The Impact of Extended Trochanteric Osteotomy with Cerclage Fixation in Revision Total Hip Arthroplasty for Prosthetic Joint Infection. The Journal of arthroplasty Whittaker, M. J., Arora, P., Huddleston, J. I., Goodman, S. B., Maloney, W. J., Amanatullah, D. F. 2022

Abstract

BACKGROUND: An extended trochanteric osteotomy (ETO) is a powerful tool for femoral component revision. There is limited evidence that directly supports its use in the setting of a prosthetic joint infection (PJI). Cerclage fixation raises the theoretical concern for persistent infection.METHODS: The institutional database included 76 ETOs for revision arthroplasty between January 1, 2008 and December 31, 2019. The cohort was divided based on indication for femoral component revision: PJI versus aseptic revision. The PJI group was subdivided based on second stage exchange versus retention of initial cerclage fixation. Operative time, estimated blood loss, complications, and rate of repeat revision surgery were evaluated.RESULTS: Forty-nine patients (64%) underwent revision for PJI and 27 patients (36%) underwent aseptic revision. There was no significant difference in operative times (p = 0.082), postoperative complications (p = 0.258), or rate of repeat revision surgery (p = 0.322) between groups. Of the 49 patients in the PJI group, 40 (82%) retained cerclage fixation while 9 (18%) had cerclage exchange. Cerclage exchange did not significantly impact operative time (p = 0.758), blood loss (p = 0.498), rate of repeat revision surgery (p = 0.302), or postoperative complications (p = 0.253) including infection (p = 0.639).CONCLUSION: An ETO remains a powerful tool for femoral component removal, even in the presence of a PJI. A multi-institutional investigation would be required to validate observed trends toward better infection control with cerclage exchange. Cerclage exchange did not appear to increase operative time, blood loss, or postoperative complication rates.

View details for DOI 10.1016/j.arth.2022.08.041

View details for PubMedID 36067886