Trochanteric Wire Research Articles

Primary Arthroplasty for Unstable and Failed Intertrochanteric Fractures: Role of Multi-Planar Trochanteric Wiring Technique.

The primary objective of the current study is to demonstrate the trochanteric wiring technique. A secondary objective is to evaluate the clinico-radiological outcomes of use of the wiring technique during primary arthroplasty for treatment of unstable and failed intertrochanteric fractures. A prospective study including follow-up of 127 patients with unstable and failed intertrochanteric fractures who underwent primary hip arthroplasty using novel multi-planar trochanteric wiring was conducted. The average follow-up period was 17.8±4.7 months. Clinical assessment was performed using the Harris hip score (HHS). Radiographic evaluation was performed for assessment of union of the trochanter and any mechanical failure. P<0.05 was considered statistically significant. At the latest follow-up, the mean HHS showed significant improvement from 79.9±1.8 (at three months) to 91.6±5.1 (P<0.05). In addition, no significant difference in the HHS was observed between male and female patients (P=0.29) and between fresh and failed intertrochanteric fractures (P=0.08). Union was achieved in all cases of fractured trochanter, except one. Wire breakage was observed in three patients. There were five cases of limb length discrepancy, three cases of lurch, and three cases of wire-related bursitis. There were no cases of dislocation or infection. Radiographs showed stable prosthesis in situ with no evidence of subsidence. Use of the proposed wiring technique was helpful in restoring the abductor level arm and multi-planar stability, which enabled better rehabilitation and resulted in excellent clinical and radiological outcomes with minimal risk of mechanical failure.

Clinical and radiological outcome of modified trochanteric wiring in fresh and failed Intertrochanteric fractures of femur during hip arthroplasty

Background: Femoral intertrochanteric fractures are common in the elderly population. Trochanteric reconstruction is very vital in these type of fracture. various technique is described for trochanteric fixation. In our study, we used modified trochanteric wiring for reconstruction of greater trochanter during hip arthroplasty in intertrochanteric fracture of femur. Objective: To assess prospectively and retrospectively, post-operative functional and radiological outcome of modified trochanteric wiring in fresh and failed intertrochanteric fracture of femur during hip arthroplasty in a tertiary care centre with follow-up upto 1 year. Result: In our study mean HHS at 3 months follow-up was 79.34, mean HHS at 6 months follow-up was 84.87, mean HHS at 1 year follow-up was 86.76. There is gradual increase in the value of HHS at the 3 consequent follow-up. With p value of

Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures

BackgroundPosteromedial and greater trochanteric fragments are a major cause of telescoping and medialization of the femoral shaft in an unstable intertrochanteric fracture. This leads to significant limb shortening, fracture collapse in varus position and implant failure, which can be prevented by trochanteric wiring in addition to dynamic hip screw (DHS) fixation. The purpose of our study is to assess the outcomes of DHS augmented with trochanteric wiring in unstable type A2 intertrochanteric fractures. Materials and methodsOne hundred and two retrospective cases of unstable intertrochanteric fractures treated with DHS between January 2010 and December 2015 with a minimum follow-up period of 12 months were reviewed. Out of 102 cases, 28 were treated with DHS and derotation screw alone (Group A), while in rest 74 cases trochanteric wiring was used as an augmentation to DHS and derotation screw (Group B). Patients were evaluated clinically for range of motion, Harris hip score and Oxford hip score. Radiologically, fracture reduction, change in neck shaft angle and neck length ratio in comparison to opposite hip and union status of greater trochanter were assessed. ResultsThe mean age of the patients at the time of surgery was 72 years (range 23–94 years) with 48 males and 54 females. The mean follow-up period was 20 months (range 12–48 months). The Harris hip score, Oxford hip score, shortening, attainment of weight bearing and change in neck shaft angle was not significantly different between the two groups (all p values >0.05). Incidence of greater trochanter nonunion was greater in group A (17.85%) as compared to group B (6.75%). We found significant association between occurrence of limp with varus change in neck shaft angle, decrease in neck length ratio and greater trochanteric non-union (all p values <0.05). We had 7 complications, one superficial infection, one deep vein thrombosis, 4 screw cut out and one deep infection treated with implant removal. ConclusionDHS augmented with trochanteric wiring in unstable intertrochanteric fractures gives similar result to group without no wiring, although greater trochanter non-union rate was more in the latter group. Limp can be prevented by anatomical or valgus fixation, augmentation of DHS to support posteromedial and greater trochanteric fragments and delayed weight bearing.

A Novel Technique for Twin-Loop Pertrochanteric Wiring

Iatrogenic calcar cracks when inserting uncemented arthroplasty stems are usually treated by stem removal and trochanteric wiring. The authors propose a novel method using a proprietary twin-wire cerclage system which confers potential benefits over a traditional single wire technique to treat this surgical problem.

Subclinical infection associated with delayed union after transtrochanteric rotational osteotomy

Infected nonunion of the transtrochanteric osteotomy site is an uncommon complication of transtrochanteric anterior rotational osteotomy. A 45-year-old male underwent anterior rotational osteotomy for osteonecrosis of the left femoral head. A radiograph obtained 4 months after surgery showed the presence of osteolytic lesions around the trochanteric wire, and the transtrochanteric osteotomy site appeared to be fuzzy. In spite of the continuation of partial weight bearing, osteolytic changes progressed. An open biopsy was performed 13 months after surgery. Samples were taken from multiple sites, including osteolytic lesions, one of which was confirmed to contain coagulase-negative staphylococcus. Nineteen days after performing thorough debridement and irrigation, the patient underwent a refixation of the osteotomy site using an iliac bone graft and a sliding hip screw system. A radiograph obtained at the final follow-up revealed bone union at the site of osteotomy.

Early loosening and secondary dislocation due to a broken trochanteric osteotomy wire following a Charnley total hip arthroplasty: a case report

We report a case of interposition of a broken trochanteric wire in the hip joint. This caused early wear of the prosthesis and dislocation of the Charnley total hip arthroplasty. The patient was treated with a revision total hip arthroplasty. This rare complication should be taken into consideration when performing a trochanteric osteotomy fixation with wiring in Charnley total hip arthroplasty.

Post-traumatic Catamenial Sciatica

This article presents a unique case of posttraumatic extrapelvic endometriosis presenting as a gluteal mass causing cyclic sciatica. A 38-year-old woman presented with an enlarging right buttock mass over the previous 6 years. She also had symptoms of radicular pain referred to the right leg and foot with sitting and daily activity. Four years prior to noticing the mass, she sustained a gunshot wound through the lower abdomen while 5 months pregnant. Excisional biopsy of the gluteal mass revealed endometrioma. Sciatica is a common and painful disorder that is believed to have an incidence of 40% in the adult population. Sciatica is most often due to intraspinal pathology affecting the lumbar nerve roots. There are many recognized extraspinal etiologies for sciatica in the literature including aneurysms, sciatic hernia, abcess, neoplasm, trochanteric wire, piriformis syndrome, ischial fracture, a posteriorly flexed uterus, and even an intrauterine device following uterine perforation. Similarly, endometriosis is a gynecologic condition that represents a significant health problem for women of reproductive age as it occurs in up to 50% of premenopausal women and 71% to 87% in women with chronic pelvic pain. Although rare, endometriosis has a well known ability to migrate outside of the abdominal cavity and proliferate ectopically under the control of systemic estrogen.

A 15- to 25- Year Follow-Up Study of Primary Charnley Low-Friction Arthroplasty: A Single Surgeon Series

Long term outcome studies are essential to determine the effectiveness and durability of a procedure. We report our 15 to 25 year clinical and radiographic follow-up with the Charnley low-friction hip arthroplasty. Four hundred and forty-seven primary Charnley hip arthroplasties were performed by a single surgeon. Ninety-eight of the 447 hips from 75 patients were available for follow up at average of 18.9 years (range 15.3 to 25.4 years). Seventy-two hips (73.5%) survived clinically. Of these 72, seventy-one stems (98.6%) and 60 sockets (83.3%) survived radiographically. Kaplan-Meier survival analysis on all 447 hips using revision as an endpoint revealed 66.2% ± 5.7% survival at 20 years. Twenty-six hips were revised. The main reason for revision was failure of the socket. Complications included dislocation (3 of 98 hips), heterotopic ossification (7 of 98 hips), trochanteric wire breakage (6 of 98 hips), and trochanteric non-union (1 of 98 hips). Charnley low-friction hip arthroplasty is an effective and durable procedure.

Mécanismes d’endommagement des pièces de frottement des arthroplasties de hanche à couple métal-polyéthylène: Influence de la migration intra-articulaire de débris métalliques

Purpose of the study The objective of this work was to identify the mechanisms leading to deterioration of the polyethylene acetabular surface in total hip prostheses. Material and methods We conducted an in vivo analysis of damage caused to articulating surfaces of metal-on-polyethylene total hip prostheses. This analysis was performed on three of the 45 explants of Harris-Galante prostheses available to use from our series of 1480 implantations performed between 1985 and 1996. These three pieces were selected because large-sized fibers of metallic debris were identified on the polyethylene surface and because the explants had been performed for reasons other than loosening in aseptic patients. Macroscopic examination was combined with scan electron microscopy to analyze morphological changes. Results We found that identical damage could be observed on the polyethylene explants despite the different sizes of the metallic heads and different metal-on-polyethylene combinations. Our analysis confirmed the deleterious effect of metallic foreign bodies trapped in contact with the articulate surfaces. These foreign bodies resulted in one case from rupture of a multifilament wire used for the trochanteric fixation and in two cases from the surfacing of the non-cemented Harris-Galante cups. The microscopic analysis demonstrated several successive localizations of the foreign bodies on the polyethylene surface before becoming deeply encrusted in the polyethylene where they deteriorated the femoral head surface (rough) and wore the polyethylene surface (abrasion). When the fibers came from the surfacing of the Harris-Galante cups, the metallic debris remained unrecognized during the revision procedure and were only identified later during the systematic examination of prosthetic explants. Discussion and conclusion These findings emphasize the importance of quality surface treatments for non-cemented prostheses and argue in favor of particular precautions during operative manipulation of these components. A systematic analysis of the prosthetic explants is advisable, particularly for components explanted because of wear or unexplained osteolysis. Use of multifilament trochanteric wires should be avoided because rupture raises the risk of intra-articulate migration of metallic debris. If the prosthesis involves a polyethylene acetabular surface, ceramic heads should be preferred to improve resistance to abrasion, particularly to limit the deleterious effect of a third body.

Metallic instrument debris: A source of third-body wear particles?

Polyethylene wear debris is considered an important factor in aseptic loosening of total joint arthroplasties [ 1 Willert HG Buchorn GH Particle disease due to wear of ultra high molecular weight polyethylene: findings from retrieval studies. in: Biological, material and mechanical considerations of joint replacement. Raven Press,, New York1993: 87 Google Scholar ]. Particles of any hard material (third-body wear particles) trapped within the articulation have been shown to increase greatly the rate of polyethylene wear [ 2 Davidson JA Poggie RA Mishra AK Abrasive wear of ceramic, metal and UHMWPE bearing surfaces from third-body bone, PMMA bone cement and titanium debris. Biomed Mater Eng. 1994; 4: 213 PubMed Google Scholar ]. Reported sources of third-body particles include bone-cement [ 3 McKellop HA Sarmiento A Schwinn CP In vivo wear of titanium alloy hip prostheses. J Bone Joint Surg Am. 1990; 72: 512 PubMed Google Scholar ], metal debris from porous coatings [ 4 Collier JP Mayor MB Jensen RE et al. Mechanisms of failure of modular prosthesis. Clin Orthop. 1992; 285: 129 PubMed Google Scholar ], broken trochanteric wires or cables [ 5 Kelley SS Johnston RC Debris from cobalt-chrome cable may cause acetabular loosening. Clin Orthop. 1992; 285: 140 PubMed Google Scholar ], and particles of bone. We have observed that small particles, just visible to the naked eye, occasionally are shed by the copper hammers commonly used in the United Kingdom during total joint arthroplasty. This phenomenon has been reported as the cause of an eye injury to the surgeon [ 6 Lourie J Hamid K One in the eye for an orthopaedic surgeon. Ann R Coll Surg Eng. 1996; 78: 67 PubMed Google Scholar ]. The hypothesis that such debris is produced with sufficient frequency to represent a possible source of third-body wear particles has not been investigated previously, however. We performed a study that simulates the intraoperative use of orthopaedic hammers. The resultant particulate debris was collected and analyzed.

Modified medial displacement and valgus osteotomy for unstable intertrochanteric fractures

We have described previously a modification of the medial displacement and valgus osteotomy of Dimon and Hughston to manage non-unions of intertrochanteric fractures. In this study, we have used the same modification to manage fresh, unstable intertrochanteric fractures. Eighty-seven patients underwent this procedure. Four died within 4 months. The remaining 83 patients were evaluated over a period ranging from 4 to 49 months. There was a low complication rate with this method. They included one perforation of the femoral head, one post operative infection that recurred as a deep infection, one partial superior migration of the implant, one varus fixation with noticeable shortening and two cases where the trochanteric wire had snapped. In the others, the hip movement, abductor function, functional recovery and rate of union (8-12 weeks) were good. The method permits early weight-bearing and avoids some of the problems seen with anatomical fixation of unstable fractures using the sliding screw plate. We feel that medial displacement and valgus osteotomy with an angled blade plate has a definite role in the treatment of unstable intertrochanteric fractures in some situations.

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

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 …

Results of Trochanteric Wire Removal Surgery and Its Relation to Revision Hip Arthroplasty

Local trochanteric symptoms can occur after Total Hip Arthroplasty through any approach but are said to be more common after the transtrochanteric approach. Most of these symptoms subside spontaneously or after a local anaesthetic and steroid injection. Unremitting symptoms can be indicative of persistent trochanteric bursitis, septic loosening or aseptic loosening. In cases of hip arthroplasties performed through a transtrochanteric approach, the trochanteric wires are commonly incriminated as a cause of persistent trochanteric pain. In this retrospective study of 92 patients who underwent trochanteric wire removal surgery, 32 patients (34.78%) had an unsatisfactory result. 24 patients (26.09%) underwent revision surgery at an average of 36.75 months after wire removal surgery. This study suggests that signs of early loosening need to be carefully looked for and ruled out before advising trochanteric wire removal for persistent trochanteric discomfort.

Proceedings of the British Medical Ultrasound Society 26th annual meeting. Scarborough, 14-16 December 1994. Abstracts.

AIM: To assess the role of ultrasound in management of patients with symptomatic total hip replacements (THR). MATERIALS AND METHOD: 26 patients with symptoms following THR (2–11 years post-surgery) were examined sonographically using a 5–6 MHz curvilinear transducer (Diasonics Prisma) over a 12 month period. Any fluid collection was aspirated for bacteriology and any soft tissue masses were core biopsied for histological assessment. Ultrasound appearances as well as transducer compression tenderness were noted. RESULTS: Ultrasound diagnoses included: wear debris granulomata, 14 (definite, 5; probable, 6; possible, 3); prosthetic infection, 3 (2 with sequestra at level of femoral component tip); trochanteric wire problems, 10 (granulation tissue formation, 3; bursa formation, 3; infection, 2; haematoma, 1; compression tenderness without focal ultrasound abnormality, 1); femoral shaft fracture, 1; greater trochanter fracture, 1; acetabular screw granulation tissue, 1; heterotopic ossification, 3; ?ceramic femoral head fracture, 1; normal study (but possible early loosening on X-ray), 3. CONCLUSION: Ultrasound is an extremely useful method of initial evaluation of symptomatic total hip replacements.

The effect of the medial collar in total hip arthroplasty with porous-coated components inserted without cement. An in vivo canine study.

We performed an in vivo study in a canine model to compare the results of the use of a porous-coated collared femoral component with those of the use of a porous-coated collarless femoral component in total hip arthroplasties without cement. Our study focused on the comparative proximal strain pattern, bone ingrowth, and cortical porosity of the two types of prostheses. We used a trochanteric wire marker to measure subsidence. The use of the limb was assessed with gait analysis. Twelve weeks after the operation, the collarless components had significantly greater bone ingrowth proximally (p = 0.003) and were associated with significantly lower cortical porosity (p = 0.006). There were no differences between the groups with regard to either axial or hoop strain. While the group that had a collarless prosthesis had significantly less proximal-medial radiolucency (p = 0.03), there were no differences between the groups with regard to subsidence.

Chevron Osteotomy and Single Wire Reattachment of the Greater Trochanter in Primary and Revision Total Hip Arthroplasty

Even at a medical center where hip arthroplasty is performed routinely without trochanteric osteotomy, selected arthroplasties still require greater trochanteric osteotomy. A technique of greater trochanteric biplane osteotomy and reattachment with one wire is described. The technique provides maximum stability with a minimum of internal fixation and it can be performed quickly. The postoperative rehabilitation protocol is the same as that used in hip arthroplasty patients without trochanteric osteotomy. Results with a minimum two-year follow-up period disclosed osseous union in 98% of 53 primary arthroplasties and 97% of 74 revision hip arthroplasties. Problems related to the greater trochanter necessitated reoperation in only two patients: one for reattachment of a migrated trochanter and one for trochanteric wire removal.

The role of trochanteric wire revision after total hip replacement.

Fifty-nine cases of trochanteric wire revision following hip arthroplasty with trochanteric osteotomy and reattachment were identified and their outcome was studied. Two were infected and were excluded. Five were revised for instability: four became stable while one continued to have persistent dislocation. Fifty-two were revised for pain, 36 by removal of the trochanteric wire and 16 by reattachment of the greater trochanter. Successful relief of pain was obtained in less than half the cases. There was no difference in the incidence of back pain, wiring technique, trochanteric advancement, previous surgery to the same hip, trochanteric size or the pattern of wire breakage in the successfully treated group and the unsuccessful group. Neither was the removal of intact wire from a united trochanter any more certain of relieving pain than removal of broken wire from an un-united trochanter. Six patients later required revision for loosening or infection. These results indicate the need for full radiological and haematological investigation before exploration of the greater trochanter. At exploration for pain the wires should simply be removed as we could show no successful union after late reattachment of the trochanter in the absence of instability.

Use of TARA hemiarthroplasty in advanced osteonecrosis

The results of 25 TARA hemiarthroplasty procedures performed on 21 patients with radiographically documented Ficat stages III and IV osteonecrosis are reported. The average patient age at the time of surgery was 37.6 years (range, 22–55 years). The average length of follow-up study was 37 months (range, 25–60 months). Preoperative Harris hip scores averaged 51 points (range, 22–69 points). Postoperative scores averaged 90 points (range, 66–100 points). Good or excellent results were obtained in 22 of 25 hips. There were no cases of infection or component dislocation. Three component revisions were performed in two patients. Four patients required removal of trochanteric wires and one patient had excision of heterotopic ossification. This procedure appears to offer selected young patients with advanced femoral head osteonecrosis a very satisfactory initial result, while preserving many options for subsequent revision procedures.

Revision hip surgery using the straight-stem Muller prosthesis

Thirty-two cemented revision hip arthroplasties done with a straightstem Muller prosthesis were reviewed an average of 3 years after operation (range, 2–4.4 years). Acetabular revision, performed in 29 cases, was done with a support ring, mesh, or bone graft in 18 of 29 (62%) cases. Acetabular and femoral cement pressurization techniques were not used. Trochanteric osteotomy was done in 15 cases (47%). The average patient age was 60.2 years (range, 20–85 years). Based on the clinical rating system of Swanson and Evarts, there were 21 (65.6%) excellent, 2 (6.3%) good, 8 (25%) fair, and 1 (3.1%) poor results. The clinical outcome was better after revision from a resurfacing arthroplasty (87.5% good/excellent results) than from uni/bipolar or total hip arthroplasty (60%). Radiographic examination suggests that two femoral components and one acetabular component are loose. These patients have a fair clinical rating. None have been revised. Trochanteric wire breakage (60%) and displacement (26.7%) was common if trochanteric osteotomy was done

Prevention of Sciatic Nerve Entrapment in Trochanteric Wiring Following Total Hip Arthroplasty

Sciatic nerve entrapment secondary to trochanteric wiring is a rare but serious complication following total hip arthroplasty (THA) in which the trans-trochanteric approach has been used. To eliminate this risk, the authors modified the Charnley drill-and-wire-guide forceps for the femur, an instrument that facilitates both the drilling of an anteroposterior hole through the femur in the intertrochanteric region and the insertion of the horizontal wire. Transformation of the slot on the lower branch of the forceps into a loop that engages the posterior end of the wire, thereby advancing it automatically when the instrument is retracted, effectively prevents entrapment of both the sciatic nerve and the soft tissues. The modified instrument also saves time, and in more than 3000 THAs in which it has been used, no case of sciatic nerve entrapment has been observed.