Effectiveness of prophylactic double-looped wiring in cementless Hip arthroplasty: A biomechanical study in osteoporotic bone model using impaction simulation system
Issued Date
2022-07-01
Resource Type
ISSN
00201383
eISSN
18790267
Scopus ID
2-s2.0-85131397792
Pubmed ID
35660012
Journal Title
Injury
Volume
53
Issue
7
Start Page
2454
End Page
2461
Rights Holder(s)
SCOPUS
Bibliographic Citation
Injury Vol.53 No.7 (2022) , 2454-2461
Suggested Citation
Wongsak S., Sa-ngasoongsong P., Pinitkwamdee S., Thongchuea N., Prasai A.B., Warinsiriruk E., Jarungvittayakon C., Jaovisidha S., Chanplakorn P. Effectiveness of prophylactic double-looped wiring in cementless Hip arthroplasty: A biomechanical study in osteoporotic bone model using impaction simulation system. Injury Vol.53 No.7 (2022) , 2454-2461. 2461. doi:10.1016/j.injury.2022.05.034 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85765
Title
Effectiveness of prophylactic double-looped wiring in cementless Hip arthroplasty: A biomechanical study in osteoporotic bone model using impaction simulation system
Author's Affiliation
Other Contributor(s)
Abstract
Background: Periprosthetic femoral fracture (PFF) is well-known complication in cementless hip arthroplasty (HA), especially in the elderly with osteoporosis. To prevent intraoperative PFFs during HA, prophylactic cerclage wiring on the calcar area during femoral broaching and implant insertion is recommended. However, biomechanical data on the benefits of cerclage wiring in osteoporotic bone during impaction are limited and controversial. This study aimed to assess the efficacy of prophylactic double-looped cerclage wiring (PDLCW) during femoral broaching in the osteoporotic bone model with an impaction simulation system. Methods: Fifteen osteoporotic femur models were prepared and allocated to three groups; control group (no cerclage), PW group (received PDLCW), and CC+PW group (prepared as having calcar crack and received PDLCW). All femurs were broached under impaction force that sequentially increased until the visible fracture or calcar crack propagation was visible. The primary outcomes were mallet impaction force (MIF-CF) and mallet velocity (MV-CF) at the time of calcar fracture. The secondary outcomes were calcar fracture pattern and subsidence during calcar fracture (S-CF). Results: PW group showed a significant increase in average MIF-CF, by 40.4% and 120.2% (p<0.001) compared to the control and CC+PW groups, respectively. The average MV-CF in PW group was also significantly greater, 13.1% and 64.6% (p<0.001), compared to the control and CC+PW groups, respectively. Control group revealed significantly greater incidence of complete calcar fracture (60% vs. 0% vs. 0%, p = 0.024), and the highest S-CF compared to those in the PW and CC+PW groups (10.6 ± 6.0 mm, 6.7 ± 4.4 mm, and 1.3 ± 2.0 mm, p = 0.020). Conclusions: This study showed that PDLCW significantly improved hoop stress resistance by increasing the calcar fracture threshold related to mallet impaction, decreasing the risk of complete calcar fracture.