Extended trochanteric osteotomy: comparison of 3 modes of fixation: metallic wires, cables, plate, about a series of 157 cases

Introduction: The trans femoral osteotomy was initially described by Wagner in 1987 and the extended trochanteric osteotomy (ETO) was described by Younger et al. in 1995 and is considered to be the gold standard technique for removal of well-fixed femoral stems in revision total hip arthroplasty (THA). The purpose of this report is: to compare the different types of fixation metallic wires, cables, metallic reinforcement plate (MRP) we have used in revision THA where an ETO was performed; analyse the clinical and radiological outcomes of these devices at 1 year; analyse the complication. Material and method: It is a retrospective continuous monocentric series of 157 patients where an ETO was performed. It was fixed by an MRP in 17 patients, cables in 43, metallic wires in 97. The main outcome was the consolidation of the osteotomized femoral flap (OFF). Secondary outcomes were Postel Merle d'Aubigne score and complications occurred at 1 year follow up. Qualitative variable was presented as percentage, quantitative variables as mean or median, standard deviation and range. Result: 157 patients (73 - 46, 5% females) were included. Mean age at surgery was 66.7 year (sd=10.63). Mean interval between index surgery and revision was 11.07 year (sd=5.67). Causes for revision and bone defects were comparable. At 1 year OFF is healed without displacement in 82% with metallic wires, 70% with cables, 88% with MRP. Not significant. Discussion: Fixation of the femoral flap is a technical issue in ETO. Metallic wires and cables are the most commonly used to secure the fixation. Fixation with a metallic plate is reported in a few number of articles and may be helpful specially when a fracture of the OFF occurred during surgery.