Stem-Sleeve Junction Failure of a Modular Femoral Hip System: A Retrieval Analysis

Waly, Feras; Abduljabbar, Fahad H.; Gascoyne, Trevor C.; Turgeon, Thomas R.; Huk, Olga L.

doi:10.1007/s11420-015-9455-7

Cited by 9 publications

(9 citation statements)

References 44 publications

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“…[18]11.6an/an/an/an/an/aFatigueStem-sleeve6912831.6a5Severe

STD, standard; DOS, date of surgery.

Values for all 7 cases reported by Huot Carlson et al. [7], [8], [9], [10], [11], [18].

…”

Section: Discussionmentioning

confidence: 99%

“… [9] 18 × 13 × 160 36 + 8L 18F Large ZTT n/a 54 Howmedica Polyethylene Fatigue Stem-sleeve 61 n/a n/a 9 n/a Waly et al. [10] 14 × 9 36 STD 14B 28 ceramic 48 Pinnacle Ceramic Fatigue Stem-sleeve 64 70 28 7 Large corrosion pit Shah et al. [7] 13 STD n/a 36 Oxinium Polyethylene Fatigue Stem-sleeve 77 n/a 34 10 n/a Patel et al.…”

Section: Discussionmentioning

confidence: 99%

“…Corrosion might reduce the area of inertia that ultimately weakens the stem's fracture resistance (Eq. 1 ) [10] , [18] . However, in line with almost all reported failures, our surface analysis showed damage patterns consistent with fatigue fracture due to cyclic loading rather than significant corrosion and fretting as the underlying cause of failure [8] , [9] , [10] , [18] .…”

Section: Discussionmentioning

confidence: 99%

“…But recent reports on the modular stem Emperion System (Smith and Nephew, Memphis, TN) demonstrated a stem fracture rate of 1.5% (8 of 547), and this stem has since been removed from commercial use [7] . The present study reports a similar failure mechanism at the sleeve-stem junction in a S-ROM Modular Hip System (DePuy Orthopedics Inc., Warsaw, IN) and includes a comprehensive review of the literature on S-ROM stem fractures [7] , [8] , [9] , [10] , [11] . The paper also discusses the proposed failure mechanism, potential risk factors, and surgical management of this complication.…”

Section: Introductionmentioning

confidence: 91%

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Fracture of an S-ROM stem at the sleeve-stem junction

et al. 2018

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Fracture of a well-ingrown femoral component is a rare and often challenging complication. Modular junctions and sleeve interfaces have been identified as one potential point of weakness with corrosion and fretting being contributing factors to ultimate femoral component fracture. Stem fractures at the sleeve interface were reported occasionally for the proximal ingrowth modular Emperion System (Smith and Nephew, Memphis, TN). However, this failure mechanism has been reported infrequently, often associated with corrosion at the modular junction, for the similarly designed S-ROM system (DePuy Orthopedics Inc., Warsaw, IN). We present the case of a 52-year-old patient, with a body weight of 84 kg (185 lbs) and a body mass index of 30.6 kg/m2, who suffered a fatigue fracture of a 14 × 09 × 130 mm S-ROM stem 42 months after implantation. The present study presents the results of the surface analysis, discusses possible failure mechanisms, provides treatment guidelines, and a review of the literature revealing 15 cases of failure at the level of the stem-sleeve junction. In particular, modifiable risk factors for potential stem failure, including stem diameter, stem offset, and the resulting cantilever bending forces on the proximal sleeve-stem junction, are discussed in detail.

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“…[18]11.6an/an/an/an/an/aFatigueStem-sleeve6912831.6a5Severe

STD, standard; DOS, date of surgery.

Values for all 7 cases reported by Huot Carlson et al. [7], [8], [9], [10], [11], [18].

…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

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Fracture of an S-ROM stem at the sleeve-stem junction

et al. 2018

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“…Pearce et al reported two stem fractures at the mid-stem junction at the top of the slotted portion of the stem. [40,41,42] One of our authors had a fractured stem (4 years postoperatively) within the sleeve/ ethylene deposits. [44] In 1992, Buly et al reported on 71 cases of titanium wear debris in failed cemented THA.…”

Section: Challenges With the Stem/sleeve Modular Junctionmentioning

confidence: 99%

Metallic Modular Taper Junctions in Total Hip Arthroplasty

McTighe¹,

Brazil²,

Keppler³

et al. 2015

ReconRev

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The emergence of modularity in total hip arthroplasty (THA) in the 1980s and 1990s was based on the fact that the benefit of these design features outweighed the risk. The use of metallic modular junctions presents a unique set of advantages and problems for use in THA. The advantages include improvement in fit and fill of the implant to bone, restoration of joint mechanics, reduced complications in revision surgery and reduction of costly inventory. However, the risks or concerns are a little harder to identify and deal with. Certainly corrosion, and fatigue failure are the two most prevalent concerns but now the specifics of fretting wear and corrosive wear increasing particulate debris and the potential biological response is having an impact on the design and potential longevity of the reconstructed hip. Material and designs are facing a shorter life expectancy than what was previously thought, mostly due to an increasing level of physical activity by the patient. Because there are no accurate laboratory test whereby the service life and performance of these implants can be predicted, early controlled clinical evaluations are necessary. Early publication of testing and clinical impressions should be encouraged in an attempt to reduce exposure to potential at risk patients, implants and material. The reduction and possible elimination of risks will require a balancing of all the variables requiring a multidisciplinary endeavor.This paper is designed to review the risk factors, and benefits of modular junctions in total hip arthroplasty (THA). Also some basic engineering principals that can reduce risk factors and improve functionality of modular junctions.

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