Extended Trochanteric Osteotomy for 2-Stage Revision of Infected Total Hip Arthroplasty Saam Morshed, MD, G. Russel Huffman, MD, MPH, and Michael D. Ries, MD Abstract: We evaluate the rate of osteotomy healing, implant stability, and eradication of infection when an extended trochanteric osteotomy, with interval placement of an antibiotic-impregnated cement spacer and delayed osteotomy fixation, is used to treat the chronically infected total hip arthroplasty. Thirteen cases were followed for a minimum of 2 years. All patients had complete healing of the extended trochanteric osteotomy within 6 months. At an average follow-up of 39 months, recurrent infection occurred in 3 (23%) patients. Femoral component subsidence of 5 mm occurred in 2 patients, both of which had recurrent infection. Extended trochanteric osteotomy with interval placement of an articulating antibiotic-impregnated cement spacer and delayed osteotomy fixation permits reliable healing of the osteotomy. Key words: extended trochanteric osteotomy, total hip arthroplasty, infection, revision hip, femoral revision. n 2005 Elsevier Inc. All rights reserved. Treatment of a chronically infected total hip arthroplasty requires 2-stage debridement with component removal, intravenous antimicrobial therapy, and delayed revision total hip arthroplasty to maintain hip function in most cases [1-3]. Removal of the well-fixed femoral stem in this setting can be challenging and risk damage to remaining bone stock. Usually, this requires the use of specialized manual instruments, power instruments, and ultrasonic devices. Trochanteric osteotomies and cortical windows have been de- scribed as useful means of gaining exposure for femoral component and cement removal. A stan- dard trochanteric osteotomy may provide adequate exposure, and a sliding trochanteric osteotomy prevents proximal migration should a nonunion occur [4]. However, removal of a well-fixed infected cemented or cementless femoral compo- nent may not be feasible without wide exposure of the femoral canal through an extended trochan- teric osteotomy [5-9]. Use of an antibiotic-impreg- nated cement spacer may also be helpful to deliver local antibiotics to the hip, maintain soft tissue tension and leg length, and permit patient mobility [10,11]. Once adequate control of infection is achieved, revision total hip arthroplasty may then be performed. Success rates of 80% to 95% have been reported with 2-stage debridement and delayed revision total hip arthroplasty [1-3,12-14]. The use of an extended trochanteric osteotomy in the setting of infection allows wide exposure for complete removal, debridement, and direct prepa- ration of the femoral canal. It can be used to remove cemented and cementless femoral implants and bypasses proximal bone deformities and protects weakened proximal bone from inadvertent injury. Moreover, proximal migration of the osteotomy is prevented by the vastus lateralis tether distally. Complications associated with the extended tro- chanteric osteotomy include nonunion, migration, and intraoperative or postoperative fracture. The The Journal of Arthroplasty Vol. 20 No. 3 2005 294 From the Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California. Submitted July 17, 2003; accepted September 18, 2004. No benefits of funds were received in support of the study. Reprint requests: Michael D. Ries, MD, Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Avenue (MU-320W), San Francisco, CA 94143. n 2005 Elsevier Inc. All rights reserved. 0883-5403/04/2003-0005$30.00/0 doi:10.1016/j.arth.2004.09.060