Is There a Role for Greater Trochanteric Osteotomies in Isolated Acetabular Revisions?

Background: The use of a greater trochanteric osteotomy (GTO) can improve exposure for complex total hip arthroplasty (THA) revisions. Although a GTOs is most commonly utilized when the femoral stem is revised or a complete revision is undertaken, this study sought to evaluate the frequency and outcome of cases where a GTO was performed without revision of the femoral component.

Methods: A retrospective analysis of an institutional database identified 1,691 THA revisions without femoral component revision, including 907 liner exchanges and 784 cup revisions, that had been performed from 1998 through 2020. The mean age at revision THA was 65 years, 57% (963 of 1,691) of THAs were performed in women, and the mean body mass index (BMI) was 27.9.

Results: A GTO was performed to aid with acetabular exposure in conjunction with 1.7% (28 of 1,691) of isolated acetabular revisions. Reasons for revision included 10 performed for cup loosening (36%), eight (29%) for pelvic discontinuity, five (18%) for instability, and five (18%) for polyethylene wear/osteolysis. The GTO procedures included 14 (50%) traditional, four (14%) extended traditional, six (21%) slides, and four (14%) extended slide osteotomies. The acetabular components included 16 custom triflange components, three cages, and nine porous hemispherical cups with a median diameter of 58 mm. The retained femoral components consisted of 15 extensively coated, 10 proximally porous coated, and three cemented stems. At a mean follow-up of 6.4 years, the most common complications included six greater trochanteric nonunions and four THAs with instability. None of the retained femoral components loosened as a result of the GTO and Harris Hip scores improved from a mean of 49 pre-revision to 60 at the most recent follow-up.

Conclusions: A GTO is rarely needed for isolated acetabular revision. With the numbers available, performing a GTO did not result in the loosening of a well-fixed stem. A GTO nonunion was the most common complication.