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Cerclage wire fixation of trochanteric osteotomies in complex hip revision: our experience and comparison with
Alicia Collado1, Camilla Arvinius1, Laura Serrano1
1Department of Orthopaedic surgery and Traumatology, Hospital Clínico San Carlos, Madrid, Spain.
Insights
Figure-of-eight cerclage wire fixation for trochanteric osteotomy in hip revision surgery showed better clinical outcomes than cable-plate fixation. Cerclage wiring resulted in less pain and fewer complications, making it the recommended method.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Osteotomy of the greater trochanter is crucial for complex revision hip arthroplasty.
- Current fixation methods lack definitive clinical evidence.
Purpose of the Study:
- To compare cable-plate fixation versus figure-of-eight cerclage wire for trochanteric "slide" osteotomies.
- To evaluate clinical and radiographic outcomes in revision hip arthroplasty.
Main Methods:
- Retrospective study of 51 patients undergoing trochanteric "slide" osteotomy.
- Two groups: 28 with cable-plate systems, 23 with figure-of-eight cerclage wire.
- Assessment of consolidation, osteolysis, migration, bursitis, gait, and implant removal at 6 months.
Main Results:
- Both methods demonstrated good union rates.
- Similar osteolysis rates (32% cable-plate vs. 29% cerclage).
- Higher trochanteric migration (43% vs. 22%) and greater trochanter pain (43% vs. 9%) with cable-plate.
- More implant removal in the cable-plate group.
Conclusions:
- Figure-of-eight cerclage wire fixation offers superior clinical outcomes compared to cable-plate systems.
- Radiographic results were comparable between the two fixation methods.
- Cerclage wire is recommended for trochanteric "slide" osteotomies in complex revision hip arthroplasty.
Introduction:
Osteotomy of the greater trochanter is a commonly used procedure in complex revision hip arthroplasty in order to achieve a wide exposure to the femoral stem and acetabular components. There is no clinical evidence in favour of a specific fixation method. The aim of this study was to compare cable-plate with figure-of-eight cerclage wire fixation in patients requiring a trochanteric "slide" osteotomy.
Material And Methods:
In a retrospective study, 51 greater trochanteric "slide" osteotomies in complex acetabular revision arthroplasties were included. Patients were divided into 2 groups: 28 hips were fixed with 1 of 2 cable-plate systems (Dall-Miles staple, Stryker or Cable-Ready plate, Zimmer) and 23 with a figure-of-eight cerclage wire.Consolidation, osteolysis, migration of greater trochanter, bursitis of the trochanteric area, Trendelenburg gait and removal of osteosynthesis material were studied at 6 months follow-up.
Results:
Both groups showed good union rates. The lysis rate was similar with 32% in the cable-plate group versus 29% in the cerclage wire group (p = 0.084). 43% of the hips with cable-plate and 22% of the cerclage wire had trochanteric migration (p = 0.297). Pain at the greater trochanter was less frequent in the cerclage wire group (9%) as compared to the cable-plate group (43%) (p = 0.007). Implant removal was more frequent in the cable-plate group (4 vs. 0 patients). Trendelenburg gait was found in 3 patients in the cerclage wire group as compared to 10 in the cable-plate group (p = 0.054).
Conclusions:
The cerclage wiring had superior clinical outcomes with similar radiographic results. The authors recommend the use of figure-of-eight cerclage wire when fixing a greater trochanteric "slide" osteotomy in complex revision hip arthroplasty.
