Outcomes of greater trochanteric reattachment with a washer in abductor mechanism repair for proximal femur endoprosthetic replacement: A retrospective cohort study

Proximal femur replacement (PFR) following oncological resections necessitates the reconstruction of the abductor mechanism, particularly through the reattachment of the greater trochanter (GT) to the endoprosthesis. This study aim is to assess radiological failure rates associated with the use of GT washer in Zimmer® Segmental System to achieve GT reattachment to the endoprosthesis. A retrospective review was conducted on patient records from 2010 to 2023 from our regional tumour unit in the West of Scotland. Included were patients who underwent PFR for malignancies and had GT reattachment using the GT washer in Zimmer® Segmental System. Patient data from electronic health records and the national PACS system were analysed to assess the radiological outcomes. The cohort comprised 22 patients, with ages ranging from 33 to 81 years (average 60.5 years) and follow-up periods spanning from 1.8 to 107.8 months (average 30.2 months). The interval between the last x-ray and the operation ranged from 3 to 66 months (average 20 months). Radiological evaluation showed a 0% failure rate of GT reattachment at the time of the last AP x-ray and/or outpatient visit. Various methods are available for GT reinsertion into the endoprosthesis, including washers, cables, and direct suturing. Our findings suggest that GT washers in the Zimmer system provide effective GT stabilization without migration, maintaining the integrity of the hip’s abductor musculature. Further comparative studies are necessary to determine the functional outcomes and advantages of each technique to enhance recovery and mobility in PFR patients.