Outcomes of Cerclage Cabling for Intraoperative Calcar Cracks in Cementless Total Hip Arthroplasty Using Broach-Only, Tapered Wedge Stems
| Autor: | Dong-Hee Ye, Chan-Woo Park, Seung-Jae Lim, Youn-Soo Park |
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| Rok vydání: | 2020 |
| Předmět: |
musculoskeletal diseases
Reoperation medicine.medical_specialty business.product_category Arthroplasty Replacement Hip Prosthesis Design 03 medical and health sciences 0302 clinical medicine medicine Humans Orthopedics and Sports Medicine Femur Retrospective Studies 030222 orthopedics Calcar Potential risk business.industry Matched control Wedge (mechanical device) Surgery Lesser Trochanter Implant Hip Prosthesis business Total hip arthroplasty |
| Zdroj: | The Journal of arthroplasty. 35(10) |
| ISSN: | 1532-8406 |
| Popis: | Background Intraoperative femoral fractures are well-known but often overlooked complications in total hip arthroplasty (THA). We examined outcomes of cerclage cabling for intraoperative calcar cracks in THA with cementless tapered wedge stems. Methods In total, 4928 primary THAs were performed using broach-only, tapered wedge stems between January 2007 and November 2017 in a single institution. Of these, we identified 71 intraoperative calcar cracks (69 patients) managed by 2-mm cerclage cables. Clinical outcomes, amount of stem subsidence, and implant survivorship of the calcar crack group (68 THAs) were compared with those of the matched control group (68 THAs) without intraoperative fractures. Multivariate analysis was performed to identify potential risk factors for stem subsidence >3 mm. Results The mean stem subsidence was greater in the calcar crack group (2.0 vs 1.2 mm, P = .021), whereas revision-free survivorships of THA were similar between groups at 6 years (98.5% vs 98.4%; log-rank, P = .987). In the calcar crack group, a Dorr type C femur and the absence of cabling proximal to the lesser trochanter (LT) were identified as independent risk factors for stem subsidence >3 mm. For the subgroup with 42 calcar cracks managed by a single cable applied proximal to the LT, revision-free survivorship of THA was 100% at 6 years. There was no complete radiolucency to indicate aseptic stem loosening in either group. Conclusion The application of a single cable proximal to the LT of the femur for intraoperative calcar cracks demonstrated 100% revision-free survivorship with lower stem subsidence in THA with tapered wedge stems. |
| Databáze: | OpenAIRE |
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