The outcome of trochanteric reattachment in revision total hip arthroplasty with a cable grip system: Mean 6-year follow-up

Abstract

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.