Prophylactic Cerclage With Braided Polyblend Suture During Femoral Broaching

Femur fractures occur during broaching and impaction of the implant during hip arthroplasty. Prophylactic cerclage of the proximal femur with braided cable and steel wire has been shown to decrease hoop stresses and has been posited as a way to decrease the incidence of intraoperative fracture. In this biomechanical study, the authors investigated the strain across the proximal femur during broaching after the application of stainless steel wire, comparing it with that for braided polyblend suture. Nine femur models were prepared, and strain gauges were applied to each of 3 groups. The control group received no cerclage, the second group received a double loop of suture, and the third group received a single loop of steel wire. A broach was firmly seated in each femur and sequentially increasing axial loads were applied at 1000 N, 2000 N, 3000 N, 4000 N, 5000 N, and 6000 N and to failure. Strain at all loads was lower in both cerclage groups than in the control group. Strain was 28.6%±12.4% lower in the suture group than in the control group (P=.0003). Strain was 30.8%±10.7% lower in the steel wire group than in the control group (P=.0011). There was no statistically significant difference between suture cerclage and steel wire cerclage (P=.7367). When used for prophylactic cerclage of the proximal femur, braided polyblend suture increases hoop stress resistance, decreases strain, and may play a clinically useful role in decreasing intraoperative proximal femur fractures during hip arthroplasty. [Orthopedics. 2016; 39(6):e1183-e1187.].