Abrasive Three-Body Wear of Polyethylene Caused by Broken Multifilament Cables of a Total Hip Prosthesis A Report of Three Cases*

Abstract

Polyethylene wear debris has been associated with osteolysis of the acetabulum and femur and may be an important cause of aseptic loosening of total joint prostheses. The rate of polyethylene wear can be accelerated by the interposition of hard particles in the joint space, so-called three-body wear. The sources of three-body wear in the hip include particles of bone cement15,25, metal beads or fibers from porous coatings17, broken wires2,7,10,11,13,24, and particles of bone. Smaller metal particles from modular interfaces5 or from instruments have also been implicated. Fixation of the greater trochanter may be necessary at the time of a primary or revision total hip arthroplasty14, but it may be associated with complications, including broken wires or cables9. Fracture of monofilament trochanteric wires appears to be relatively common, occurring in approximately 8 per cent (eight of 100 total hip replacements) to 33 per cent (ninety-two of 277 total hip replacements)1,4,8,18,22. However, we are aware of only six reports in which the migration of broken wires into the joint space has been documented radiographically2,7,10,11,13,24. In 1983, Dall and Miles described the use of a multifilament cable-grip system for improving the attachment of the greater trochanter in a total hip arthroplasty. Although this technique is clinically useful for trochanteric attachment, Ritter et al. reported breakage of the Dall-Miles cables after thirteen (33 per cent) of forty hip replacements in which stainless-steel cables had been used but after only one (5 per cent) of twenty-two hip replacements in which cobalt-chromium-alloy cables had been used20. Kelley and Johnston …