Debris From Cobalt-Chrome Cable May Cause Acetabular Loosening

Abstract

To address the issue of nonunion with trochanteric osteotomy, surgeons have experimented with various modes of fixation, wire and cable being the two most popular. From a group of 643 primary cemented total hip arthroplasties performed by a single surgeon via the trans-trochanteric approach, minimum four-year roentgenographic follow-up evaluations were performed on 322 hips (50%). The method of fixation was stainless steel monofilament wire in 162 cases and Co-Cr cable in 160. Trochanteric union rates were 75% (122 patients) for the wire group and 79% (126 patients) for the cable. Breakage rates of the entire trochanteric fixation construction (all three wires or cables) were 43% (68 patients) for the wire and 12% (20 patients) for the cable. Unraveled cable was seen in 56% of the hips (90 patients), and in 47% of these hips, there were no broken cables. Blinded roentgenographic analysis of the acetabulum, preformed independently, revealed that loosening of the acetabulum in the cable group was greater than in the wire group. Cables offer no significant benefit over wires and may have potential adverse effects. Generation of significant particulate debris was noted roentgenographically, and marked reaction/destruction was found at the time of revision surgery.