Trochanteric Arthroplasty


Hips without a femoral head can be stabilized by directing the cartilaginous greater trochanter into the acetabulum to act as the head. As the greater trochanter needs to be cartilaginous, it is best done at a young age, but results are poor even in them after the new head ossifies. This procedure is more for temporary stabilization of the hip and  allow some acetabular growth and it does not address the loss of proximal femoral growth.

In earlier descriptions, the entire GT was put into the acetabulum with varus subtrochanteric osteotomy, and gluteus medius is attached to the lateral aspect of the newly created neck.  Harmon modification splits the GT and puts the medial part into the acetabulum and the lateral part will keep the abductors attached.

The technique I want to try at the next opportunity is – Watson Jones approach. Free 80-90% of the medial GT of abductors, but leave them attached to the lateral aspect. Divide the medial GT from the lateral part. The split should go far enough to create enough neck. Crack the medial cortex of the medial segment just below the LT and open the split. Trim the GT and clear the acetabulum. The acetabulum can even be reamed to deepen it’s socket. Maintain the gap created by the split with screws and bone graft. Repair the capsule, splint the hip for a few weeks before mobilization.