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Israel et al: Outcome of canine cementless collared stem total hip replacement with proximal femoral periprosthetic cerclage application: 184 consecutive cases
Veterinary Surgery 2, 2022

🔍 Key Findings

  • No proximal femoral fractures occurred in any of the 184 hips with cerclage wire placement
  • Cerclage wire was well tolerated, with no failures or complications related to the wire
  • Application of a single cerclage wire took <10 minutes, was cost-effective, and required minimal instrumentation
  • 3 postoperative complications (1 fissure, 2 fractures) occurred distal to the cerclage site, near the stem tip, requiring plate/screw fixation
  • All dogs returned to normal activity, and all owners were satisfied with the outcome
  • Cerclage placement location is critical—must be proximal to the lesser trochanter and close to the calcar to resist hoop strain
  • Biomechanical evidence supports that cerclage wires improve resistance to hoop strain and subsidence of cementless stems
  • Press-fit cementless stems may settle, but when supported by cerclage, this does not result in fractures even in undersized implants

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← Articles

Israel et al: Outcome of canine cementless collared stem total hip replacement with proximal femoral periprosthetic cerclage application: 184 consecutive cases
Veterinary Surgery 2, 2022

🔍 Key Findings

  • No proximal femoral fractures occurred in any of the 184 hips with cerclage wire placement
  • Cerclage wire was well tolerated, with no failures or complications related to the wire
  • Application of a single cerclage wire took <10 minutes, was cost-effective, and required minimal instrumentation
  • 3 postoperative complications (1 fissure, 2 fractures) occurred distal to the cerclage site, near the stem tip, requiring plate/screw fixation
  • All dogs returned to normal activity, and all owners were satisfied with the outcome
  • Cerclage placement location is critical—must be proximal to the lesser trochanter and close to the calcar to resist hoop strain
  • Biomechanical evidence supports that cerclage wires improve resistance to hoop strain and subsidence of cementless stems
  • Press-fit cementless stems may settle, but when supported by cerclage, this does not result in fractures even in undersized implants

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Multiple Choice Questions on this study

In Israel 2022 et al., on cerclage wire in THR, what is the most appropriate placement location for the cerclage to prevent proximal femoral fractures?

A. Distal to the lesser trochanter
B. At the femoral shaft midpoint
C. Proximal to the greater trochanter
D. Proximal to the lesser trochanter and near the calcar
E. Below the femoral stem tip

Answer: Proximal to the lesser trochanter and near the calcar

Explanation: This location targets the area of greatest hoop strain and is essential for preventing fissures during press-fit implantation.
In Israel 2022 et al., on cerclage wire in THR, what is a biomechanical benefit of cerclage application around the proximal femur?

A. Reduces blood flow to femur
B. Increases torsional load to failure by 50%
C. Improves implant osteointegration
D. Increases peak torque resistance by ~20%
E. Prevents diaphyseal fractures

Answer: Increases peak torque resistance by ~20%

Explanation: Studies show cerclage wires increase torsional failure thresholds by about 20%, aiding fracture prevention.
In Israel 2022 et al., on cerclage wire in THR, which of the following statements about cerclage wire outcomes is CORRECT?

A. Cerclage wires caused radiographic bone reaction
B. Cerclage wires failed in 10% of cases
C. Cerclage wires were associated with implant loosening
D. No complications were reported from cerclage wire use
E. All cases required revision surgery for wire problems

Answer: No complications were reported from cerclage wire use

Explanation: No wire-related complications or failures occurred in the study's 184 THRs.
In Israel 2022 et al., on cerclage wire in THR, which complication did occur postoperatively despite cerclage placement?

A. Calcar fracture
B. Stem loosening
C. Dislocation
D. Fissure/fracture near stem tip
E. Proximal femoral fracture

Answer: Fissure/fracture near stem tip

Explanation: Three dogs developed complications near the femoral stem tip, not in the region protected by cerclage.
In Israel 2022 et al., on cerclage wire in THR, what was the reported incidence of proximal femoral fractures in dogs with cerclage placement?

A. 1%
B. 2.5%
C. None
D. 8%
E. 12.2%

Answer: None

Explanation: Cerclage wire placement proximal to the lesser trochanter prevented proximal femoral fractures in all 184 hips reviewed.

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