Fracture of the neck of a femoral component in a total hip arthroplasty: a case report

Díaz, Valeriano Artime; Ramos, João Carlos; Fernández-Medina, J.M.; Luis, M. C. de; Aguilera, L.

doi:10.1007/s002640050119

Cited by 12 publications

(2 citation statements)

References 10 publications

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“…Other causes for failure as laser etching on the neck, 3 poor cementing technique, implant neck corrosion, 8,19 the use of elongated femoral heads, 20 excessive machining, 11 malposition of the implant or fixation problems were not present in this cohort. 21 Although this implant is no longer available on the market, we believe this study to be clinically important as a significant number of patients with this stem in situ are still at risk for early failure.…”

Section: Discussionmentioning

confidence: 76%

High rates of implant fracture of a generic polished tapered femoral stem

et al. 2020

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Objectives: Cemented polished tapered stems have demonstrated excellent long-term outcomes. Based on this concept, many generic tapered stems have been released into the market. The aim of this study was to evaluate implant-related complications of 1 specific stem design. Methods: Between 2010 and 2017, 315 total hip replacements were performed using a Fortress stem (Biotechni, La Ciotat, France). Patient records and radiology were retrospectively reviewed for implant-related complications. A failure analysis was performed on the failed Fortress stems in order to determine the cause of premature failure. Results: 7 (2.2%) patients sustained a fracture of the neck of the implant after a mean of 5 years (range 50–81 months). All fractures were atraumatic, originating at the introducer inlet of the stem. All fractured occurred in obese patients (BMI >33 kg/m2) with a small sized prosthesis. Of these, there were 5 135° and 2 125° stems. Fracture risk was 23% (7/30) for patients with a small sized stem and a BMI >30 kg/m2. All cases were revised using a cement-in-cement technique or a cementless modular revision stem. Failure analysis on the retrieved stems revealed a stress riser at the bottom of the introducer inlet. Conclusions: An alarmingly high rate of early implant fractures was seen using this specific type of cemented stem, particularly when using smaller implant sizes in obese patients. Although based on a proven design, a specific modification led to a stress riser in the neck area, which resulted in a high incidence of implant failure. This series underlines the importance of a stepwise introduction into the market of new orthopaedic devices even when based on established concepts. Generic stems may not behave as the original stem upon which it was designed.

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Section: Discussionmentioning

confidence: 76%

High rates of implant fracture of a generic polished tapered femoral stem

et al. 2020

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“…Cementless stem fractures are thought to be caused by a weakness of the prosthesis, such as the prosthesis neck [ 10 – 12 ], a narrow stem diameter excluding madreporic corrugation [ 8 ], the junction of the madreporic corrugations and smooth plate [ 13 ], or narrowness of the anteroposterior dimension and the depth of recess for the titanium mesh pads [ 14 ]. Sotereanos et al reported two cases of cementless stem fracture among 122 patients (1.6%) who received an extensively porous-coated, single-sized cobalt-chrome component, while in their subsequent series no stem fractures were noted (0/227) when stems of multiple size were available, suggesting that inadequate stem thickness increases the risk of fracture [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Implant Fracture of Extensively Porous-Coated, Distally Fixated Cementless Long Stem: Detailed Course of Stem Bending Development

Mimura

2015

Case Reports in Orthopedics

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We report the fracture of a cementless long stem in a distally fixated, extensively porous-coated femoral prosthesis used for revisional total hip arthroplasty (THA) 9 years previously in a 48-year-old woman, measuring 58 kg in weight and 155 cm in height. Following resolution of an infection 7 years after the revisional THA, a series of posterior dislocations occurred up until 7 months before sudden stem fracture. Extensive radiographic imaging evidence indicated a gradual progression of bending in the stem, and scanning electron microscope energy dispersive X-ray spectroscopy revealed oxygen in the medial and lateral sections, suspecting in vivo corrosion. We retrospectively examined the detailed course of stem bending development prior to stem fracture. The stem bending immediately after the revisional THA, at the first dislocation, and immediately before the stem fracture was 0°, 1.9°, and 5.2°, respectively. We consider that the cyclic loading with poor proximal bone support, distal fixation, and small diameter were the potential risk of this implant fracture. However, the course of stem bending development suggested that repeated operations and several dislocations might have aggravated the implant fatigue in the present case.

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Pre-operative Workup and Planning for Periprosthetic Fractures of the Hip and Knee

DelSole,

Slover

2024

Trauma and Infection Control in Revision Hip and Knee Arthroplasty

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Fracture of the neck of a femoral component in a total hip arthroplasty: a case report

Cited by 12 publications

References 10 publications

High rates of implant fracture of a generic polished tapered femoral stem

High rates of implant fracture of a generic polished tapered femoral stem

A Case Report of Implant Fracture of Extensively Porous-Coated, Distally Fixated Cementless Long Stem: Detailed Course of Stem Bending Development

Pre-operative Workup and Planning for Periprosthetic Fractures of the Hip and Knee

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