcomes were evaluated using the Harris Hip Score (HHS).
Results: All patients had preoperative varus femoral deformity (mean 16.3° ± 5.7°). The mean postoperative alignment was 4.3 ± 1.6° varus achieving an average correction of 12° (95% CI -15.7 to -8.3, p < 0.0001). Both the ETO and the medial corticotomy consolidated in 10 of 11 patients (91%) with available 1-year radiographs at a mean of 11 ± 7.7 months. The mean HHS improved significantly from 42 preoperatively to 82 at 5-year follow-up (p = 0.0002). Complications related to the ETO and corticotomy occurred in 4 patients (30%), including 1 intraoperative fracture, 1 postoperative greater trochanteric fracture, 1 nonunion of the medial corticotomy, and 1 postoperative wound-hematoma. All femoral components remained well fixed at final follow-up.
Conclusion: The combination of ETO and medial corticotomy in revision THA effectively corrected femoral alignment in patients with a preoperative varus deformity and was associated with significant functional improvement at the final follow-up.
Level of evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.
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