Extended Trochanteric Osteotomy (ETO) in Revision THR

Various surgical approaches have been described for revision hip arthroplasty. Approaches using extended trochanteric osteotomies (sometimes referred to as transfemoral approaches) offer some specific advantages. These include an excellent exposure to the acetabulum and even more of the femoral medullary canal. Extended trochanteric osteotomies (ETOs) can be performed by following the intermuscular and internervous plane between the superior gluteal nerve (gluteus medius and minimus) and direct nerve branches of the sacral plexus L5-S2 (piriformis and short external rotator muscles). It eases the removal of the cement mantel or well-ingrown stems in the revision setting and allows for preservation of posterior structures and short external rotators and maintains posterior joint stability. It offers the option to change the position of the greater trochanter (e.g., distalization). However, it requires refixation of the osteotomized fragment bearing risks of secondary displacement and nonunion during the rehab period.