[The trochanteric flip osteotomy.].

GOAL OF SURGERY

Easy access to the posterior, superior and anterior joint capsule through an osteotomy which reduces the risk of complications and the incidence of non-union.

INDICATIONS

Hip joint revision with or without intertrochanteric osteotomy, periarticular ossifications, difficult total hip procedures, exchange procedures.

CONTRAINDICATIONS

Absolute: None Relative: Distal transfer of the trochanter.

PREOPERATIVE WORK UP

Radiographs in 2 planes (anterior-posterior pelvis+"false profile" hip).

POSITIONING AND ANAESTHESIA

Lateral decubitus. General anaesthesia.

SURGICAL TECHNIQUE

In lateral decubitus the greater trochanter will be osteotomized from posterior leaving a 1 to 1.5 cm thick bony wafer uniting the insertion of the gluteus medius and minimus with the origin of the vastus lateralis. The trochanteric crest remains untouched. After refixation with nonresorbable sutures #3 the fragment is not subjected to a unidirectional tension by the abductors which could interfere with the consolidation.

POSTOPERATIVE MANAGEMENT

Bed rest with lower limb in neutral position. Mobilization with 2 canes on the 2nd postoperative day. The timing of partial weight bearing depends on the type of surgery. Abductor exercises after 6 weeks.

POSSIBLE COMPLICATIONS

Bony wafer too thin or too thick. Inadequate refixation. Delayed consolidation. Cranial migration of the greater trochanter.

RESULTS

Between 1991 and 1994 41 patients were operated. Diagnoses, see Table 1. Method of refixation: see Table 2. After 21+/-9 months 39 patients could be reexamined clinically, and radiological after 17+/-11 months: 38 osteotomies consolidated. Cranial migration varied between 0 and 8 mm. 25 patients were free of symptoms, 12 had slight and 2 moderate pain over the trochanter. Avulsion of wire cerclage: 2, foreign body irritation: 2 necessitating implant removal.