Introduction: Third generation fixation systems allow for the retightening of cables, and are associated with high rates of trochanteric union. This is a prospective study undertaken to evaluate the outcome of the first 40 patients treated with a third generation cable plate and trochanteric hook system.

Methods: 36 patients treated by two revision hip arthroplasty surgeons using a third generation cable plate system were enrolled and followed up. These included 28 females and 12 males with an average age of 64 (range: 48–91). Large hooks were used in 30 with an average of 4.8 cables (range: 4–9). The need to retighten cables intra-operatively was noted. Clinical and radiographic follow-up was undertaken at 2 years.

Results: A third generation fixation system was used for 16 peri-prosthetic fractures, 6 trochanteric non unions, 5 structural femoral allografts, 6 complex revisions and for trochanteric advancement in 3 cases. The first cable tightened was loose by the end of the procedure in the majority of cases and had to be retightened. There were no cases of fretting or cable breakage. Two further trocanteric non unions needed re-fixation and bone grafting in a further procedure

Discussion and Conclusion: Third generation cable system allow for re-tightening, as the cable is not damaged by the crimping mechanism. This facility appears critical as some retightening is invariably required in the process of applying this type of device. There were only 2 re-operations for trochanteric non unions, but the overall outcomes were otherwise excellent, with no fretting or cable breakage. Modern cable systems afford improved, more flexible trochanteric fixation possibilities.

We reviewed 194 revision arthroplasties of the hip and knee performed over a ten-year period. The results of intraoperative Gram staining were available in 169 (87%). Thirty-two were found to be infected (11 hips and 21 knees) and 137 had no evidence of infection.

Intraoperative Gram staining was negative in all 169 cases. The method therefore had a sensitivity of 0% for detecting infection. We conclude that the absence of organisms on intraoperative Gram staining during revision arthroplasty does not confirm the absence of infection.