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THA with cable fixation associated with increased nonunion, osteolysis rates
The researchers found both fixation methods had similar clinical results.
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BERLIN — Cable fixation of osteotomies or fractures during total hip arthroplasty yielded higher complication rates compared to wire fixation methods, according to research presented at the 13th EFORT Congress 2012, here.
“We found a higher incidence of complication and a trend toward increasing infection and foreign body reaction with the use of cable, suggesting that wiring may be the preferable surgical technique,” Charles Berton, MD, said when he presented results of the prospective cohort study he and his colleagues recently performed.
They included in their investigation all primary and revision total hip arthroplasty (THA) procedures performed from March 1996 to December 2005.
“Cables or wires are routinely used in complex primary and revision hip arthroplasty,” Berton said, and noted that “there is little in the literature to support the preferential use of cable or wire.”
Berton and colleagues looked at the cohort’s 5-year clinical and radiographic outcomes, studying the complication rates of cable fixation compared to wire fixation of fractures or osteotomies that occurred concomitantly with THA.
“The choice between cable or wire was according to surgeon preference,” in this study, Berton noted.
This radiograph is of a 70-year-old man, 5 years postoperative to revision total hip arthroplasty. He had groin pain with radiographic evidence of osteolysis around the cable, pelvis and femur, with multiple fragments of broken cable and trochanteric nonunion seen.
Image: Berton C
Surgeons used cable fixation in 51 THAs and wire fixation in 126 THAs. At 5-years postoperatively, the 33 THAs with cable fixation and the 91 THAs with wire fixation that were available for the study had device breakage rates of 36% and 46%, respectively, on radiographs.
Investigators found cable fixation was associated with a significantly higher 36% risk of nonunion vs. wire fixation, which had a 21% nonunion rate. The rates of femoral and acetabular osteolysis adjacent to the fixation materials were measured at 52% for cables and 11% for wires.
Cable breakage, Berton said, increased the osteolysis risk to 86%. However, he reported that overall clinical results did not substantially differ between the cable fixation and wire fixation groups.
Three patients who received cable fixation later developed foreign-body reactions. – by Robert Press
Reference:
Berton C, Lubbeke A, Puskas GJ, et al. Outcomes of cable vs. wire fixation five years after total hip arthroplasty. Paper #12-2811. Presented at the 13th EFORT Congress 2012. May 23-25. Berlin.
For more information:
Charles Berton, MD, can be reached at Université Lille-Nord-de-France, 59000 Lille, France; email: charles.berton@gmail.com.
Disclosure: Berton has no relevant financial disclosures.