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. 2018 Jun;6(6):e4.
doi: 10.2106/JBJS.RVW.17.00164.

Fixation Options Following Greater Trochanteric Osteotomies and Fractures in Total Hip Arthroplasty: A Systematic Review

Xin Y Mei  1 , Ying Jia Gong, Oleg A Safir, Allan E Gross, Paul R Kuzyk
Affiliations

Fixation Options Following Greater Trochanteric Osteotomies and Fractures in Total Hip Arthroplasty: A Systematic Review

Xin Y Mei et al. JBJS Rev. 2018 Jun.

Abstract

Background: The optimal system for greater trochanteric fixation following osteotomy or fracture remains unknown. This systematic review aims to synthesize the available English-language literature on 5 commonly reported trochanteric fixation methods to quantify and compare rates of complications and reoperation.

Methods: A comprehensive search of MEDLINE and Embase databases from January 1946 to June 2017 was performed for articles in English describing fixation of trochanteric osteotomies and fractures using wires, cables, cable-plate devices, claw or locking plates, and trochanteric bolts. Pooled mean rates of complications and reoperation with 95% confidence intervals (CIs) were analyzed using a random-effects model.

Results: Fifty-seven studies involving 10,956 hips were eligible for inclusion. Five studies had Level-III evidence and 52 had Level-IV evidence. The pooled mean rate of nonunion was 4.17% (95% CI, 3.21% to 5.13%; I = 79%) for wires, 5.07% (95% CI, 0.37% to 9.77%; I = 74%) for cables, 16.11% (95% CI, 10.85% to 21.37%; I = 89%) for cable-plate systems, 9.60% (95% CI, 2.23% to 16.97%; I = 59%) for claw or locking plates, and 12.42% (95% CI, 3.41% to 21.43%; I = 75%) for trochanteric bolts. Substantial heterogeneity in the data precluded formal statistical comparison of outcomes and complications between implants.

Conclusions: Available literature on the various trochanteric fixation implants is heterogeneous and consists primarily of retrospective case series. Based on the current literature, it is difficult to support the use of one implant over another. Despite superior mechanical properties, rates of complication and reoperation following cable-plate fixation remains suboptimal, especially in complex revision scenarios. Additional rigorous prospective randomized and cohort studies are needed to make definitive recommendations regarding the most reliable method of trochanteric fixation.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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References

    1. Archibeck MJ, Rosenberg AG, Berger RA, Silverton CD. Trochanteric osteotomy and fixation during total hip arthroplasty. J Am Acad Orthop Surg. 2003 May-Jun;11(3):163-73.
    1. Barrett WP. Standard trochanteric osteotomy. Semin Arthroplasty. 2004 Apr;15(2):108-112.
    1. Kim IS, Pansey N, Kansay RK, Yoo JH, Lee HY, Chang JD. Greater trochanteric reattachment using the third-generation cable plate system in revision total hip arthroplasty. J Arthroplasty. 2017 Jun;32(6):1965-9. Epub 2017 Jan 20.
    1. Dall DM, Miles AW. Re-attachment of the greater trochanter. The use of the trochanter cable-grip system. J Bone Joint Surg Br. 1983 Jan;65(1):55-9.
    1. Jarit GJ, Sathappan SS, Panchal A, Strauss E, Di Cesare PE. Fixation systems of greater trochanteric osteotomies: biomechanical and clinical outcomes. J Am Acad Orthop Surg. 2007 Oct;15(10):614-24.

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