Question:My wife had a very complicated hip surgery to revise the first hip replacement she got last year. They had to cut off part of her hip bone and then reattach it with wires. X-rays show that the wire didn't hold the bone in place and it has slid up. We're trying to decide what to do. Can she avoid another surgery?
Answer:The operation to remove a portion of the femur is called a trochanteric osteotomy. This is done to help give the surgeon better access to the hip joint. It's a procedure used most often in complex cases requiring revision surgery of a total hip replacement already in place.
The trochanteric bone removed is reattached using a wire or cable system of fixation. Sometimes the device breaks or it isn't tightened enough and the bone migrates (moves).
Trochanteric migration can be a major complication. It causes the hip muscles to lose their mechanical advantage. Walking without pain and/or a limp may become impossible.
The surgeon will use X-rays to measure how much the fragment has moved. Migration less than two centimeters can be watched and monitored carefully. If functional changes are already present, then surgery to stabilize the fixation is usually advised.Gregg J. Jarit, MD, et al. Fixation Systems of Greater Trochanteric Osteotomies: Biomechanical and Clinical Outcomes. In Journal of the American Academy of Orthopaedic Surgeons. October 2007. Vol. 15. No. 10. Pp. 614-624.
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