Background: Securing the osteotomized greater trochanter (GT) during total hip arthroplasty (THA) for dislocated dysplastic hips (DDH) poses a significant challenge. This study evaluates the union rate and effectiveness of a 2-strand transverse wiring technique utilizing the lesser trochanter for wire anchorage and tensioning.

Materials and Methods: Anterior slide trochanteric osteotomy was performed in 106 patients (118 hips) undergoing THA for high dislocated DDH. Following uncemented stem insertion, the GT was transferred and fixed to the lateral cortex of the proximal femur using monofilament stainless steel wires. In 72 out of 106 patients (80 hips), the GT was fixed with 2 transverse wire cerclages threaded through 2 drill holes in the base of the lesser trochanter, spaced vertically 5-10 millimeters apart. The wires were wrapped transversely over the GT and tightened, avoiding contact with its tendinous attachments. Patients were regularly monitored, and GT union was assessed clinically and radiographically.

Results: Patient ages ranged from 20 to 57 years (mean 35.5), with a follow-up period ranging from 1.5 to 12 years (mean 6.2). The mean union time was 3.3 months (range 2-7). Among all hips, two developed stable nonunion and single wire breakage, but no fragment displacement (2.5%). Two hips exhibited delayed union, eventually healing at 6 and 7 months after surgery.

Conclusion: Reattachment of the greater trochanter utilizing a 2-strand transverse wire cerclage anchored at the base of the lesser trochanter demonstrated a high rate of union (97.5%) following THA in dislocated DDH cases.

Morteza Kalhor, MD, is a distinguished orthopedic surgeon specializing in hip and pelvic surgeries at the Iran University of Medical Sciences (IUMS), Firoozgar Medical Center, Tehran, Iran. He has completed multiple fellowship courses with Prof. Reinhold Ganz in Switzerland between 2000 and 2007 and has maintained a close professional collaboration with him since then. Dr. Kalhor has been a member of the prestigious International Hip Society (IHS) since 2017 and has played a leading role in advancing hip surgery education and practice globally. He served as Chairman and Organizer of two international hip symposiums in Tehran, with Prof. R. Ganz as honorary speaker—Tehran International Hip Symposium: Impingement and Dysplasia (2004) and Tehran International Hip Symposium: Preserving Hip Surgery (2018). With over 30 international oral presentations and 20 publications in leading international journals, including award-winning research, Dr. Kalhor has made significant contributions to the field of hip preservation and complex pelvic surgery.