Modified sliding trochanteric osteotomy in revision total hip arthroplasty.

Traditional trochanteric sliding osteotomy preserves the lateral aspect of the greater trochanter, the abductors, and vastus lateralis in continuity. Our modification uses a lateral approach to the hip and osteotomy immediately anterior to the insertion of the posterior capsule and external rotators onto the greater trochanter. The osteotomy and attached abductors and vastus lateralis are translated anteriorly, leaving the posterior capsule and external rotators attached to the proximal femur. This surgical approach preserves the posterior soft-tissue stabilizing structures that resist posterior dislocation of the hip. In a retrospective review of 2 consecutive 2-year series of acetabular component revisions only between 1997 and 2001, 4 of 27 acetabular revisions using a traditional trochanteric slide subsequently dislocated; only 1 of 30 subsequent cases using a modified sliding trochanteric osteotomy dislocated. Modified sliding trochanteric osteotomy facilitated surgical exposure and produced a trend toward a lower dislocation rate that did not reach statistical significance with the small numbers of patients available.

Complications of ilioischial reconstruction rings in revision total hip arthroplasty.

The complications, management, and outcome of a consecutive series of 61 ilioischial reconstruction rings performed by 1 surgeon over a 15-year period are reported. Structural corticocancellous allografts were used in 48 cases. Twenty-seven cases had no complications, 9 had medical complications, and 5 had complications related to femoral revision. Other complications included 4 sciatic and 2 peroneal nerve palsies, 4 rings that lost fixation, 1 possibly loose ring, 3 fractured flanges, 3 loose cups, 7 dislocations, and 3 deep infections. Success, defined as a stable reconstruction with no further acetabular revision and bone graft incorporation, was 76%. We recommend a constrained acetabular liner to avoid dislocation in selected cases, slotting the ischial flange into bone for further ring stability and protection of the sciatic nerve.