Use of a cerclage cable‐plate system to stabilize a periprosthetic femoral fracture after total hip replacement in a dog

Outcome of canine cementless collared stem total hip replacement with proximal femoral periprosthetic cerclage application: 184 consecutive cases

OBJECTIVE

To report outcomes of cementless collared stem total hip replacement (THR) with proximal femoral periprosthetic cerclage application in dogs.

STUDY DESIGN

Retrospective case series.

ANIMALS

Client-owned dogs (n = 150) with THR (n = 184).

METHODS

Serial postoperative radiographs and medical records of dogs that underwent consecutive index cementless THR, with a single full cerclage wire placed distal to the femoral neck osteotomy line and proximal to the lesser trochanter, were reviewed for intraoperative and postoperative complications.

RESULTS

No proximal femoral fractures occurred. No complications associated with the use of the cerclage wire were encountered. A fissure (n = 1) or fractures (n = 2) occurred near the tip of the femoral stem in three cases postoperatively. All three cases required plate and screw fixation. All dogs returned to subjectively normal function at home and all owners were satisfied with the outcome.

CONCLUSION

A single full cerclage wire may minimize the risk of a proximal femur fracture following cementless collared stem total hip replacement in dogs. No complications were encountered with the cerclage wire.

CLINICAL SIGNIFICANCE

Application of a cerclage wire is a simple and economically feasible procedure that requires minimal additional instrumentation, takes little time, and may decrease the risk of proximal femur fractures after cementless press-fit THR.

Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement

OBJECTIVE

 The aim of this study was to report outcomes in dogs with periprosthetic femoral fractures associated with a press-fit cementless femoral total hip replacement implant.

MATERIALS AND METHODS

 Electronic medical records and digital radiographs were used to identify dogs with periprosthetic femoral fractures associated with press-fit cementless total hip replacement. Data collected included signalment, weight, time of fracture, cause of fracture, presence of intra-operative fissure, fracture type, repair technique, and clinical and radiographic outcomes. Long-term patient outcome was assessed by communication with owners or referring veterinarians.

RESULTS

 Twenty-eight dogs with femoral fracture repair associated with cementless press-fit total hip replacement were identified. Eight of the fractures occurred intraoperatively and 20 occurred at a median of 2 days postoperatively. An oblique or spiral configuration was noted in 19 cases and 15 occurred at the distal end of the femoral stem (type B), with thirteen type B1, one type B2 and one type B3 fractures. Fractures were repaired with non-locking (18/28) or locking-plate fixation (10/28). Cerclage wire was applied around the plate and proximal bone segment in 17/28 dogs. Major complications occurred in 7/28 cases (five deep infection, two mechanical failures). Bone healing was noted in 21/23 cases, for which follow-up radiographic interpretation was available. Return to function was complete in 17 cases, acceptable in 8 cases and unacceptable in 3 cases.

CONCLUSIONS

 While cementless total hip replacement periprosthetic femoral fractures can be successfully repaired with lateral plate fixation, the risk of infection appears to be high.