Results of interlocking wire trochanteric reattachment and technique refinements to prevent complications following total hip arthroplasty.

In 3.2% of 712 procedures performed in 668 hips after May 1, 1976, separation and migration of the trochanteric fragment occurred after total hip arthroplasty (THA) through a transtrochanteric approach and an interlocking cruciate two-wire technique of reattachment. Of these hips, 23 trochanters showed separation, and in eight the Trendelenburg test was positive. The abductor weakness was correlated with the amount of separation, especially if it exceeded 2 cm. Trochanteric separation was attributed to technical deficiencies, including a small trochanteric fragment, wire placed around the lesser trochanter, and/or a loose wire loop. Improved technique reduced the separation and migration rate from 4.5% to 2.3% following primary surgery. Trochanteric advancement with impaction against the vastus ridge and repair of the vastus lateralis were major determinants in reducing the migration rate of those that did not unite and were responsible for improved gait in this second series. However, the failure rate remained at 7% following reoperations for failed THA. As a result, a more secure three-wire technique with two vertical wires has been used in 36 revision operations since July 1981 with no incidence of migration.