Effectiveness of prophylactic double-looped wiring in cementless Hip arthroplasty: A biomechanical study in osteoporotic bone model using impaction simulation system

Siwadol Wongsak; Paphon Sa-Ngasoongsong; Siwadol Pinitkwamdee; Nutchanat Thongchuea; Abigyat Babu Prasai; Eakkachai Warinsiriruk; Chavarat Jarungvittayakon; Suphaneewan Jaovisidha; Pongsthorn Chanplakorn

doi:10.1016/j.injury.2022.05.034

Effectiveness of prophylactic double-looped wiring in cementless Hip arthroplasty: A biomechanical study in osteoporotic bone model using impaction simulation system

Injury. 2022 Jul;53(7):2454-2461. doi: 10.1016/j.injury.2022.05.034. Epub 2022 May 21.

Authors

Siwadol Wongsak¹, Paphon Sa-Ngasoongsong², Siwadol Pinitkwamdee¹, Nutchanat Thongchuea³, Abigyat Babu Prasai⁴, Eakkachai Warinsiriruk⁵, Chavarat Jarungvittayakon¹, Suphaneewan Jaovisidha⁶, Pongsthorn Chanplakorn¹

Affiliations

¹ Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
² Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand. Electronic address: paphon.sag@mahidol.ac.th.
³ Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand. Electronic address: nutchanat.tho@student.mahidol.edu.
⁴ Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand.
⁵ Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand. Electronic address: eakkachai.war@mahidol.ac.th.
⁶ Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.

PMID: 35660012
DOI: 10.1016/j.injury.2022.05.034

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.

Keywords: Calcar crack; Hoop stress resistance; Mallet impaction force; Osteoporosis; Periprosthetic femoral fracture; Prophylactic wiring.

MeSH terms

Aged
Arthroplasty, Replacement, Hip* / adverse effects
Femoral Fractures* / etiology
Femur / surgery
Hip Prosthesis* / adverse effects
Humans
Osteoporosis* / complications
Periprosthetic Fractures* / etiology
Periprosthetic Fractures* / prevention & control
Periprosthetic Fractures* / surgery