Anatone Alex J, Flevas Dimitrios A, Sokrab Ruba, Selkridge Isaiah K, Lee Haena-Young, Sculco Peter K
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2025 Sep;40(9S1):S571-S575. doi: 10.1016/j.arth.2025.05.040. Epub 2025 May 20.
Periprosthetic femoral fractures (PPFs) following total hip arthroplasty (THA) are challenging complications, and as THA is increasingly performed in younger, more active populations, the incidence of PPFs is expected to rise. Treatment often requires tapered titanium stems to provide axial and rotational stability, and cerclage fixation is commonly used. Traditional metallic cerclage cables are effective, but carry risks such as fretting, corrosion, and intraoperative injury. Polymer-based cerclage cables have emerged as an alternative, though biomechanical data comparing them to metallic cables is limited. This study aimed to compare the strength of metal versus polymer-based cerclage cables in the treatment of isthmic PPFs during revision THA with a tapered titanium stem.
A biomechanical study was performed using 20 fresh-frozen human cadaver femora (10 matched pairs). Femora were divided into two groups: one using stainless steel cables (stainless steel group) and the other using polymer-based cables (polymer group). The femora were osteotomized to simulate isthmic fractures and fixed with three cerclage cables per femur. The specimens underwent cyclic loading, stepwise loading, and loading to failure. Axial testing was performed using a servohydraulic material testing system, and primary outcomes included stem subsidence and vertical fracture displacement.
Under cyclic fatigue loading at a 500 N force, there were no differences in subsidence (P = 0.19) or fracture displacement (P = 0.14) between the groups. Under stepwise loading to 2,600 N, subsidence (P = 0.23) and vertical fracture displacement (P = 0.22) were similar across both groups. When tested to failure, both groups also demonstrated similar forces required to cause subsidence greater than 10 mm (P = 0.27) and fracture displacement (P = 0.22).
Polymer-based cerclage cables provide biomechanical stability equivalent to metallic cables in the treatment of isthmic PPFs during revision THA and may reduce risks, such as corrosion and injury, associated with metallic cables. Further studies are needed to assess long-term outcomes.
全髋关节置换术（THA）后假体周围股骨骨折（PPF）是具有挑战性的并发症，随着THA在更年轻、活动量更大的人群中越来越多地开展，PPF的发生率预计会上升。治疗通常需要使用锥形钛柄来提供轴向和旋转稳定性，并且通常采用环扎固定。传统的金属环扎缆线是有效的，但存在微动、腐蚀和术中损伤等风险。基于聚合物的环扎缆线已成为一种替代方案，不过将它们与金属缆线进行比较的生物力学数据有限。本研究旨在比较金属与基于聚合物的环扎缆线在使用锥形钛柄进行翻修THA治疗峡部型PPF时的强度。
使用20具新鲜冷冻的人尸体股骨（10对匹配样本）进行了一项生物力学研究。股骨被分为两组：一组使用不锈钢缆线（不锈钢组），另一组使用基于聚合物的缆线（聚合物组）。将股骨截骨以模拟峡部骨折，每根股骨用三根环扎缆线固定。对标本进行循环加载、逐步加载和直至破坏的加载。使用伺服液压材料测试系统进行轴向测试，主要结果包括柄的下沉和垂直骨折移位。
在500 N力的循环疲劳加载下，两组之间的下沉（P = 0.19）或骨折移位（P = 0.14）没有差异。在逐步加载至2600 N时，两组的下沉（P = 0.23）和垂直骨折移位（P = 0.22）相似。当测试至破坏时，两组导致下沉大于10 mm所需的力（P = 0.27）和骨折移位（P = 0.22）也相似。
在翻修THA治疗峡部型PPF时，基于聚合物的环扎缆线提供的生物力学稳定性与金属缆线相当，并且可能降低与金属缆线相关的腐蚀和损伤等风险。需要进一步研究来评估长期结果。
