Parikh Nihir, Lam Alan D, Held Michael B, Shields John S, Krueger Chad A
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Arthroplasty. 2025 Sep;40(9S1):S400-S404. doi: 10.1016/j.arth.2025.05.051. Epub 2025 May 20.
Periprosthetic fractures (PPFx) represent a common cause of revision total hip arthroplasty (rTHA). Among PPFx, Vancouver B2 and B3 are more challenging, often requiring reoperation and femoral stem revision. Cables have been shown to reduce stem subsidence, fracture propagation, and stress during axial loading. However, there is a paucity of literature on the role of prophylactic cabling during rTHA. Therefore, this study aimed to determine the acute PPFx rate and types of PPFx in rTHA for patients who had prophylactic cables compared to those who did not have cables.
This retrospective study identified patients who underwent rTHA at our institution. Current Procedural Terminology codes and radiographic images were reviewed to group patients into the cables or no cables cohorts. The primary outcome was the rate of acute PPFx (<30 days postoperatively). The secondary outcomes were the Vancouver classification of PPFx, reoperations for PPFx, and all-cause re-revisions. There were 2,977 patients identified: 192 who had and 2,785 who did not have cables.
There was no difference in acute PPFx rates between the prophylactic cables and no cables (1.56 versus 2.08%, P = 0.80). However, cabling substantially lessened the more complex B2 and B3 fractures and reoperation rates. In the prophylactic cable group, 100% of the fractures were B1 compared to 30 B1 (51.7%), 16 B2 (27.5%), nine B3 (15.5%), and three C (5.2%) fractures in the no cables cohort. Reoperation rates for acute PPFx were significantly lower in the cables cohort (33.3%) than in the no cables cohort (50.0%), P = 0.022. All-cause rerevisions were also significantly lower in those who had cables (7.3 versus 12.8%, P = 0.038).
Prophylactic cabling for taper fluted, diaphyseal fitting stems protects against more complex Vancouver B2 and B3 fractures while reducing reoperations. In rTHA, surgeons should consider prophylactically cabling the femur to lessen the risk of reoperation and complex fracture.
假体周围骨折（PPFx）是全髋关节翻修术（rTHA）的常见原因。在PPFx中，温哥华B2型和B3型骨折更具挑战性，通常需要再次手术和股骨柄翻修。已证明缆线可减少柄的下沉、骨折扩展和轴向加载时的应力。然而，关于rTHA期间预防性使用缆线的作用的文献较少。因此，本研究旨在确定与未使用缆线的患者相比，使用预防性缆线的患者在rTHA中的急性PPFx发生率和PPFx类型。
这项回顾性研究确定了在我们机构接受rTHA的患者。审查当前的手术操作术语代码和影像学图像，将患者分为使用缆线组或未使用缆线组。主要结局是急性PPFx发生率（术后<30天）。次要结局是PPFx的温哥华分类、PPFx的再次手术以及全因再次翻修。共确定了2977例患者：192例使用缆线，2785例未使用缆线。
预防性使用缆线组和未使用缆线组的急性PPFx发生率无差异（分别为1.56%和2.08%，P = 0.80）。然而，使用缆线可显著减少更复杂的B2型和B3型骨折以及再次手术率。在预防性使用缆线组中，100%的骨折为B1型，而在未使用缆线组中，30例为B1型（51.7%），16例为B2型（27.5%），9例为B3型（15.5%），3例为C型（5.2%）。急性PPFx的再次手术率在使用缆线组（33.3%）显著低于未使用缆线组（50.0%），P = 0.022。使用缆线患者的全因再次翻修率也显著更低（分别为7.3%和12.8%，P = 0.038）。
对于锥形凹槽、骨干适配柄进行预防性缆线固定可预防更复杂的温哥华B2型和B3型骨折，同时减少再次手术。在rTHA中，外科医生应考虑对股骨进行预防性缆线固定，以降低再次手术和复杂骨折的风险。
