Trochanteric fixation in total hip arthroplasty using the S-ROM bolt and washer

We evaluated the S-ROM bolt and washer (DePuy, Inc, Warsaw, IN) for fixation of the greater trochanter after trochanteric osteotomy in 29 hips in 28 consecutive patients. Of 29 cases, 9 (31%) resulted in trochanteric nonunion, with bony union being achieved in only 38% of cases. There was dislocation and subluxation in 7 of 29 (24%) cases with 6 of the 7 dislocations associated with trochanteric nonunion. Revision was necessary in 4 of 8 hips to obtain fixation of the trochanter. The rate of complications in this series suggests that the S-ROM bolt and washer is associated with a high rate of nonunion, particularly in the multiply-revised hip. Avoidance of trochanteric osteotomy whenever possible would be desirable. When an osteotomy is necessary, alternative forms of fixation should be considered.