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Department Of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
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This review article presents a comprehensive literature review regarding extended trochanteric osteotomy (ETO).
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The history, rationale, biomechanical considerations as well as indications are discussed.
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The outcomes and complications as reported in the literature are presented, discussed and compared with our own practice.
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Based on the available evidence, we present our preferred technique for performing ETO, its fixation, as well as post-operative rehabilitation.
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The ETO aids implant removal and enhanced access. Reported union rate of ETO is high. The complications related to ETO are much less frequent than in cases when accidental intra-operative femoral fracture occurred that required fixation.
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Based on the literature and our own experience we recommend ETO as a useful adjunct in the arsenal of the revision hip specialist.
Cite this article: EFORT Open Rev 2020;5:104-112. DOI: 10.1302/2058-5241.5.190005
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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Swedish Hip Arthroplasty Register, Gothenburg, Sweden
Department of Orthopaedics, Prince Philip Hospital, HDUHB, Wales
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Finnish Arthroplasty Register, Helsinki, Finland
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Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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The use of larger femoral head size in total hip arthroplasty (THA) has increased during the past decade; 32 mm and 36 mm are the most commonly used femoral head sizes, as reported by several arthroplasty registries.
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The use of large femoral heads seems to be a trade-off between increased stability and decreased THA survivorship.
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We reviewed the literature, mainly focussing on the past 5 years, identifying benefits and complications associated with the trend of using larger femoral heads in THA.
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We found that there is no benefit in hip range of movement or hip function when head sizes > 36 mm are used.
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The risk of revision due to dislocation is lower for 36 mm or larger bearings compared with 28 mm or smaller and probably even with 32 mm.
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Volumetric wear and frictional torque are increased in bearings bigger than 32 mm compared with 32 mm or smaller in metal-on-cross-linked polyethylene (MoXLPE) THA, but not in ceramic-on-XLPE (CoXLPE).
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Long-term THA survivorship is improved for 32 mm MoXLPE bearings compared with both larger and smaller ones.
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We recommend a 32 mm femoral head if MoXLPE bearings are used. In hips operated on with larger bearings the use of ceramic heads on XLPE appears to be safer.
Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170061.
