An extended trochanteric osteotomy (ETO) is a powerful tool for femoral component revision. There is limited evidence that directly supports its use in the setting of a periprosthetic joint infection (PJI). Cerclage fixation raises the theoretical concern for persistent infection. Our institutional database included 76 ETOs for revision hip arthroplasty between January 1, 2008 and December 31, 2019. The cohort was divided based on indication for femoral component revision: PJI versus aseptic revision. The PJI group was subdivided based on second-stage exchange versus retention of initial cerclage fixation. Operative time, estimated blood loss, complications, and rate of repeat revision surgery were evaluated. Forty-nine patients (64%) underwent revision for PJI and 27 patients (36%) underwent aseptic revision. There was no significant difference in operative times ( = .082), postoperative complications ( = .258), or rate of repeat revision surgery ( = .322) between groups. Of the 49 patients in the PJI group, 40 (82%) retained cerclage fixation while 9 (18%) had cerclage exchange. Cerclage exchange did not significantly impact operative time ( = .758), blood loss ( = .498), rate of repeat revision surgery ( = .302), or postoperative complications ( = .253) including infection ( = .639). An ETO remains a powerful tool for femoral component removal, even in the presence of a PJI. A multi-institutional investigation would be required to validate observed trends toward better infection control with cerclage exchange. Cerclage exchange did not appear to increase operative time, blood loss, or postoperative complication rates.

中文翻译：

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扩大转子截骨术后更换环扎固定对假体周围感染修复全髋关节置换术的影响

延长转子截骨术 (ETO) 是股骨假体翻修的有力工具。直接支持其在假体周围感染（PJI）情况下使用的证据有限。环扎固定引起了对持续感染的理论上的担忧。我们的机构数据库包括 2008 年 1 月 1 日至 2019 年 12 月 31 日期间进行髋关节翻修术的 76 个 ETO。队列根据股骨假体翻修指征进行划分：PJI 与无菌翻修。 PJI 组根据第二阶段交换与保留初始环扎固定进行细分。评估了手术时间、估计失血量、并发症和重复翻修手术率。 49 名患者 (64%) 接受了 PJI 翻修，27 名患者 (36%) 接受了无菌翻修。各组之间的手术时间 (= .082)、术后并发症 (= .258) 或重复翻修手术率 (= .322) 没有显着差异。 PJI 组的 49 例患者中，40 例（82%）保留环扎固定，9 例（18%）进行环扎交换。环扎交换不会显着影响手术时间 (= .758)、失血量 (= .498)、重复翻修手术率 (= .302) 或包括感染 (= .639) 在内的术后并发症 (= .253)。即使存在 PJI，ETO 仍然是股骨假体移除的强大工具。需要进行多机构调查来验证观察到的通过环扎交换更好地控制感染的趋势。环扎交换似乎不会增加手术时间、失血量或术后并发症发生率。