Cerclage in Total Hip Arthroplasty: A Comprehensive Review

Abstract Background Cerclage fixation is widely used in total hip arthroplasty (THA) for managing intraoperative and periprosthetic fractures, securing osteotomies, and augmenting fixation in both primary and revision procedures. Despite broad application, the variations in materials, techniques, and outcomes merit evaluation. Methods This review synthesizes evidence on the evolution of cerclage systems, biomechanical performance, surgical techniques, and complications. Studies of metallic, polymer-based, and hybrid constructs, as well as open versus percutaneous approaches, were critically appraised. Results Cerclage has evolved from stainless steel to materials like cobalt-chromium, which demonstrates load-to-failure values exceeding 3000 N. Percutaneous techniques show high union rates of 95–100% and higher anatomic reduction. Nonetheless, mechanical failures, metallic debris, infection, and other rare complications remain concerns. Conclusions Cerclage fixation remains indispensable in THA. Careful implant choice, precise technique, and recognition of complications are essential, while further comparative studies are needed.