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Nonunion of greater trochanter following total hip arthroplasty: Treated by an articulated hook plate and bone grafting

  • Original Article
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Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background:

Trochanteric osteotomy still has an important role in hip arthroplasty in cases of (1) preexisting developmental hip dysplasia with superior subluxation, (2) revision arthroplasty, specifically with acetabular component revision in the face of well-fixed femoral component, and (3) recurrent dislocation without component loosening or malalignment, in treatment of complicated trochanteric fixation in osteoporotic bone and nonunions may be difficult. This study reports the clinical outcomes of trochanteric fixation following total hip arthroplasty (THA) utilizing a hook plate construct in a cohort of ten patients.

Materials and Methods:

The Arbeitsgemeinschaft für Osteosynthesefragen (AO) articulated hook plate was used in nine cases of established approach related nonunion following THA and in one case of osteopenic bone during primary THA. All ten patients returned for interviews and clinical examination. The average time for clinical followup was 35 months (range 5–48 months). The mean age of the study cohort was 65 years (range 56–74 years). Time to union and incidence of postoperative complications were assessed.

Results:

Union occurred in all ten cases at an average of 3.3 months postoperatively. One patient developed symptomatic trochanteric bursitis and required plate removal. Another patient developed a superficial infection which was successfully treated with local wound debridement and antibiotics. A third patient developed a symptomatic neuroma at the site of the iliac crest bone harvest and was successfully treated with excision of the neuroma. No catastrophic implant failures occurred.

Conclusions:

The articulated design of the plate allows for ease in application and functional construct stability. The articulated hook plate is an option for fixation of osteopenic bone fragments and established nonunions of the greater trochanter.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Bern, Bern, Switzerland

    Maurice E. Müller

  2. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, 10003, New York, USA

    John T. Capo, Eduardo Gonzalez-Hernandez & Richard M. Hinds

  3. Miami Hand Center, Miami, FL, USA

    Diego L. Fernandez

Authors
  1. Diego L. Fernandez
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  2. John T. Capo
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  3. Eduardo Gonzalez-Hernandez
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  4. Richard M. Hinds
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  5. Maurice E. Müller
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Correspondence to John T. Capo.

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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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Fernandez, D.L., Capo, J.T., Gonzalez-Hernandez, E. et al. Nonunion of greater trochanter following total hip arthroplasty: Treated by an articulated hook plate and bone grafting. IJOO 51, 273–279 (2017). https://doi.org/10.4103/0019-5413.205680

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  • DOI: https://doi.org/10.4103/0019-5413.205680

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