The outcome of trochanteric reattachment in revision total hip arthroplasty with a Cable Grip System: mean 6-year follow-up
| Autor: | Timothy Kremchek, James V. Bono, Joseph C. McCarthy, Jo-Ann Lee, Roderick H. Turner |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
musculoskeletal diseases
Reoperation medicine.medical_specialty medicine.medical_treatment Arthroplasty Replacement Hip Nonunion Osteotomy Prosthesis law.invention Intramedullary rod law Medicine Humans Orthopedics and Sports Medicine Femur Fixation (histology) Trochanter business.industry musculoskeletal system medicine.disease Arthroplasty Surgery Treatment Outcome Lesser Trochanter business Follow-Up Studies |
| Zdroj: | The Journal of arthroplasty. 14(7) |
| ISSN: | 0883-5403 |
| Popis: | We have reviewed 251 hips that were revised by the senior authors with subsequent reattachment using the Dall-Miles Cable Grip System. Of these patients, 223 were available for follow-up. A trochanteric slide osteotomy was used for most cases (n = 170), and the remainder had conventional trochanteric osteotomy to facilitate surgical exposure. Follow-up period was 1 to 8 years. Forty-eight percent (n = 108) of the hips had a previous trochanteric osteotomy. Thirteen percent (n = 30) had a prior trochanteric nonunion. Of the 223 hips, 91% (n = 204) of the trochanters remained attached to the trochanteric bed when reapproximated by the cable grip system. The 2 multifilament cables were passed medially through drill holes in the lesser trochanter in 67% (n = 149) of cases. Of the hips, 16% (n = 35) had 2 cables passed through bone lateral to the prosthesis, and 17% (n = 39) had cables passed 1 medial and 1 lateral to the prosthesis. Cable breakage was noted in 10% (n = 23) of cases. Of those 23, 70% (n = 16) were stainless steel. Unraveling of the cable occurred in 18% (n = 41) of cases. There were 19 nonunions (9%). Of the 19 nonunions, 74% (n = 14) were stainless steel. The trochanter was reattached to bone in 9 hips, to cement in 4 hips, and to a proximal femoral allograft in 6 hips (P = .0001). Eight of the 19 hips (42%) had the cables placed lateral to the prosthesis (P = .0002). When bone-to-bone apposition was achieved at surgery, the nonunion rate was 4%. In this difficult group of revision procedures, the Dall-Miles Cable Grip has provided reliable trochanteric fixation. Factors associated with successful trochanteric healing include use of vitallium cables, use of a trochanteric slide osteotomy, cables passed medially through the lesser trochanter, cerclage rather than intramedullary placement, and bone-to-bone apposition. |
| Databáze: | OpenAIRE |
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