Comparison of the outcome following the fixation of osteotomies or fractures associated with total hip replacement using cables or wires THE RESULTS AT FIVE YEARS

Geneva University Hospitals, Division of Orthopaedics and Trauma Surgery, 4 Rue Gabrielle-Perret-Gentil, CH-1211 Geneva, Switzerland.
The Bone & Joint Journal (Impact Factor: 3.31). 11/2012; 94(11):1475-81. DOI: 10.1302/0301-620X.94B11.29687
Source: PubMed


There are no recent studies comparing cable with wire for the fixation of osteotomies or fractures in total hip replacement (THR). Our objective was to evaluate the five-year clinical and radiological outcomes and complication rates of the two techniques. We undertook a review including all primary and revision THRs performed in one hospital between 1996 and 2005 using cable or wire fixation. Clinical and radiological evaluation was performed five years post-operatively. Cables were used in 51 THRs and wires in 126, and of these, 36 THRs with cable (71%) and 101 with wire (80%) were evaluated at follow-up. The five-year radiographs available for 33 cable and 91 wire THRs revealed rates of breakage of fixation of 12 of 33 (36%) and 42 of 91 (46%), respectively. With cable there was a significantly higher risk of metal debris (68% vs 9%; adjusted relative risk (RR) 6.6; 95% confidence interval (CI) 3.0 to 14.1), nonunion (36% vs 21%; adjusted RR 2.0; 95% CI 1.0 to 3.9) and osteolysis around the material, acetabulum or femur (61% vs 19%; adjusted RR 3.9; 95% CI 2.3 to 6.5). Cable breakage increased the risk of osteolysis to 83%. There was a trend towards foreign-body reaction and increased infection with cables. Clinical results did not differ between the groups. In conclusion, we found a higher incidence of complications and a trend towards increased infection and foreign-body reaction with the use of cables.

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    ABSTRACT: Oxinium femoral heads are supposed to be more scratch-resistant thanks to their oxidized layer. However, damages to this thin layer can jeopardize implant's properties. Following revision total hip arthroplasty performed for recurrent posterior dislocations, the Oxinium femoral head initially implanted was observed to be dramatically damaged. A metallic foreign body from a trochanteric fixation wire was found within the polyethylene cup. Only few cases of damaged Oxinium femoral heads have been reported and all were related to either dislocation or reduction of THA. The aim of this report is to describe a non-reported mechanism of damaged Oxinium femoral head due to a broken trochanteric fixation wire device. Any broken metallic wire from a transtrochanteric approach should be carefully followed to detect migration within the polyethylene cup. If such a migration occurs, revision surgery should be rapidly scheduled.
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