# Cerclage Wires Used for Extended Trochanteric Osteotomy Fixation During Two-Stage Revision Total Hip Arthroplasty for Periprosthetic Joint Infection Are Not Colonized by Bacteria: A Case Series

## TL;DR

This study found that cerclage wires used in hip surgery for infection are not colonized by bacteria, suggesting they may not need to be replaced in follow-up procedures.

## Contribution

The study is the first to investigate bacterial colonization of cerclage wires in two-stage revision hip surgery for infection.

## Key findings

- Cerclage wires showed no bacterial colonization in 26 out of 28 cases.
- Only one case of bacterial contamination was found in cerclage wires and spacers.
- Systematic exchange of cerclage wires during second-stage surgery may not be necessary.

## Abstract

Eradication of infection after total hip arthroplasty (THA) is particularly challenging. The aim was to evaluate whether cerclage wires, used to stabilize an extended trochanteric osteotomy (ETO) in patients undergoing two-stage revision THA for infection, become colonized with bacteria. The findings could help discern whether cerclage wires should be systematically exchanged during the second surgery to reduce the risk of persistent infection.

Patients were included in the study if they had undergone two-stage revision THA for infection, that required stem removal using an ETO, and the cerclage wires had been exchanged during the second-stage procedure. The cohort comprised a consecutive series of 28 patients, 14 females and 14 males, aged 67.9 ± 13.1 years with a body mass index of 29.8 ± 6.6 kg/m2. Following the second-stage procedure, sonication of the explanted spacer and cerclage wires was performed separately to check for bacteria.

Twenty-six of the 28 patients were available for bacterial testing following the second-stage procedure. Sonication of the cerclage hardware revealed one case of bacterial contamination and no cases of bacterial colonization. Furthermore, sonication of the spacer revealed one case of bacterial contamination and no cases of bacterial colonization.

Cerclage wires used for fixation of ETO during two-stage revision THA for infection are not colonized by bacteria, suggesting that it may not be necessary to systematically exchange them during the second-stage procedure. Further studies with larger cohort sizes are necessary to confirm these findings.