title: Use of Cortical Strut Allograft After Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty.
abstract: Cortical strut allografts restore bone stock and improve postoperative clinical scores after revision total hip arthroplasty (THA). However, use of a cortical strut allograft is implicated in delayed healing of an extended trochanteric osteotomy (ETO). To date, there are no reports directly comparing ETO with or without cortical strut allografts.
  
  
  
  We reviewed prospectively gathered data on 50 revision THAs performed from 2004-2014 using an ETO. We compared the demographic, radiological, and clinical outcome of patients with (16 hips) and without (34 hips) cortical strut allograft after an ETO.
  
  
  
  There were no significant differences in Western Ontario McMaster Universities Osteoarthritis Index or Harris Hip Score between the ETOs with and without a cortical strut allograft. Fifteen of the ETOs (94%) with a cortical strut allograft and 31 of the ETOs (91%) without a cortical strut allograft were in situ at final follow-up (P = 1.000). A higher proportion hips with cortical strut allograft (100%, 16 patients) had preoperative Paprosky grade bone loss more than IIIA compared to those without allograft (29%, 10 patients) (P < .001). There were no differences in femoral stem subsidence (P = .207), alignment (P = .934), or migration of the osteotomized fragment (P = .171). Fourteen of the ETOs (88%) in patients with cortical strut allograft united compared to 34 ETOs (100%) in patients without allograft (P = .095).
  
  
  
  Our study shows that the use of cortical strut allograft during revision THA with ETO does not reduce the rate of union, radiological or clinical outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California; Department of Orthopaedic Surgery, National University Hospital, Singapore.
authors.forename: Chin Tat
authors.initials: CT
authors.lastname: Lim
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
authors.forename: Derek F
authors.initials: DF
authors.lastname: Amanatullah
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
authors.forename: James I
authors.initials: JI
authors.lastname: Huddleston
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Hwang
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
authors.forename: William J
authors.initials: WJ
authors.lastname: Maloney
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Goodman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016025:Bone Transplantation; D005260:Female; D005269:Femur / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D014184:Transplantation, Homologous
keywords: cortical strut allograft; extended trochanteric osteotomy; modular femoral stem; revision hip arthroplasty; total hip arthroplasty