Surgical treatment of high-standing greater trochanter

Abstract

Eleven patients with high-standing greater trochanter (13 joints) aged 13-36 years underwent surgery. Distal transfer of the greater trochanter (group T) was performed in 4 patients (5 joints) and lateral displacement osteotomy (group L) in 7 (8 joints). The average follow-up duration was 13.4 years in group T and 5.9 years in group L. Clinical results were evaluated by the hip score according to Merle d'Aubigne. The mean hip score in group T was 13.4 points before operation and 15.4 points after operation, and in group L, 12.8 and 17.4 points, respectively. The postoperative clinical results of group L were significantly better than those of group T (P = 0.0494). In radiological evaluation, although the articulo-trochanteric distance (ATD) increased in both groups in group L it improved remarkably from 9.8 to 24.3, indicating a large descending distance of the greater trochanter. The lever arm ratio (LAR) did not change significantly in group T, but it decreased from 1.97 to 1.60 in group L (P = 0.004). This means that the lever arm of the abductors can certainly be extended by lateral displacement osteotomy. Lateral displacement osteotomy is the most effective procedure for high-standing greater trochanter.

Does Trochanteric Transfer Eliminate the Trendelenburg Sign in Adults?

“…Lateral displacement of the greater trochanter has been described as the most important component of the trochanteric transfer [17,26,30], as distal displacement alone does not increase the lever arm of the abductors. Further, distal transfer alone changes the resultant vector of the forces acting on the hip to a more vertical position, increasing the pressure over a reduced area of the joint and possibly accelerating the development of osteoarthritis The articulotrochanteric distance and centrotrochanteric distance are negative on the preoperative radiograph, and a small trochanteric offset can be seen.…”

“…This deformity is termed coxa brevis [5,25], high-standing greater trochanter [26] or relative trochanteric overgrowth [6,13,23], and occurs as a sequela of diseases such as developmental dysplasia of the hip, slipped capital femoral epiphysis, infections of the hip, and Legg-Calvé-Perthes disease. In this situation the hip abductors habitually become functionally insufficient owing to the reduction of their resting length and lever arm [20].…”

Double Intertrochanteric Osteotomy for Trochanteric Overgrowth and a Short Femoral Neck in Adolescents

“…8 Morscher's 3 parallel osteotomies 7 for restoring normal proximal femoral anatomy can be performed in children with a Trendelenburg gait and limited abduction after the ossification of the greater trochanter. 3,4,7,8,[20][21][22][23] Morscher osteotomy reduced the mean CTD from 33 to 7 mm. 20 It achieved good results in 32 of 37 patients with no or little arthrosis.…”

“…10 A plate with angle blade has been used for collodiaphysis osteosynthesis, and tensionband wiring is added for greater trochanter osteosynthesis. 4,[20][21][22][23] In our study, a custom-made locked proximal femoral plate with a trochanteric hook was used to stabilise trochanteric osteotomy. Although a trochanteric proximal femur plate has been used in paediatrics, it is not appropriate for adolescents.…”

Do osteotomies of the proximal femur still have a role?

“…Relative neck lengthening morbidity is not higher than for surgical dislocation alone; this aspect may increase the biomechanical value of the procedure. Lateral displacement of the greater trochanter has been described as the most important component of the trochanteric transfer [34,35]. Those authors suggested that distal displacement alone does not increase the lever arm of the abductors and distal transfer alone increases the pressure over a reduced area of the joint, possibly accelerating the development of osteoarthritis [36].…”