Retrospective review of 166 revision hip arthroplasties reconstructed with an extended trochanteric osteotomy and an extensively porous-coated cementless stem. At mean 3-year, 9-month follow-up it asks how reliably the ETO unites and how well the revision stem achieves ingrowth. At the time it was the largest reported ETO series.
When you cannot remove a well-bonded cement mantle or a well-fixed cementless stem through a standard approach, the ETO is the exposure that gives direct axial access to the distal canal.
The key teaching point is vascular: standard trochanteric osteotomy divides the lateral circumflex branches feeding the trochanter and nonunion rates reach 13%. The ETO keeps the vastus lateralis and abductors on the fragment, preserving blood supply and dropping nonunion to about 1%.
Match the technique to the defect. Type 3B and 4 Paprosky femurs need diaphyseal fixation, and this paper shows an extensively coated canal-filling stem with 60+ mm of scratch-fit achieves ingrowth in over 90%. Anticipate two pitfalls: distal cortical cracks at the osteotomy tip (protect with a cerclage wire distal to it) and dislocation, the leading complication and reason for reoperation here.
Retrospective review of 166 revision hip arthroplasties reconstructed with an extended trochanteric osteotomy and an extensively porous-coated cementless stem. At mean 3-year, 9-month follow-up it asks how reliably the ETO unites and how well the revision stem achieves ingrowth. At the time it was the largest reported ETO series.
When you cannot remove a well-bonded cement mantle or a well-fixed cementless stem through a standard approach, the ETO is the exposure that gives direct axial access to the distal canal.
The key teaching point is vascular: standard trochanteric osteotomy divides the lateral circumflex branches feeding the trochanter and nonunion rates reach 13%. The ETO keeps the vastus lateralis and abductors on the fragment, preserving blood supply and dropping nonunion to about 1%.
Match the technique to the defect. Type 3B and 4 Paprosky femurs need diaphyseal fixation, and this paper shows an extensively coated canal-filling stem with 60+ mm of scratch-fit achieves ingrowth in over 90%. Anticipate two pitfalls: distal cortical cracks at the osteotomy tip (protect with a cerclage wire distal to it) and dislocation, the leading complication and reason for reoperation here.