Select Femoral Revisions Without an Extended Trochanteric Osteotomy Demonstrated Excellent 10-Year Survivorship in Over 600 Revision Total Hip Arthroplasties.

BACKGROUND

Modern implants, instruments, and techniques afford femoral component revision without the utilization of an extended trochanteric osteotomy (ETO) in a subset of patients. The aim of this study was to evaluate the survivorship free of any revision and reoperation, radiographic results, complications, and clinical outcomes associated with femoral revisions performed without the use of an ETO.

METHODS

We retrospectively identified 624 revision total hip arthroplasties (THAs) in which the femoral component was revised without an ETO from 2005 to 2021 using our institutional total joint registry. The mean age was 68 years, 47% were women, and the mean body mass index was 30. Indications for revision THAs included aseptic loosening (61%), periprosthetic joint infection (PJI; 25%), adverse local tissue reaction (5%), dislocation (4%), and other (5%). Revisions, reoperations, stem subsidence, complications including intraoperative fractures, and clinical outcomes were studied. The mean follow-up was 5 years.

RESULTS

The 10-year survivorship free of revision for aseptic loosening of the femoral component, free of any revision, and free of any reoperation were 99, 86, and 80%, respectively. The leading causes of rerevision were dislocation (46%) and PJI (20%, half occurred in patients who had prior PJI). The mean stem subsidence was 0.7 mm, with 4% of the stems subsiding greater than five mm. There were 69 intraoperative fractures (11%), with most occurring during final stem insertion (46%) or removal of the femoral component (35%). Harris Hip scores improved from a mean of 58 preoperatively to 81 postoperatively (P < 0.0001).

CONCLUSIONS

In this large, single-institution study of over 600 revision THAs, we demonstrated excellent 10-year survivorship free of aseptic femoral component loosening of 99% when revised without an ETO. It is important to note this was a select group of patients amenable to stem removal and insertion without an ETO. Dislocation remains the leading cause of rerevision.