REVISION PEARLS: ETO for Extensile Exposure with the Posterior Approach

    Editor’s Note: ICJR’s annual Revision Hip & Knee Course is one of the most popular continuing medical education activities we host. Due to the COVID-19 pandemic, however, the course – which would have started on Thursday, June 18 – had to be canceled this year. Although the course will not be held, this week we’ll be highlighting some of the highest-rated sessions from past meetings and offering a special discount for you to attend the course in 2021.

    When preparing for a revision total hip arthroplasty (THA), the surgeon’s “wish list” for the femoral side typically includes good exposure, efficient component and cement removal, and ease of component insertion.

    All of these can be facilitated by an extended trochanteric osteotomy (ETO) when performing THA through a posterior approach, according to Wayne G. Paprosky, MD, from Rush University Medical Center in Chicago, Illinois. Dr. Paprosky shared his thoughts on ETO at ICJR’s annual Revision Hip & Knee Course in Rochester, Minnesota.

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    An ETO presents the surgeon with a window of opportunity to deal with issues on the femoral side, Dr. Paprosky said, including:

    • Varus remodeling
    • Cement removal
    • Severe trochanteric osteolysis
    • Well-fixed stem removal
    • Abductor tensioning
    • Stimulation of osseous formation

    An ETO is most commonly done after dislocation of the hip, before stem removal, but it can also be done prior to dislocation in patients with scarring, abundant heterotopic ossification, or subsidence. Dr. Paprosky noted that an ETO can also be done after dislocation and after stem removal, but this is currently less common because fully porous-coated stems are less likely than older, cemented stems to loosen.

    During his presentation, Dr. Paprosky discussed and demonstrated his ETO technique with:

    • Difficult acetabular exposure
    • Removal of cement
    • Removal of a large proximal femoral component
    • Removal of a fully porous-coated stem
    • Varus remodeling
    • Vancouver B2 femoral fracture

    Click the image above to watch Dr. Paprosky’s presentation from ICJR’s annual Revision Hip & Knee Course.

    Disclosure: Dr. Paprosky has disclosed that he is a consultant for and receives royalties from Stryker and Zimmer Biomet and that he is a consultant for Intellijoint and Medtronic-Salient.