Cemented Total Hip Replacement Cable Debris and Acetabular Construct Durability

Altenburg, Aaron J.; Callaghan, John J.; Yehyawi, Tameem M.; Pedersen, Douglas R.; Liu, Steve S.; Leinen, Jessica A.; Dahl, Kevin A.; Goetz, Devon D.; Brown, Thomas D.; Johnston, Richard C.
July 2009
Journal of Bone & Joint Surgery, American Volume;Jul2009, Vol. 91-A Issue 7, p1664
Academic Journal
Background: Third-body wear can adversely affect the outcome of total hip arthroplasty by causing increased polyethylene wear, osteolysis, and component loosening. We hypothesized that there would be greater generation and migration of metal debris to the bearing surfaces in hips in which cobalt-chromium cables were used to reattach the osteotomized greater trochanter when compared with hips in which stainless steel wires were used. Methods: Between June 1981 and December 1983, 196 consecutive total hip arthroplasties were performed with use of an Iowa stem and a titanium-backed cemented acetabular component, with cobalt-chromium cable trochanteric re-attachment. After nineteen to twenty years of follow-up, the patients were evaluated with regard to the depth of head penetration into the polyethylene (as a surrogate for wear), osteolysis, loosening, and the need for revision. The results were compared with those for a series of 304 total hip arthroplasties that were performed by the same surgeon from January 1984 to December 1985 with use of the same components and the same surgical technique, but with stainless steel wire trochanteric reattachment. The two groups had a comparable nineteen to twenty-year follow-up. All living patients (fifty-nine hips in the cable group and ninety-two hips in the wire group) had minimum ten-year follow-up radiographs. Results: The polyethylene wear rate was 0.101 mm/yr for the cable group and 0.082 mm/yr for the wire group (p = 0.039). For the living patients, the rate of revision of the acetabular component because of aseptic loosening was 37.3% (twenty-two hips) for the cable group and 20.7% (nineteen hips) for the wire group (p = 0.025). The rate of acetabular osteolysis was 44% (twenty-six hips) for the cable group and 26% (twenty-four hips) for the wire group (p = 0.022). Kaplan- Meier analysis with revision of the acetabular component because of aseptic loosening as the end point demonstrated survival rates of 73.7% ± 9% and 83% ± 7% for the cable and wire groups, respectively, at twenty years (p = 0.03). Conclusions: Because cable trochanteric attachment led to significantly greater polyethylene wear, osteolysis, acetabular loosening, and acetabular revision, presumably due to third-body metallic debris generation in this cemented total hip replacement construct, surgeons should be aware of the deleterious effects of third-body debris and avoid the use of potential debris generators in the total hip arthroplasty construct. If cable is used and fretting is recognized, especially with intra-articular migration of metallic material or nonunion of the greater trochanter, consideration should be given to cable removal.


Related Articles

  • Ten-year results with the Morscher press-fit cup: an uncemented, non-modular, porous-coated cup inserted without screws. Garavaglia, Guido; Lübbeke, Anne; Barea, Christophe; Roussos, Constantinos; Peter, Robin; Hoffmeyer, Pierre // International Orthopaedics;Jul2011, Vol. 35 Issue 7, p957 

    Total hip arthroplasty (THA) with well designed cementless acetabular implants has shown excellent results. The purpose of this study was to assess our clinical and radiological outcomes using an uncemented cup. We conducted a prospective cohort study including all consecutive primary THAs...

  • The use of structural periacetabular allografts in acetabular revision surgery: 2.5–5 years follow-up. Schelfaut, S.; Cool, S.; Mulier, M. // Archives of Orthopaedic & Trauma Surgery;Apr2009, Vol. 129 Issue 4, p455 

    “Acetabular bone loss” presents a major reconstructive challenge in total hip arthroplasty. Loss of acetabular bone stock is a consequence of removal of bone during the original procedure, subsequent prosthetic failure and osteolysis resulting from wear particles of cement and...

  • Clinical Performance of Highly Cross - Linked Polyethylenes in Total Hip Arthroplasty. Jacobs, Cale A.; Christensen, Christian P.; Greenwald, A. Seth; McKellop, Harry // Journal of Bone & Joint Surgery, American Volume;Dec2007, Vol. 89-A Issue 12, p2779 

    The article discusses the clinical performance of highly cross-linked polyethylenes in total hip arthroplasty. Polyethylene wear of total hip prostheses is affected by multiple factors, including the type of resin used, the diameter of the femoral head and the alignment of the acetabular and...

  • EFFECT OF ACETABULAR MODULARITY ON POLYETHYLENE WEAR AND OSTEOLYSIS IN TOTAL HIP ARTHROPLASTY. Young, Anthony M.; Sychterz, Christi J.; Hopper Jr., Robert H.; Engh, Charles A. // Journal of Bone & Joint Surgery, American Volume;Jan2002, Vol. 84-A Issue 1, p58 

    Background: Debris from polyethylene wear causes osteolysis. In this study, we examined the effect of acetabular liner modularity on polyethylene wear and osteolysis. Methods: We compared forty-one hips (thirty-nine patients) treated with a nonmodular, porous-coated acetabular component with a...

  • The First 50 Years of Total Hip Arthroplasty: Lessons Learned.  // Clinical Orthopaedics & Related Research;Jan2009, Vol. 467 Issue 1, p28 

    Abstract  Fifty years have passed since the first total hip arthroplasty of the modern era was performed. At this, the vantage point, it is reasonable to review these five decades, inquiring behind the single dominating observation that, in its current form, this operation is one...

  • The effects of peroxide content on the wear behavior, microstructure and mechanical properties of peroxide crosslinked ultra-high molecular weight polyethylene used in total hip replacement. Gul, Rizwan // Journal of Materials Science: Materials in Medicine;Jun2008, Vol. 19 Issue 6, p2427 

    The wear of the ultra-high molecular weight polyethylene (UHMWPE) acetabular components and wear debris induced osteolysis are the major causes of failure in total hip replacements. Crosslinking has been shown to improve the wear resistance of UHMWPE by producing a network structure, resisting...

  • Deformation of press-fitted metallic resurfacing cups. Part 1: experimental simulation. Jin, Z. M.; Meakins, S.; Morlock, M. M.; Parsons, P.; Hardaker, C.; Flett, M.; Isaac, G. // Proceedings of the Institution of Mechanical Engineers -- Part H;Feb2006, Vol. 220 Issue 2, p299 

    The interference press fit of a metallic one-piece acetabular cup employed for metal-on-metal hip resurfacing procedures was investigated experimentally under laboratory conditions in the present study, in particular regarding the cup deformation. Tests were carried out in cadavers as well as...

  • A simple mathematical standardized measurement of acetabulum anteversion after total hip arthroplasty. Chen-Kun Liaw; Rong-Sen Yang; Sheng-Mou Hou; Tai-Yin Wu; Chiou-Shann Fuh // Computational & Mathematical Methods in Medicine;Jun2008, Vol. 9 Issue 2, p105 

    We invented a standardization method to measure the cup's anteversion after total hip arthroplasty without the influence of patient's position. We measured 68 radiographs of 10 patients after total hip replacement (THR) and calculated the error of each measurement, defined as the difference with...

  • Improving Cup Positioning Using a Mechanical Navigation Instrument. Steppacher, Simon D.; Kowal, Jens H.; Murphy, Stephen Barry // Clinical Orthopaedics & Related Research;Feb2011, Vol. 469 Issue 2, p423 

    Background: Although surgical navigation reduces the rate of malpositioned acetabular cups in total hip arthroplasty (THA), its use has not been widely adopted. As a result of our perceived need for simple and efficient methods of navigation, we developed a mechanical navigation device for...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics