The Biomechanical and Biological Advantages of a New Polyaxial Angular Stable Plate for Stable Fixation of Transfemoral Osteotomy in Acetabular Revision Arthroplasty

Paul-Dan Sîrbu^1,2, Wilhelm Friedl³, Norin Forna^1,2, Răzvan Tudor¹, Liliana Savin^1,2, Tudor Pinteală^1,2, Gheorghe Șofron¹, Mihnea-Theodor Sîrbu^1,2

¹ Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iași, Romania, contact-author E-mail: paul.sirbu@umfiasi.ro

² Department of Orthopedics and Traumatology, Clinical Rehabilitation Hospital, 700661 Iași, Romania

³ Department of Orthopedics and Traumatology, Wertheim Hospital, 97877 Wertheim, Germany

Introduction. Acetabular revision arthroplasty often requires controlled transfemoral osteotomy to obtain exposure while preserving soft tissues and reducing the risk of instability [1]. Secure osteotomy refixation remains essential for early mobilization. This study reassessed a polyaxial locking Trochantus plate as a fixation device for femoral osteotomy during complex acetabular revision.

Experimental. Seventeen patients (14 women, 3 men; mean age 68.6 years, range 57-84) who underwent acetabular component revision were retrospectively evaluated. The index procedure included transfemoral osteotomy, acetabular reconstruction with a Contour revision ring in 14 cases or a Burch-Schneider cage in 3 cases, graft-substitute augmentation of bone defects, and cemented cup implantation. The osteotomy was fixed with one cerclage wire and a screw-fixed polyaxial Trochantus plate. Full weight-bearing rehabilitation was started immediately after surgery.

Results and Discussion. At a mean follow-up of 26 months (range 6-68), all osteotomy sites achieved complete union. The median postoperative Harris Hip Score was 96 points (range 78-100) [2]. Fourteen outcomes were excellent and three were good. All patients reported no hip pain, and 15 patients walked without distance limitation. No implant-related complications, plate irritation, loss of fixation, or nonunion were recorded. These findings suggest that polyaxial screw placement and the anatomic plate geometry provide stable fixation while adapting to local bone morphology.

Conclusions. The Trochantus plate offered reliable fixation of transfemoral osteotomies during acetabular revision arthroplasty, enabling early rehabilitation and consistent healing. Its practical value lies in combining polyaxial locking stability with a low-profile design that may reduce soft-tissue irritation.

Keywords. acetabular revision arthroplasty; transfemoral osteotomy; Trochantus plate; polyaxial locking; medical device; Harris Hip Score.

References.

[1] Sundaram, K.; Siddiqi, A.; Kamath, A.F.; Higuera-Rueda, C.A. Trochanteric osteotomy in revision total hip arthroplasty. EFORT Open Rev. 2020, 5, 477-485.

[2] Harris, W.H. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J. Bone Joint Surg. Am. 1969, 51, 737-755.