Reattachment of the migrated ununited greater trochanter after revision hip arthroplasty: The abductor slide technique - A review of four cases

Background: Proximal migration of the ununited greater trochanter following total hip arthroplasty may produce pain and substantial functional disabil ity. Successful reattachment of the migrated fragment is difficult followin g multiple hip procedures. The purpose of this report is to describe four p atients in whom a severely migrated trochanteric fragment was reattached su ccessfully with a modified Charnley-Harris wiring technique after subperios teal advancement of the abductor muscles from their origin on the iliac win g, Methods: This series consisted of one man and three women with an average a ge of sixty years (range, fifty-one to sixty-eight years) at the time of th e index procedure. The patients were followed for an average of eighty-one months (range, fifty-five to ninety-six months). All patients had undergone mobilization of the abductor muscles based on the superior gluteal neurova scular pedicle to aid with trochanteric reattachment, and all had undergone prior hip operations (average, two). Advancement of the abductor muscles w as achieved through a separate transverse curvilinear incision over the ili ac crest, and subperiosteal releases of the entire origins of the gluteus m inimus, medius, and maximus muscles from the ilium were performed. Results: Roentgenographic union of the trochanteric fragment occurred in al l four patients. There were three excellent functional outcomes (Harris hip scores of 90, 94, and 96 points) and one fair functional outcome (76 point s). The average improvement in the Harris hip score was 47.5 points (range, 35 to 58 points). Two patients continued to have a mild or moderate Trende lenburg gait postoperatively, Two patients had heterotopic bone formation o f no clinical importance. Conclusions: Use of this technique resulted in union of the greater trochan ter, pain relief, and decreased functional disability without major complic ations in these four patients. More widespread use of this technique may be indicated for the treatment of symptomatic nonunion of the greater trochan ter when the fragment cannot be reattached to its anatomical location with the hip in less than approximately 20 degrees of abduction.