The Extended Lesser Trochanteric Osteotomy (ELTO) in Complex Revision Hip Arthroplasty

The extended trochanteric osteotomy (ETO) has been a standard technique in complex revision hip arthroplasty. Despite the satisfactory healing rates with ETO, nonunion may occur, and failure of fixation and displacement of the trochanter may compromise abductor strength. The extended lesser trochanteric osteotomy (ELTO) is an alternative to the ETO in select patients that allows medial access to 3 sides of the femoral stem and incorporates the lesser trochanter along with a variable length of the medial femoral cortex, to which the iliopsoas tendon and adductors remain attached. The ELTO might be easier, faster, and shorter compared with the ETO while offering unobstructed exposure of 3 sides of the femoral stem. The most substantial advantage is the ability to spare the abductor attachment, eliminating the need for postoperative protected weight-bearing and abduction braces.