Cerclage wires or cables for the management of the intraoperative fracture associated with a cementless-tapered femoral prosthesis: results at 2–16 years

Initial stability is critical for fixation and survival of cementless total hip arthroplasty (THA). Occasionally, a split of the calcar occurs intraoperatively. We use a cerclage to protect against propagation. We present mid- to long-term results and survivorship with this technique. A review of radiographs and clinical records of 1320 primary THAs with 2-year follow-up, performed between August 1985 and February 2001 using the Mallory-Head Porous femoral component, revealed 58 hips in 55 patients with an intra-operative calcar fracture managed with single or multiple cerclage wires or cables and immediate full weight bearing. This represents approximately 4% of primary THAs with a minimum 2-year follow-up and an identical component. Preoperative and most recent postoperative Harris Hip Scores (HHS) were recorded. Failure of the femoral component is defined as revision of the stem, evidence of radiographic loosening, or severe thigh pain. At 7.5 years average follow-up (range: 2 -16 years), there were no radiographic failures or patients with severe thigh pain, for a stem survival rate of 100% at up to 16 years. HHS improved an average of 33.8 points. Fracture of the proximal femur occurs in approximately 4% of primary THAs using the Mallory-Head Porous tapered femoral component. When this situation is managed intraoperatively with the use of cerclage wire or cable, the mid- to long-term results appear to be unaffected, with 100% femoral component survival at up to 16 years. Initial component stability should be the primary intraoperative goal of THA.