An in-vitro biomechanical study of different fixation techniques for the extended trochanteric osteotomy in revision THA

Abstract

BackgroundThe wire fixation and the cable grip fixation have been developed for the extended trochanteric osteotomy (ETO) in the revision of total hip arthroplasty (THA). Many studies reported the postoperative performance of the patients, but with little quantitative biomechanical comparison of the two fixation systems.MethodsAn in-vitro testing approach was designed to record the loosening between the femoral bed and the greater trochanter after fixations. Ten cadaveric femurs were chosen in this study. Each femur underwent the THA, revision by ETO and fixations. The tension to the greater trochanter was from 0 to 500N in vertical and lateral direction, respectively. The translation and rotation of the greater trochanter with respect to the bony bed were captured by an optical tracking system.ResultsIn the vertical tension tests, the overall translation of the greater trochanter was observed 0.4 mm in the cable fixations and 7.0 mm in the wire fixations. In the lateral tension tests, the overall motion of the greater trochanter was 2.0 mm and 1.2° in the cable fixations, while it was 6.2 mm and 5.3° in the wire fixations. The result was significantly different between the two fixation systems.ConclusionsThe stability of the proximal femur after ETO using different fixations in the revision THA was investigated. The cable grip fixation was significantly more stable than the wire fixation.

Outcomes of Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty for Periprosthetic Joint Infection: A Systematic Review

“…MacDonald, et al found that using a lateral approach for ETO, fixation using cerclage wires was associated with significantly more proximal migration of the osteotomized fragment than fixation with cables [34]. Biomechanical studies have demonstrated increased stability and decreased incidence of nonunion using cable fixation compared to wire fixation [35,36]. However, Morshed, et al also demonstrated that delayed fixation at stage two can yield high union rates and femoral stability, suggesting that fixation with wires/cables may not be needed at stage one.…”

Anterior Cortical Window Technique Instead of Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty: A Minimum 10-Year Follow-up

“…Because the osteotomized fragment in ETO is bigger than that in the anterior cortical window technique and the abductor muscle is attached onto the trochanteric fragment, ETO requires strong fixation of the greater trochanter. Various techniques and materials were introduced for the fixation ETO 72627). Although the fixation using a cable grip was excellent in a biomechanical study, cable grip–related complications appeared to be an issue 28).…”

Extended trochanteric osteotomy: comparison of 3 modes of fixation: metallic wires, cables, plate, about a series of 157 cases

“…Several options of fixation are reported in the literature. Most of them compare fixation with metallic wires or cables or cords [ 15 – 17 ].…”

“…There are only 2 publications of fixation with a plate as we propose. Zhu et al [ 15 ] report a cadaveric study of different types of fixation (wires, wire with a short claw plate, long claw plate). Sheridan et al [ 18 ] reported on the use of ETO in the treatment of 31 femoral stem revision in peri-prosthetic fractures.…”