Cerclage wires or cables for the management of intraoperative fracture associated with a cementless, tapered femoral prosthesis: Results at 2 to 16 Years

Joint Implant Surgeons, Inc., Columbus, Ohio 43215, USA.
The Journal of Arthroplasty (Impact Factor: 2.67). 11/2004; 19(7 Suppl 2):17-21. DOI: 10.1016/j.arth.2003.12.016
Source: PubMed


Initial stability is critical for fixation and survival of cementless total hip arthroplasty. Occasionally, a split of the calcar occurs intraoperatively. A review of 1,320 primary total hip arthroplasties with 2-year follow-up, performed between August 1985 and February 2001 using the Mallory-Head Porous tapered femoral component, revealed 58 hips in 55 patients with an intraoperative calcar fracture managed with single or multiple cerclage wires or cables and immediate full weight bearing. At 7.5 years average follow-up (range, 2-16 years), there were no revisions of the femoral component, radiographic failures, or patients with severe thigh pain, for a stem survival rate of 100%. Average Harris hip score improvement was 33.8 points. Fracture of the proximal femur occurs in approximately 4% of primary THAs using the Mallory-Head Porous femoral component. When managed intraoperatively with cerclage wire or cable, the mid- to long-term results appear unaffected with 100% femoral component survival at up to 16 years.

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    • "Once stem and/or cement removal have been completed, cerclages are the treatment of choice for reattaching the bony lid (Klein and Rubash, 1993; Wagner et al., 1996). These should secure a solid fixation of the osteotomy fragment to provide appropriate tension of the abductor tendons (Hajnik et al., 2007; Mallory, 1974) and to achieve primary stability of the new prosthesis (Berend et al., 2004). The latter is the most important basic requirement for a successful bony ingrowth and, therefore, the longevity of a cementless revision stem (Jakubowitz et al., 2008; Wagner et al., 1996). "
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    ABSTRACT: Cerclage wires are widely used in revision hip surgery to reattach the lid of a femoral osteotomy. The present study compared the influence of multifilaments and monofilaments on primary stability of revision hip stems with different fixation principles. A standardized extended proximal femoral osteotomy was performed in the anterior cortex of 6 synthetic femora. We used a high-resolution measuring device to explore spatial micromovements of a diaphyseal and a metaphyseal fixating revision stem. Both of these were implanted in 3 femora. The specimens were measured again after consecutive restabilization of osteotomies with multifilaments and monofilaments. The movement graphs generated defined relative micromovements between stems and bones and the stabilizing effect of the two wire systems compared. Both multifilaments and monofilaments effected a major reduction of relative micromovements for both fixation principles. There were no differences in relative movements between the multifilament and monofilament treatments for the diaphyseal fixating stem. Yet for the metaphyseal fixating stem a significantly better restabilization was observed with multifilaments. Both multifilaments and monofilaments can support the revision hip stem in bridging the extended proximal femoral osteotomy. Yet, which wiring system should be chosen depends on the fixation principle of the revision stem. Multifilaments seem to be advantageous when used with metaphyseal fixating stems. However, the use of multifilaments with diaphyseal fixating components should be reconsidered as this might constrict the periosteal vascularity.
    Full-text · Article · Dec 2010 · Clinical biomechanics (Bristol, Avon)
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    • "Berend et al. (2004) followed a series of 50 patients with uncemented THAs treated with cerclage wires or cables due to intraoperative femoral fracture. They showed an implant survival rate of 100% after an average follow-up of 7.5 years (Berend et al. 2004). However, this study only included minor fractures and the results are therefore not directly comparable with our findings. "
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    ABSTRACT: Intraoperative femoral fracture is a well known complication of primary total hip arthroplasty (THA). Experimental studies have indicated that intraoperative fractures may affect implant survival. Very few clinical data are available, however. We used data from the Danish Hip Arthroplasty Registry to identify patients in Denmark who underwent a primary THA due to primary osteoarthritis between 1995 and 2005 (n = 39,478). Data were linked to two national Danish databases in order to conduct time-dependent implant survival analyses. Implant survival and relative risk estimates were calculated for patients treated nonoperatively and for patients treated with osteosynthesis after sustaining intraoperative femoral fractures during THA surgery. THAs performed without sustaining intraoperative femoral fracture served as the reference group. 282 patients (0.7%) were treated non operatively due to intraoperative femoral fracture and 237 patients (0.6%) were treated with osteosynthesis. In the 0-6 month postoperative period, the adjusted relative risk (RR) of revision was 1.5 (95% CI: 1.1-1.7) for patients treated nonoperatively and 5.7 (3.3-10) for patients treated with osteosynthesis. In the period from 6 months to 11 years postoperatively, we did not find any statistically significant differences in the RR of revision between the groups. Intraoperative fractures increase the relative risk of revision during the first 6 postoperative months. Thus, patients should be informed about the risk of revision after sustaining an intraoperative femoral fracture. Furthermore, initiatives aimed at reducing the risk of revision in the first 6 months following THA should be considered in patients with intraoperative fractures, including immediate change to a larger stem with distal fixation and restricted weight bearing.
    Full-text · Article · Jul 2008 · Acta Orthopaedica
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    ABSTRACT: Häufigkeit und Risikofaktoren Die steigende Zahl an prothetischen Primär- und Wechseloperationen sowie eine veränderte Altersstruktur bedingen eine Zunahme intraoperativer periprothetischer Frakturen. Risikofaktoren sind Revisionsoperationen, die Verwendung unzementierter Pfannen, Schäfte und Langschäfte, verminderte Knochenqualität und weibliches Geschlecht. Präventive Maßnahmen müssen berücksichtigt werden. Therapie Eine intraoperative Diagnosestellung ist für eine adäquate Behandlung essenziell, um eine Ausheilung ohne Beeinträchtigung der Funktion und Lebensqualität zu gewährleisten. Therapieziele sind neben der Stabilisierung der Fraktur die Vermeidung ihres Fortschreitens und eine stabile Verankerung der Prothese.
    No preview · Article · Mar 2013 · Trauma und Berufskrankheit
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