Femoral prosthesis neck fracture following total hip arthroplasty — a systematic review

Abstract

Purpose Head-neck modularity was introduced into total hip arthroplasty to provide more intraoperative surgical options. However, modularity led to new problems, such as trunnionosis and fractures of the femoral prosthesis neck. The purpose of this study was to identify risk factors for hip neck fractures and to provide recommendations to prevent damage and fractures of the neck. Methods A systematic review of the literature was performed according to the PRISMA guidelines. Results Thirty-three case studies were included. Methodologically, most included studies were of moderate or good quality. The 80 neck fractures included in the review took place, on average, 7 years after stem placement. Male gender, high body weight, obesity, previous revision surgery, mixing components from different manufacturers, use of long skirted heads, cobalt-chromium (large size) heads were identified as potential risk factors. Conclusion Hip neck fractures occur on average 7 years after stem placement. The etiology of hip neck fractures is multifactorial. This review revealed several preventable implant- and surgeon-related risk factors.

Gross Taper Failure and Fracture of the True Neck in Total Hip Arthroplasty: Retrieval Scanning Electron Microscope Analysis

“…Although the Morse cone theoretically represents a high-locking mechanism, in the literature, micromovements are frequently reported, in particular in the case of not properly fitted components [ 7 , 16 ]. These micromovements allow the seepage of synovial fluid inside the junctional spaces, resulting in fretting corrosion and, subsequently, leading to local and general complications, even rarely including fatigue fracture of the prosthetic neck [ 12 , 16 ]. Considering that this phenomenon is often present in models with a single modularity, modular neck femoral stems seem to be even more likely to show this kind of issue as they present an additional component coupling (neck–head + stem–neck) [ 16 ].…”

“…Neck fractures are complications documented in the clinical literature but not very common. In a recent systematic review, van Doesburg reported the results of 33 studies documenting a total of 80 prosthetic neck fractures of which 55 were in the head–neck region and 25 were more distal in the neck-shoulder region of the stem [ 12 ]. The fracture of the trunnion itself is an absolutely extraordinary event.…”

“…The most striking cases of trunnionosis, often called gross trunnion failures (GTF), include fracture, the disassembly of the femoral head component, and a massive material loss from the trunnion [ 7 , 27 ]. Many situations can facilitate the occurrence of GTF, and the most important risk factors acknowledged in the literature are male sex, a body mass index (BMI) of >30, prosthetic implants with a high offset, long neck length or large CoCr femoral head (>36 mm), intraoperative damage of the components, and finally implant malpositioning [ 12 , 28 ].…”

“…In the literature, it has been demonstrated that a defective fitting is responsible for micromovements between surfaces, allowing the seepage of synovial fluid and the subsequent fretting corrosion [ 11 , 12 ]. This mechanism may lead to the increase in metal ion levels and debris inside the periprosthetic soft tissues, leading to both local and systemic complications [ 13 ].…”

Trunnions and Modularity in Total Hip Arthroplasty: A Historical Review With Current Clinical Implications

“…However, corrosion and wear at the neck-stem junction led to unforeseen complications, such as implant fractures and increased revision rates, typically around 7 years postoperatively. 26,27 The most common patient report is insidious onset of groin, thigh, or buttock pain after a certain length of pain-free postoperative period. Workup in such cases involves obtaining serum markers, metal ion levels, and advanced imaging such as an MRI scan.…”