The Effect of Prophylactic Cerclage Wires in Primary Total Hip Arthroplasty: A Biomechanical Study

Waligora, Andrew C.; Owen, John R.; Wayne, Jennifer S.; Hess, Shane R.; Golladay, Gregory J.; Jiranek, William A.

doi:10.1016/j.arth.2017.01.019

Cited by 28 publications

(19 citation statements)

References 24 publications

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“…Following this application recommendation, the additional wire cerclage significantly increased the load to failure and, therefore, contributed to the overall stability of the osteosynthesis construct. The findings of the present study are, therefore, in line with the previous related examinations reporting on increased load to failure in nail osteosynthesis for subtrochanteric femoral fractures and in primary hip arthroplasty [19,20].…”

Section: Discussionsupporting

confidence: 93%

More than a reposition tool: additional wire cerclage leads to increased load to failure in plate osteosynthesis for supracondylar femoral shaft fractures

Bliemel

Anrich

Knauf

et al. 2020

Arch Orthop Trauma Surg

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Introduction Surgical treatment of supracondylar femoral fractures can be challenging. An additional wire cerclage is a suggested way to facilitate fracture reduction prior to plate osteosynthesis. Denudation to the periosteum remains a problematic disadvantage of this procedure. This study analyzed the effect of an additional wire cerclage on the load to failure in plate osteosynthesis of oblique supracondylar femoral shaft fractures. Materials and methods On eight pairs of non-osteoporotic human femora (mean age 74 years; range 57-95 years), an unstable AO/OTA 32-A2.3 fracture was established. All specimens were treated with a polyaxially locking plate. One femur of each pair was randomly selected to receive an additional fracture fixation with a wire cerclage. A servohydraulic testing machine was used to perform an incremental cyclic axial load with a load to the failure mode. Results Specimens stabilized with solely plate osteosynthesis failed at a mean load of 2450 N (95% CI: 1996-2904 N). In the group with an additional wire cerclage, load to failure was at a mean of 3100 N (95% CI: 2662-3538 N) (p = 0.018). Compression deformation with shearing of the condyle region through cutting of screws out of the condylar bone was the most common reason for failure in both groups of specimens. Whereas axial stiffness was comparable between both groups (p = 0.208), plastic deformation of the osteosynthesis constructs differed significantly (p = 0.035). Conclusions An additional wire cerclage significantly increased the load to failure. Therefore, an additional cerclage represents more than just a repositioning aid. With appropriate fracture morphology, a cerclage can significantly improve the strength of the osteosynthesis.

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Section: Discussionsupporting

confidence: 93%

More than a reposition tool: additional wire cerclage leads to increased load to failure in plate osteosynthesis for supracondylar femoral shaft fractures

Bliemel

Anrich

Knauf

et al. 2020

Arch Orthop Trauma Surg

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“…These patients might require the use of acetabular augmentation devices. 13 Literature also advocates optimal component positioning as the key to prevent dislocation. 2,6 Also, patients with paralytic limbs could benefit from the use of a constrained cup because of the increased risk of subluxation.…”

Section: Discussionmentioning

confidence: 99%

“…Modular implants like the S-ROM prosthesis allow distal plus proximal anchorage and modification of the antetorsion. 13 Currently, the Wagner cone prosthesis is considered as the implant of choice for patients with dysplastic coxarthrosis. 12 The Wagner cone prosthesis is made of a Protasul-64 titanium alloy rough blasted with corundum.…”

Section: Discussionmentioning

confidence: 99%

“…Although loose implants may achieve rotational stability after initial subsidence, the patients are likely to have limb length inequality, joint instability and undesirable joint mechanics which affect the gait of the patient, while also aggravating the wear. 13 It is a well-known strategy to use a prophylactic cerclage with a steel wire, controlled cable systems or, more recently, using a braided polyblend suture to prevent intra operative fractures. [14][15][16] Based on this idea, the senior author conceptualized a technique to achieve a controlled expansion of the medullary canal using multiple 18 gauge monofilament stainless steel wires (Synthes™-0.8 mm) which are flexible enough to allow the longitudinal cracks to open up in a controlled manner.…”

Section: The Osteotomy Techniquementioning

confidence: 99%

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A controlled diaphyseal expansion osteotomy for the implantation of a wagner cone prosthesis in a stenotic femoral canal encountered in a polio limb: a case report of the technique

Kadam

Desai

2020

Int J Res Orthop

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<p class="Default">Dysplastic hips pose a significant technical challenge to arthroplasty surgeons. Such deformed hips might be encountered either in congenital and developmental conditions or as sequel of neuromuscular disorders (like poliomyelitis), following infections, or after childhood surgical procedures of the hip. The scientific literature, focussing on total hip arthroplasty (THA), for coxarthrosis in patients with residual poliomyelitis, is relatively rare. Several anatomical distortions seen in dysplastic femurs are described, one of which includes an undersized diaphysis with a stenotic medullary canal. We present a case of a 28 years old male with residual poliomyelitis who underwent a cementless THA for a non united transcervical neck of femur fracture. The patient had an extremely narrow medullary canal which posed a formidable difficulty in the procedure. This was overcome by a novel diaphyseal expansion osteotomy, which enabled the implantation of Wagner Cone prosthesis. This technique, which has hitherto not been described in the literature, can significantly facilitate the implantation of an appropriately sized stem in an undersized femur while at the same time ensuring a good long-term result.</p>

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“…In terms of prevention, some studies have suggested that prophylactic cerclage cabling with either steel cable or braided suture can theoretically reduce the risk of IPPF by reducing strain and increasing hoop stress resistance. 26 , 27 There are no current studies showing clinical correlation, though a cadaveric study by Waligora et al 28 suggested that the rotation and energy to failure is higher when using one or more monofilament calcar wires. Interestingly, Greenhill et al 29 have shown that not only implant choice, but also broach design, could affect IPPF.…”

mentioning

confidence: 99%

Intraoperative femoral fractures

Young

Patil

Meek

2018

Bone & Joint Research

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The Effect of Prophylactic Cerclage Wires in Primary Total Hip Arthroplasty: A Biomechanical Study

Cited by 28 publications

References 24 publications

More than a reposition tool: additional wire cerclage leads to increased load to failure in plate osteosynthesis for supracondylar femoral shaft fractures

More than a reposition tool: additional wire cerclage leads to increased load to failure in plate osteosynthesis for supracondylar femoral shaft fractures

A controlled diaphyseal expansion osteotomy for the implantation of a wagner cone prosthesis in a stenotic femoral canal encountered in a polio limb: a case report of the technique

Intraoperative femoral fractures

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