Reattachment of the greater trochanter in total hip-replacement arthroplasty. A new technique.

For certian total hip-replacement operations osteotomy of the greater trochanter is essential, and for others it is advantageous. A system of management of trochanter reattachment is described that takes into account multiple factors, such as the need to remove large or small amounts of the trochanter depending on the patient's anatomy and on the style of the femoral component used, the need in some cases to advance the trochanter to lie against the cortex of the femur, the need in other instances to deal with markedly porotic trochanters, and the fact that a small number of the wires will fatigue, regardless of the technique used. The basic technique has one horizontal and two separate vertical wires, all passing medial to the femoral stem and each tied to itself in a square knot; All wires pass through the trochanter to prevent rotation. Wire mesh is used prophylactically if the trochanter is porotic. All patients use two crutches for two months postoperatively; In a consecutive series of 136 total hip replacements in which the trochanter was reattached using this technique, none of the trochanters migrated and all united.