JAAOS - 2026-05-11 - Journal Article
Immediate Weight Bearing Is Safe Following Combined Extended Trochanteric Osteotomy and Revision Total Hip Arthroplasty.
Abwini LZ, Tang A, Zeiman M, Andriani NT, Gillinov L, Shichman I, Schwarzkopf R, Liporace FA, Yoon RS
Topics
Key Takeaway
Immediate weight-bearing following ETO during revision THA achieved 86.8% bony union at a mean of 4.2 months with a 3.8% deep infection rate and significant HOOS JR improvement (16.4 to 3.5, p≤0.000001).
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Summary
This multicenter retrospective study evaluated the safety and efficacy of immediate weight-bearing protocols in 53 patients undergoing ETO during revision THA at two academic centers from 2014–2021. Bony union was achieved in 86.8% at a mean of 4.2 months, HOOS JR improved from 16.4 to 3.5 at one year (p≤0.000001), and ambulatory status improved in the majority. The 90-day complication profile included 3.8% deep infection, 9.4% revision surgeries, and 11.0% total revisions.
Key Limitation
The absence of a concurrent matched restricted weight-bearing control group prevents definitive causal attribution of outcomes to the immediate WB protocol rather than patient selection or surgeon factors.
Original Abstract
INTRODUCTION
An extended trochanteric osteotomy (ETO) is used in complex cases to enhance access to the femoral canal and aid implant and cement removal during revision total hip arthroplasty (RTHA). However, there is no consensus regarding postoperative rehabilitation protocols. The aim of this study was to assess the efficacy and safety of immediate weight-bearing (WB) protocols in patients undergoing ETO during RTHA.
METHODS
A multicenter retrospective review was conducted at two academic medical centers between 2014 and 2021 to identify patients undergoing an ETO during RTHA with a minimum 1-year follow-up. Thirty-nine patients underwent an immediate WB protocol postoperatively. Union rates, ambulatory status, 90-day orthopaedic-related complications, revision surgeries, revisions, and Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR) scores were collected.
RESULTS
Fifty-three patients were included in the final analysis. The average follow-up time was 15.8 ± 20.4 months, with a mean age of 63.7 ± 11.5 years. Bony union was achieved in 46 patients (86.8%). The mean earliest time to union was 4.2 ± 5.4 months. Average HOOS JR scores significantly improved from preoperative to 1-year follow-up (mean 16.4 ± 4.1 vs 3.5 ± 4.2), P ≤ 0.000001). At the final follow-up, ambulatory status improved, with fewer patients kept as non-weight bearing (11 (21.6%) versus 7 (15.2%)). Two complications (3.8%) due to deep infection, 5 revision surgeries (9.4%), and 6 revisions (11.0%) were observed within 90 days.
CONCLUSION
Most patients who underwent ETO during RTHA and were placed on an immediate WB protocol achieved union at 4.2 months on average. HOOS JR scores improved as early as 2 weeks. More importantly, a greater proportion of patients experienced an improved ambulatory status at the final follow-up. These findings suggest that an immediate WB protocol-particularly WBAT-may be effective and safely implemented in patients undergoing an ETO during RTHA.
LEVEL OF EVIDENCE
Level III retrospective cohort comparison study.