RESULTS OF THE TROCHANTERIC SLIDE APPROACH FOR REVISION HIP ARTHROPLASTY SURGERY

Abstract

Introduction & Aims: Revision hip arthroplasty surgery is technically demanding and good exposure is a pre-requisite to successful re-implantation. The traditional pertro-chanteric approach gives circumferential exposure of the acetabulum and excellent exposure of the proximal femur. The Trochanteric Slide approach theoretically reduces the incidence of trochanteric pull off and non-union. The aim of this study was to establish the efficacy of the Trochanteric Slide approach to revision hip arthroplasty.

Materials & Methods: Fifty revision hip replacements were performed using the Trochanteric Slide surgical approach. Fixation of the osteotomy was performed with the Dall Miles cable grip system. All patients were prospectively followed for a minimum of 18 months (Mean 3.4 years). 36 of the revisions were for aseptic loosening, 6 for septic loosening, 3 for peri-prosthetic fracture and 5 for recurrent dislocation. In 19 cases, previous revision surgery had been performed.

Results: 8 of the 50 trochanteric re-attachments showed suggestion of movement from the immediate postoperative x-ray. 8 showed less than 5mm migration, 3 showed 5–10mm migration, 1 showed 10–15mm migration and 1 showed 15–20mm migration. Radiological union was definite in 38 cases. Probable union was observed in 5 cases and non-union in 7 cases. 36 hips had a positive Trendelenberg test prior to surgery compared to 11 cases at 12-month review. Trochanteric bursitis was present in 15 cases. Cable end fraying occurred in 8 cases. There were 2 instances of cable breakage and one instance of cable migration onto the prosthesis.

Conclusion: The authors feel that the trochanteric slide approach gives excellent exposure whilst retaining the distal tether of vastus lateralis. This distal tether when combined with cable grip fixation appears to give a good outcome with regards trochanteric migration but is prone to causing trochanteric bursitis.