Effects of Cerclage Cabling on Preventing Periprosthetic Femoral Fractures When Using Cementless Stems for Unstable Femoral Neck Fractures

• Published in: The Journal of arthroplasty 2024-11, Vol.39 (11), p.2807-2811
• Main Authors: Iwasa, Makoto, Ando, Wataru, Takashima, Kazuma, Uemura, Keisuke, Hamada, Hidetoshi, Sugano, Nobuhiko
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - instrumentation; cementless stem; cerclage cabling; Female; femoral neck fracture; Femoral Neck Fractures - surgery; Hip Prosthesis - adverse effects; Humans; intraoperative periprosthetic fracture; Male; Middle Aged; Periprosthetic Fractures - etiology; Periprosthetic Fractures - prevention & control; Periprosthetic Fractures - surgery; Postoperative Complications - etiology; Postoperative Complications - prevention & control; postoperative periprosthetic fracture; Reoperation; Retrospective Studies; Treatment Outcome
• ISSN: 0883-5403; 1532-8406; 1532-8406
• DOI: 10.1016/j.arth.2024.04.085

Periprosthetic femoral fractures (PFFs) are serious complications in hip arthroplasty for femoral neck fractures. The rates of intraoperative (iPFFs) and postoperative PFFs (pPFFs) are higher in cementless stem cases than in cemented cases. This study aimed to investigate the effects of cerclage cabling on PFF prevention in cementless arthroplasty for femoral neck fractures. This retrospective study included 329 consecutive patients who underwent hip arthroplasty using a cementless stem for femoral neck fractures. A total of 159 and 170 patients were in the non-cabling and cabling groups, respectively. Patient characteristics were comparable in both groups. The PFF occurrence (iPFF and pPFF) rates, reoperation rates, operative time, and blood loss volume were compared between the groups. The iPFF rate was significantly higher in the noncabling group (6.3%) than in the cabling group (0%, P < .001). The rate of pPFF was significantly higher in the non-cabling group (5.1%) than in the cabling group (0.6%; P = .016). All patients in the non-cabling group required reoperation (5.1%), whereas the patient in the cabling group was an ambulatory case and required no reoperation (0%, P = .003). No significant difference in either operative time or blood loss volume was observed between the non-cabling (50 minutes, 133 mL) and cabling (52 minutes, P = .244; 149 mL, P = .212, respectively) groups. When a cementless stem is used to treat unstable femoral neck fractures, cerclage cabling effectively prevents iPPF and pPPF without increasing surgical time or blood loss volume.