Eur J Orthop Surg Traumatol (2018) 28:471–476
ORIGINAL ARTICLE • HIP - ARTHROPLASTY
Extended trochanteric osteotomy (ETO) ﬁxation for femoral stem
revision in periprosthetic fractures: Dall–Miles plate versus cables
Gerard A. Sheridan
· Adam Galbraith
· Stephen R. Kearns
· William Curtin
Colin G. Murphy
Received: 20 June 2017 / Accepted: 9 October 2017 / Published online: 20 October 2017
© Springer-Verlag France SAS 2017
Conclusion When utilising an ETO approach for femoral
stem revision in acute periprosthetic fractures, superior clini-
cal and radiographic outcomes can be achieved if ﬁxation
involves a cable–plate system instead of cables only.
Keywords Periprosthetic fracture (PPF) · Extended
trochanteric osteotomy (ETO) · Cable–plate · Cable
Post-operative periprosthetic fractures (PPFs) occurring in
total hip arthroplasty (THA) patients are a signiﬁcant source
of patient morbidity and mortality. They also place a large
strain on resources. Historically, the prevalence of PPF’s has
been described as ranging from 0.1 to 4% [1–4]. More recent
research by Katz et al.  reviewed a population base of over
32,000 THA’s and found a periprosthetic fracture prevalence
of 0.7% with an incidence of 26/10,000.
Extended trochanteric osteotomy (ETO) was originally
described by Wagner  as an eﬀective method of retrieving
femoral prostheses in revision hip arthroplasty procedures.
Modern-day reconstructive surgery regularly utilises this
approach for periprosthetic fractures as classiﬁed by Dun-
can and Masri  in their original paper as Vancouver-type
B2 and B3. Periprosthetic femoral fractures with a stable
stem may be treated with locking plates without the need for
stem revision through an ETO . In cases of femoral stem
revision in the context of a periprosthetic femoral fracture,
the ETO incorporates the fracture line into the dissection,
highlighting the diﬀerence between conventional ETO and
modiﬁed ETO for periprosthetic fracture revision. ETO is
most commonly utilised for revision of femoral components
for either aseptic loosening or in the context of infection.
Background Extended trochanteric osteotomy (ETO) is a
well-established surgical technique used for femoral stem
retrieval in revision hip arthroplasty procedures. Fixation of
ETO is commonly achieved through wire, cable or cable–
plate ﬁxation. No evidence exists to date to suggest which
method is superior when used in an acute traumatic setting.
Methods Thirty cases of acute periprosthetic fracture
requiring femoral stem revision with an ETO were iden-
tiﬁed over a 10-year period. Each case had a loose femo-
ral prosthesis which was revised using an ETO approach.
Nineteen of these were ﬁxed using cables only, and 11 were
ﬁxed using a cable–plate construct. Radiographic outcomes
measured included greater trochanter migration, osteolysis,
union, time to union and overall success using the Beals and
Tower classiﬁcation. Clinical outcomes were assessed using
the modiﬁed Harris Hip Score.
Results Twenty-three Vancouver B/C-type fractures were
identiﬁed. The remaining seven consisted of other fracture
types with a loose femoral stem requiring revision through
ETO. Mean follow-up was 32 months in the cable group and
12 months in the cable–plate group. The cable–plate con-
struct performed better than cables alone. Mean migration
rates were 1.7 mm lower in the cable–plate group (p < 0.05).
Beals and Tower classiﬁcation of radiographic outcomes
was signiﬁcantly better in the cable–plate group (p < 0.01).
Modiﬁed Harris Hip Scores were better in this group also
(p < 0.05).
* Gerard A. Sheridan
“Deerpark”, Lobinstown, Navan, Co. Meath, Ireland
Department of Orthopaedic Surgery, University Hospital
Galway, Newcastle Rd, Galway, Co. Galway, Ireland