Prophylactic Cabling of the Femur in Revision Total Hip Arthroplasty Lowers the Risk of Vancouver B2 and B3 Acute Periprosthetic Fractures and Reoperations.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.