Sliding Versus Step-Cut Trochanteric Osteotomy

The transtrochanteric approach offers a unique access to the hip allowing for a multitude of intracapsular procedures. Despite the attachment of the vastus lateralis, a slide (flat) osteotomy can sometimes be difficult to anatomically reduce and is less stable and, therefore, prone to malposition, secondary loss of reduction, and, as a consequence, impaired healing. Single-plane osteotomies are associated with inferior rotational stability as primary stability is limited, healing might occur with callus formation, and healing of the osteotomy requires partial weight-bearing for 6–8 weeks with restriction in range of motion (ROM). However, the slide osteotomy may be advantageous, especially when the trochanteric fragment requires substantial advancement or repositioning. In contrast, in a step-cut osteotomy, the two planes and the step in between neutralize the proximal pull of the gluteus medius and minimus and hence avoid secondary proximal displacement of the trochanteric fragment. In addition, the step improves the rotational stability of the osteotomy and partial weight-bearing can be reduced to 4 weeks without limiting ROM.