Use of Electrocautery to Facilitate Suture Passage Through the Greater Trochanter of the Femur: A Biomechanical Study.

Introduction: The specific aims of this study were to evaluate (1) the axial force reduction of suture passage utilizing electrocautery when applied to the greater trochanter of the femur, (2) the temperature change caused while using electrocautery for suture passage, and (3) the failure loads and failure modes utilizing this technique. Methods: Five matched pairs of fresh-frozen femurs were used and classified into two groups: with electrocautery on needle (study group) and without electrocautery on needle (control group). Two bicortical, osseous tunnels were made around the insertion of the gluteus medius tendon. Each specimen was sequentially tested in a needle penetration test and a single load-to-failure test. A #5 Ethibond suture with a straight needle was used. Results: Electrocautery reduced the peak axial force for bone penetration in 40% (near cortex) and 70% (far cortex) of the trials, and no significant difference was detected between groups or between two osseous tunnels. The average peak force was significantly higher for the far cortex for both groups and for both osseous tunnels compared to the near cortex. There was no significant change in temperature of the tunnel site with electrocautery. Ninety percent of the samples experienced bone tunnel failure for the study group compared to 70% in the control group. The average ultimate failure load for the study group was lower compared with the control group, but this finding was not statistically significant (range: 6%-15%). Conclusions: Suture passage using electrocautery may not significantly decrease the peak force needed to pass a needle directly through the greater trochanter.