JOA - 2026-07-13 - Journal Article
Trochanteric Osteotomy in Two-Stage Revision Total Hip Arthroplasty for Periprosthetic Joint Infection: A Retrospective Cohort Study.
Entezari B, Hakim R, Cao K, Alrefai S, Axelrod D, Safir OA, Gross AE, Kuzyk PR
Topics
Key Takeaway
Trochanteric osteotomy during two-stage revision THA for PJI eliminated intraoperative periprosthetic femoral fractures (0% vs. 12.1% in non-osteotomy group, P=0.0059) without increasing blood loss or postoperative complication rates.
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Summary
This single-center retrospective study compared intraoperative and postoperative outcomes in 114 patients undergoing two-stage revision THA for PJI stratified by use of trochanteric osteotomy. Trochanteric osteotomy was associated with longer stage-1 operative time (165.0 vs. 148.7 min, P=0.0399) but zero intraoperative periprosthetic femoral fractures versus 12.1% in the non-osteotomy group (P=0.0059). Infection control by MSIS ORT criteria, EBL, and final ambulatory status did not differ between groups; trochanteric non-union occurred in 7 osteotomy patients, 2 requiring reoperation.
Key Limitation
The marked group size imbalance (81 vs. 33) and absence of standardized indications for osteotomy selection introduce substantial selection bias, making it impossible to determine whether fracture prevention reflects the osteotomy itself or avoidance of the most difficult extractions in the non-osteotomy group.
Original Abstract
BACKGROUND
Trochanteric osteotomy is a technique that may be utilized during revision to improve femoral component access and facilitate implant removal, yet its effect on surgical outcomes in the context of periprosthetic joint infection (PJI) remains uncertain. This study aimed to compare intra- and postoperative outcomes between patients undergoing two-stage revision for PJI who had and did not have a trochanteric osteotomy.
METHODS
A retrospective chart review was conducted at a single academic center, including 114 patients who underwent two-stage revision for PJI between 2000 and 2023. Patients were stratified into trochanteric osteotomy (n = 81) and non-trochanteric osteotomy (n = 33) groups. Baseline demographic and clinical variables were recorded. The primary intraoperative outcomes included surgical duration and estimated blood loss (EBL) at both stages. Postoperative outcomes included complications requiring reoperation, infection control based on the Musculoskeletal Infection Society (MSIS) Outcome Reporting Tool (ORT), and final ambulatory status.
RESULTS
Baseline characteristics were similar between groups. At the first stage, but not the second stage revision, trochanteric osteotomy was associated with significantly increased operative times (stage 1: 165.0 versus 148.7 minutes, P = 0.0399; stage 2: 143.7 versus 141.5 minutes, P = 0.7711). The EBL did not differ significantly. Notably, intraoperative periprosthetic femoral fractures occurred only in the non-trochanteric osteotomy group (12.1 versus 0%, P = 0.0059). There were seven trochanteric osteotomy patients who experienced non-union; two required a reoperation. Other postoperative complication rates, infection control, and final ambulatory status were similar.
CONCLUSION
The use of trochanteric osteotomy during two-stage revision for PJI was associated with longer operative times at the first stage, but did not increase blood loss or complication rates. Increased operative times may reflect case complexity in the trochanteric osteotomy group. The use of trochanteric osteotomy appears protective against intraoperative femoral fractures and may offer advantages in difficult femoral extractions. Judicious use of trochanteric osteotomy may enhance surgical safety in complex PJI revisions.