Immediate Weight Bearing Is Safe Following Combined Extended Trochanteric Osteotomy and Revision Total Hip Arthroplasty

INTRODUCTION: An extended trochanteric osteotomy (ETO) is used in complex cases to enhance access to the femoral canal and aid implant and cement removal during revision total hip arthroplasty (RTHA). However, there is no consensus regarding postoperative rehabilitation protocols. The aim of this study was to assess the efficacy and safety of immediate weight-bearing (WB) protocols in patients undergoing ETO during RTHA. METHODS: A multicenter retrospective review was conducted at two academic medical centers between 2014 and 2021 to identify patients undergoing an ETO during RTHA with a minimum 1-year follow-up. Thirty-nine patients underwent an immediate WB protocol postoperatively. Union rates, ambulatory status, 90-day orthopaedic-related complications, revision surgeries, revisions, and Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR) scores were collected. RESULTS: Fifty-three patients were included in the final analysis. The average follow-up time was 15.8 ± 20.4 months, with a mean age of 63.7 ± 11.5 years. Bony union was achieved in 46 patients (86.8%). The mean earliest time to union was 4.2 ± 5.4 months. Average HOOS JR scores significantly improved from preoperative to 1-year follow-up (mean 16.4 ± 4.1 vs 3.5 ± 4.2), P ≤ 0.000001). At the final follow-up, ambulatory status improved, with fewer patients kept as non-weight bearing (11 (21.6%) versus 7 (15.2%)). Two complications (3.8%) due to deep infection, 5 revision surgeries (9.4%), and 6 revisions (11.0%) were observed within 90 days. CONCLUSION: Most patients who underwent ETO during RTHA and were placed on an immediate WB protocol achieved union at 4.2 months on average. HOOS JR scores improved as early as 2 weeks. More importantly, a greater proportion of patients experienced an improved ambulatory status at the final follow-up. These findings suggest that an immediate WB protocol-particularly WBAT-may be effective and safely implemented in patients undergoing an ETO during RTHA. LEVEL OF EVIDENCE: Level III retrospective cohort comparison study.