Trochanteric Osteotomy in Two-Stage Revision Total Hip Arthroplasty for Periprosthetic Joint Infection: A Retrospective Cohort Study.

Abstract

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. 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. 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. 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.