Trochanteric osteotomy and advancement: a technique for abductor related hip instability.

Current indications for trochanteric osteotomy include improving exposure to the femoral intramedullary canal through correction of proximal femoral angular deformities, such as medial greater trochanteric overhang1; improving general exposure to the acetabulum and femoral canal in complex primary and revision hip total hip arthroplasty (THA)2; and facilitating exposure to the anterosuperior acetabular rim and femoral neck in operative management of femoroacetabular impingement.3 An additional indication for trochanteric osteotomy is in the patient with recurrent dislocation following THA with well-aligned components and no evidence of mechanical impingement. In many of these patients, the soft-tissue envelope (myotendinous units, hip capsule, etc) surrounding and supporting the hip is not adequately tensioned to maintain hip stability. Trochanteric osteotomy and distal advancement of the greater trochanter have been used to tighten the surrounding capsuloligamentous structures and abductor mechanism, increasing the moment arm and the force generating capacity of the abductor musculature to improve hip stability4 (Figures 1 and 2). This article presents a trochanteric osteotomy, advancement, and fixation technique that has proved reliable with high union rates.