Contribution of cable debris generation to accelerated polyethylene wear

The decision of the senior author of a large total hip replacement practice to switch from wire to braided cable for reattachment of the greater trochanter provided the opportunity to evaluate the long term effects (on acetabular component wear, osteolysis, and component loosening) caused by the introduction of metallic debris (generated by cable fretting and breakage) into the total hip arthroplasty construct. Seven hundred and nine consecutive primary total hip arthroplasties were performed during a 5-year period and followed up for a minimum of 10 years. Wire and cable reattachment of the greater trochanter was used sequentially. At minimum 10-year followup the cable group had significantly more wear, osteolysis, and acetabular radiographic evidence of loosening. Those involved in the design and use of total hip arthroplasty devices must minimize potential sources of metallic debris and other potential sources for third body wear in the total hip arthroplasty construct to help ensure longevity of the arthroplasty.