A novel figure-of-eight polymeric cerclage wiring technique for greater trochanter fixation in revision arthroplasty and conversion of failed proximal femur fracture fixations to total hip arthroplasty

Introduction: Periprosthetic femoral fractures occur in 0.8–10% of primary total hip arthroplasties (THA) and up to 17.5% for revision THA (revTHA), with isolated greater trochanter (GT) fractures being the most predominant pattern. This study aimed to evaluate a novel figure-of-eight cerclage wiring technique for greater trochanter fixation in hip replacement cases. Methods: These retrospectively collected data included 36 hips (36 patients) undergoing revision THA or conversion of failed intertrochanteric fracture to THA with figure-of-eight cerclage wiring between April 2021 and June 2023. Patients under 18 years, with incomplete records, or lost to follow-up before 24 months were excluded. Primary outcomes included Trendelenburg sign, periprosthetic infections, and hip dislocation rates. Secondary outcomes evaluated THA stem subsidence and trochanteric migration using calibrated digital imaging. Statistical analysis included descriptive statistics, independent t-tests, linear regression, and correlation analyses with significance set at p < 0.05. Results: Mean follow-up was 404.76 ± 22.51 days. Patient demographics showed mean age 76.5 ± 12.3 years, body mass index (BMI) 25.8 ± 4.5 kg/m2, with 73.8% female patients. At final follow-up, one patient (2.8%) experienced post-surgical infection, one patient (2.8%) had dislocation, and three patients (8.3%) exhibited positive Trendelenburg sign. Mean trochanteric migration was 4.01 mm at 12 months (range 0.0–30.4 mm), with one clinically significant case (30.4 mm migration). Mean stem subsidence was 1.3 ± 2.7 mm (range 0.0–16.4 mm), with one clinically significant case (16.4 mm subsidence). No statistically significant differences were found between posterior-lateral and anterior approaches for migration (p = 0.276) or subsidence (p = 0.324). Linear regression analysis revealed no significant predictors of migration or subsidence among age, BMI, surgical approach, or treatment type. Conclusions: The figure-of-eight cerclage wiring technique with polymeric cerclages demonstrates promising results for greater trochanter fixation with low complication rates and adequate stability across different surgical approaches and patient populations. Level of Evidence IV.