JOA - 2026-05-21 - Journal Article
Select Femoral Revisions Without an Extended Trochanteric Osteotomy Demonstrated Excellent 10-year Survivorship in Over 600 Revision Total Hip Arthroplasties.
Owen AR, Dilger OB, Hannon CP, Bedard NA, Berry DJ, Abdel MP
Topics
Key Takeaway
Femoral revision THA without ETO achieved 99% 10-year survivorship free of aseptic femoral loosening in 624 carefully selected cases, with dislocation (46% of re-revisions) as the dominant failure mode.
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Summary
This study evaluated 10-year survivorship, radiographic, and clinical outcomes of femoral revision THA performed without ETO in 624 cases at a single institution from 2005–2021. Indications included aseptic loosening (61%), PJI (25%), and instability (4%); all cases were selected as amenable to stem removal and insertion without osteotomy. Survivorship free of aseptic femoral loosening was 99% at 10 years; survivorship free of any revision was 86% and free of any reoperation was 80%; Harris Hip Score improved from 58 to 81 (p<0.0001); intraoperative fracture rate was 11%.
Key Limitation
Selection criteria for ETO-free eligibility were not explicitly defined or reported, preventing reproducible application of these results to other surgeons' patient populations.
Original Abstract
BACKGROUND
Modern implants, instruments, and techniques afford femoral component revision without the utilization of an extended trochanteric osteotomy (ETO) in a subset of patients. The aim of this study was to evaluate the survivorship free of any revision and reoperation, radiographic results, complications, and clinical outcomes associated with femoral revisions performed without the use of an ETO.
METHODS
We retrospectively identified 624 revision total hip arthroplasties (THAs) in which the femoral component was revised without an ETO from 2005 to 2021 using our institutional total joint registry. The mean age was 68 years, 47% were women, and the mean body mass index (BMI) was 30. Indications for revision THAs included aseptic loosening (61%), periprosthetic joint infection (PJI; 25%), adverse local tissue reaction (5%), dislocation (4%), and other (5%). Revisions, reoperations, stem subsidence, complications including intraoperative fractures, and clinical outcomes were studied. The mean follow-up was five years.
RESULTS
The 10-year survivorships free of revision for aseptic loosening of the femoral component, free of any revision, and free of any reoperation were 99, 86, and 80%, respectively. The leading causes of re-revision were dislocation (46%) and PJI (20%, half occurred in patients who had prior PJI). The mean stem subsidence was 0.7 mm, with 4% of stems subsiding > five mm. There were 69 intraoperative fractures (11%), with most occurring during final stem insertion (46%) or removal of the femoral component (35%). Harris Hip scores improved from a mean of 58 preoperatively to 81 postoperatively (P < 0.0001).
CONCLUSION
In this large, single-institution study of over 600 revision THAs, we demonstrated excellent 10-year survivorship free of aseptic femoral component loosening of 99% when revised without an ETO. It is important to note this was a select group of patients amenable to stem removal and insertion without an ETO. Dislocation remains the leading cause of re-revision.