Dall-Miles Cable Grip System Research Articles

Pseudotumor Associated with Dall-Miles Cable Breakage Following Revision Total Hip Arthroplasty: A Case Report

A pseudotumor is a benign granulomatous or cystic lesion associated with the deposition of metal debris in joint arthroplasties. To the best of our knowledge, this is the first report on a pseudotumor caused by the breakage of the Dall-Miles cable grip system, a multifilament cable used to fix the trochanteric osteotomy in revision total hip arthroplasty. This rare case demonstrates that pseudotumor formation can be caused by various types of orthopedic materials and implant components. When encountering a palpable mass around an orthopedic implant, a pseudotumor should be considered along other differential diagnoses. To treat pseudotumors and also prevent recurrence, its complete resection and sufficient removal of orthopedic materials are necessary.

Early Catastrophic Failure of Trochanteric Fixation with the Dall-Miles Cable Grip System

Multi-filament orthopaedic cerclage cables have been used in clinical practice for several decades, and are commonly utilized to provide greater trochanteric fixation following an osteotomy or fracture. We present the first known report of patients who experienced early catastrophic failure following use of the Dall-Miles Cable Grip System (DMCGS). A root cause analysis determined that the jaws of one crimper had an increased distance at closure, resulting in inadequate ultimate fixation strength. It was discovered that operating room staff had not been trained to perform regular calibration checks and the required calibration tool was not included in any of the institution’s DMCGS sets. Surgeons should be aware that these surgical instruments require regular maintenance and should be gauge tested prior to every use.

The biomechanical analysis of three plating fixation systems for periprosthetic femoral fracture near the tip of a total hip arthroplasty

BackgroundA variety of techniques are available for fixation of femoral shaft fractures following total hip arthroplasty. The optimal surgical repair method still remains a point of controversy in the literature. However, few studies have quantified the performance of such repair constructs. This study biomechanically examined 3 different screw-plate and cable-plate systems for fixation of periprosthetic femoral fractures near the tip of a total hip arthroplasty.MethodsTwelve pairs of human cadaveric femurs were utilized. Each left femur was prepared for the cemented insertion of the femoral component of a total hip implant. Femoral fractures were created in the femurs and subsequently repaired with Construct A (Zimmer Cable Ready System), Construct B (AO Cable-Plate System), or Construct C (Dall-Miles Cable Grip System). Right femora served as matched intact controls. Axial, torsional, and four-point bending tests were performed to obtain stiffness values.ResultsAll repair systems showed 3.08 to 5.33 times greater axial stiffness over intact control specimens. Four-point normalized bending (0.69 to 0.85) and normalized torsional (0.55 to 0.69) stiffnesses were lower than intact controls for most comparisons. Screw-plates provided either greater or equal stiffness compared to cable-plates in almost all cases. There were no statistical differences between plating systems A, B, or C when compared to each other (p > 0.05).ConclusionsScrew-plate systems provide more optimal mechanical stability than cable-plate systems for periprosthetic femur fractures near the tip of a total hip arthroplasty.

Reattachment of the greater trochanter in total hip arthroplasty: the pin-sleeve system compared with the Dall-Miles cable grip system

The purpose of this study was to compare two different types of fixation systems used to reattach the greater trochanter after revision or total hip arthroplasty. This is a retrospective review of the results of patients that were treated with the two systems. We reviewed the clinical and radiological records of 35 hips with the Dall-Miles cable grip system (DMCGS) and 42 hips with the pin-sleeve system (PSS); follow-up averaged 24 months (range, 4-54) and 30 months (range, 11-42), respectively. The incidences of unsatisfactory clinical and radiological results in the PSS group was less than half that in the DMCGS group. Significant differences were found between the groups with respect to discomfort, tenderness, pain on motion, cable fragmentation, and bone absorption. Compared with the DMCGS, these results suggest the PSS could be the instrument of choice for re-attachment of the greater trochanter in hip arthroplasty.

Reattachment of greater trochanter after osteotomy for primary hip replacement: Dall-Miles cable or monofilament wires

A total of 102 cases of trochanteric reattachment were retrospectively evaluated clinically and radiologically after trochanteric osteotomy for primary total hip replacement. A comparison was made between the use of monofilament steel wires and Dall-Miles cable-grip system for reattachment of the greater trochanter. Wires were used in 52 patients while cables were used for 50 patients. Mean follow up was 17.4 months (range, 12–24 months). No significant difference was seen between the two groups.

Dall-miles cable-grip system for periprosthetic fractures of femur

Periprosthetic femur fractures are one of the most serious complications in hip surgery. Treatment of femoral shaft fractures complicating endoprosthesis remains controversial.

Reattachment of the greater trochanter using the Dall-Miles cable grip system in revision hip arthroplasty

Clinical and radiographic results of trochanteric osteotomy after revision hip arthroplasty in 62 hips were reviewed. The osteotomized fragment had been reattached using the Dall-Miles cable grip system in each hip. The patients’ average age at operation was 64.4 years (range, 40–86 years). The average duration of follow-up was 30.0 months (range, 12–60 months). Trochanteric nonunion was found in 19 hips (30.6%). Trochanteric nonunion developed in 14 (38.9%) of 36 hips with each cable attached around the medial cortex bone, in 2 (16.7%) of 12 hips with each cable passed in a drill hole, and in 3 (21.4%) of 14 hips with one cable passed through a hole and the other attached around the medial cortex. Fragmentation developed in 18 hips (29.0%). In 3 of these 18, the fragments had migrated close to the acetabular component. Cable breakage was seen in 4 hips (6.5%), and bone absorption around the cable in the medial cortex was seen in 17 hips (27.4%). There were 16 hips (25.8%) that presented symptoms at the greater trochanter, including spontaneous pain and tenderness. When the Dall Miles cable grip device is used for reattachment of the greater trochanter, attention should be paid to the condition of the trochanteric bed, the tension of the abductor muscles, and to the placement of the cables and the H-shaped grip.

インプラント挿入後における大腿骨骨幹部骨折の治療経験

Aim;The purpose of this study was to assess whether plate and cable-wire can be used in the treatment of periprosthetic femoral shaft fractures.Patient and Methods;We treated 7 cases of 6 patients (all females) who exhibited periprosthetic femoral shaft fractures. The age of the patients ranged from 73 to 94 years (average; 79.1 years). The prostheses that had been inserted before were 6 components of THA or BEA (3 were cemented, 3 non-cemented), and one intramedullar nail. The case involving the intramedullar nail, not with standing, the fractures were categorized by Johansson's classification: 4 cases were type I fracture, and 2 were type III. All cases were treated by open reduction, using the Dall-Miles Cable Grip System (Howmedica product) in 5 cases and the Cable-Ready Cable Grip System (Zimmer product) in 2, and were clinically and radiologically assessed after the open reduction.Results;Regardless of not using external fixation, refractures did not occurr in any of the cases. Except for 2 patients with severe dementia or hemiparesis, the initiation of weight-bearing after open reduction was relatively early, ranging from 14 to 40 days (average; 26.2 days).Conclusion;It was concluded that plate and cable-wire can be used for the treatment of periprosthetic femoral shaft fractures.

Problems of Dall-Miles Cable Grip System in re-attachment of greater trochanter

Problems of Dall-Miles Cable Grip System in re-attachment of greater trochanter

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

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.

Complications of a cable grip system

From a group of 643 total hip arthroplasties, 98 patients required trochanteric osteotomies, and in 68 the trochanteric osteotomies were repaired with the Dall-Miles cable grip system (Howmedica, Rutherford, NJ). Trochanteric nonunion occurred in 17 of these patients (25%), with fraying and fragmentation of the cable present in 15 (88%). Of the 51 patients with radiographic union, 18 (35%) also had signs of fraying and fragmentation. Bone destruction around the cable in the area of the lesser trochanter was seen in seven patients (10%). Large deposits of metal debris at the inferior border of the acetabulum were seen in eight hips (12%). Multifilament cable did not appear to offer significant advantages over standard monofilament wire, and the potential problems of fraying, fragmentation, and free-floating metallic debris must be considered.

Ｄａｌｌ‐Ｍｉｌｅｓ Ｃａｂｌｅ Ｇｒｉｐ Ｓｙｓｔｅｍによる大転子固定

Due to local bone loss, re-attachment of the greater trochanter is often difficult in revision total hip arthroplasty and pseudoarthrosis of the greater trochanter. We use the Dall-Miles cable grip system (DMCGS) for trochanteric fixation in 17 hips (ten hips with revision, five hips with T. H. R. and two hips with pseudoarthrosis of the greater trochanter). Post-operatively, the trochanter failed to unite in two hips, caused by failure of the position of the cable grip. In all other cases, good radiological and clinical results were achieved. Better results are obtained using the DMCGS in cases of trochanteric bone loss following hip surgery using trochanteric osteotomy.

Early experience with Dall-Miles cable grip system at femur fracture after hip arthroplasty: 3 case report

Early experience with Dall-Miles cable grip system at femur fracture after hip arthroplasty: 3 case report