JBJS - 2026-06-02 - Journal Article
The Extended Lesser Trochanteric Osteotomy (ELTO) in Complex Revision Hip Arthroplasty: An Alternative to the Extended Trochanteric Osteotomy (ETO).
Farid YR
Topics
Key Takeaway
The ELTO preserves abductor attachment by incorporating the lesser trochanter and medial femoral cortex, potentially eliminating postoperative abduction bracing and protected weight-bearing compared to standard ETO.
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Summary
This paper describes the ELTO as an alternative to ETO in complex revision THA, incorporating the lesser trochanter and a variable length of medial femoral cortex to expose 3 sides of the femoral stem while preserving the abductor mechanism. The technique is proposed to be faster and shorter than ETO, with the key advantage of sparing the greater trochanter and abductor attachment. No outcome data or comparative numbers are provided in the available text.
Key Limitation
No clinical outcome data, union rates, or complication rates are reported, making it impossible to determine whether ELTO achieves equivalent stem exposure and superior functional recovery compared to ETO.
Original Abstract
The extended trochanteric osteotomy (ETO) has been a standard technique in complex revision hip arthroplasty. Despite the satisfactory healing rates with ETO, nonunion may occur, and failure of fixation and displacement of the trochanter may compromise abductor strength. The extended lesser trochanteric osteotomy (ELTO) is an alternative to the ETO in select patients that allows medial access to 3 sides of the femoral stem and incorporates the lesser trochanter along with a variable length of the medial femoral cortex, to which the iliopsoas tendon and adductors remain attached. The ELTO might be easier, faster, and shorter compared with the ETO while offering unobstructed exposure of 3 sides of the femoral stem. The most substantial advantage is the ability to spare the abductor attachment, eliminating the need for postoperative protected weight-bearing and abduction braces.