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Cemented total hip replacement cable debris and acetabular construct durability.

Aaron J Altenburg1, John J Callaghan, Tameem M Yehyawi

  • 1University of Iowa, Iowa City, and Des Moines Orthopaedic Surgeons, West Des Moines, Iowa 52242, USA.

The Journal of Bone and Joint Surgery. American Volume
|July 3, 2009
PubMed
Summary
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Cobalt-chromium cables for trochanteric reattachment in total hip arthroplasty led to increased polyethylene wear and aseptic loosening compared to stainless steel wires. Surgeons should avoid potential debris generators like cables to improve long-term outcomes.

Area of Science:

  • Orthopedic surgery
  • Biomaterials science
  • Arthroplasty research

Background:

  • Third-body wear is a significant concern in total hip arthroplasty (THA), potentially leading to polyethylene wear, osteolysis, and component loosening.
  • The study investigates the hypothesis that cobalt-chromium (Co-Cr) cables used for greater trochanter reattachment generate more metal debris than stainless steel (SS) wires, impacting THA outcomes.

Purpose of the Study:

  • To compare the long-term effects of cobalt-chromium cable versus stainless steel wire trochanteric reattachment on polyethylene wear, osteolysis, and aseptic loosening in cemented total hip arthroplasty.

Main Methods:

  • A retrospective comparison of 196 THAs using Co-Cr cables (1981-1983) with 304 THAs using SS wires (1984-1985) by the same surgeon, employing identical stems and acetabular components.
  • Evaluation at 19-20 years post-surgery included polyethylene wear (head penetration), osteolysis, loosening, and revision rates.

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  • Radiographic follow-up of at least 10 years for all living patients (59 in cable group, 92 in wire group).

    • Main Results:

    • The Co-Cr cable group exhibited a significantly higher polyethylene wear rate (0.101 mm/yr vs. 0.082 mm/yr, p=0.039).
    • Revision rates for aseptic loosening were substantially greater in the cable group (37.3% vs. 20.7%, p=0.025), as was the incidence of acetabular osteolysis (44% vs. 26%, p=0.022).
    • Twenty-year survival rates for the acetabular component due to aseptic loosening were lower for the cable group (73.7% ± 9%) compared to the wire group (83% ± 7%, p=0.03).

    Conclusions:

    • Cobalt-chromium cable trochanteric attachment is associated with increased polyethylene wear, osteolysis, and acetabular loosening in cemented THA, likely due to third-body metallic debris.
    • Surgeons should avoid using potential debris-generating materials like Co-Cr cables in THA constructs to mitigate adverse outcomes.
    • Consideration for cable removal should be given if fretting, intra-articular migration, or nonunion of the greater trochanter is observed.