Total hip arthroplasty after failed intertrochanteric osteotomy.

From 1969 through 1982, 305 hips in 290 patients had total hip arthroplasty for failed femoral intertrochanteric osteotomy. Of these, we reviewed 215 hips (70.5%) with a minimum follow-up of five years. The results were good or excellent in 79%, but there were technical problems at operation in 23% and a total perioperative complication rate of 11.8%. Late complications occurred in 13.1% including seven late infections (3.2%). At a mean follow-up of ten years, 39 hips had been revised (18.1%), there was probable loosening in 19.5% of stems and 12.6% of cups and possible loosening in 11.4% of stems and 7.2% of cups. The cumulative probability of failure at ten years was 20.6%. We recommend that intertrochanteric osteotomy be advised, planned and executed bearing in mind the possible need for a subsequent total hip arthroplasty, and that screws and plates should be routinely removed soon after union of the osteotomy.