Cerclage Fixation in Total Hip Arthroplasty: Anatomy, Surgical Options and Clinical Outcomes

Cerclage fixation has become an essential adjunct in total hip arthroplasty (THA), offering surgeons a versatile means of achieving mechanical stability in the face of complex challenges such as intraoperative femoral fractures, trochanteric osteotomies, and periprosthetic fracture management. This comprehensive review synthesizes current evidence regarding anatomical considerations, surgical techniques, fixation options, and clinical outcomes related to cerclage use in both primary and revision THA. Emphasis is placed on the importance of precise anatomical knowledge, particularly in navigating neurovascular danger zones along the femur, to mitigate the risk of iatrogenic injury during cerclage application. Various cerclage systems are evaluated, including traditional stainless-steel wires, multifilament metallic cables, cable-plate constructs, nonmetallic polymer loops, and high-strength sutures, highlighting differences in biomechanical performance, cost, and clinical reliability. Clinical indications for cerclage fixation are reviewed in detail, including its role in prophylactic stabilization of high-risk femurs, fixation of trochanteric osteotomies, and management of periprosthetic fractures. As THA continues to evolve, strategic use of cerclage fixation, grounded in anatomical precision and tailored implant selection, remains a critical skillset for optimizing surgical outcomes and minimizing complications in both routine and complex cases.