TITLE

Fracture of Cemeñtless Femoral Stems at the Mid-Stem Junction in Modular Revision Hip Arthroplasty Systems

AUTHOR(S)
Lakstein, Dror; Eliaz, Noam; Levi, Ofer; Backstein, David; Kosashvili, Yona; Safir, Oleg; Gross, Allan E.
PUB. DATE
January 2011
SOURCE
Journal of Bone & Joint Surgery, American Volume;1/5/2011, Vol. 93-A Issue 1, p57
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Mechanical failure of femoral stems at the modularjunction of revision hip arthroplasty systems has been reported only infrequently. In the current study, the cause of six stem fractures, which occurred in vivo, was analyzed with use of clinical data and failure analysis. Methods: Six patients with a fracture at the mid-stem junction of a modular revision hip implant were identified in our database of patients who had undergone revision arthroplasty. The characteristics of the patients with a fractured stem were.compared with those of 165 patients from the same prospective database who had a modular stem implanted, had at least two years of follow-up, and had not had a fracture of the stem. Failure analysis of three implants (six fracture surfaces) was carried out, with use of microscopic, chemical, and microhardness characterization techniques. Results: Patients with a fractured stem had significantly higher body mass indices than patients without a stem fracture. Radiographs demonstrated that these femoral implants lacked adequate osseous support of the junction area of the stem. All stems failed approximately 1 to 2 mm proximal to the body-stem junction, thus indicating the presence of a bending moment. The chemical composition and microhardness matched those of Ti-6A1-4V. Evidence of wear and fatigue were found on the fracture surface. A wear strip was also observed along the circumference of the stem near the junction. Conclusions: We concluded that the stem failure was initiated by a fretting fatigue mechanism and was propagated by a pure bending fatigue mechanism. Risk factors for fractures of the modular junction include excessive body weight and inadequate proximal osseous support because of trochanteric osteotomy, reduced preoperative bone stock, osteolysis, loosening, and/or implant undersizing. Surgeons should consider the use of implants with strengthened junctions when using modular stems in such patients.
ACCESSION #
57308554

 

Related Articles

  • Extended Slide Trochanteric Osteotomy for Revision Total Hip Arthroplasty. Chen, Wei-Meng; McAuley, James P.; Engh Jr., C. Anderson; Hopper Jr., Robert H.; Engh, Charles A. // Journal of Bone & Joint Surgery, American Volume;Sep2000, Vol. 82-A Issue 9, p1215 

    Background: The purpose of this study was to assess the rate of union, time to union, and complications associated with the extended slide trochanteric osteotomy. We also evaluated how outcomes were influenced by the preoperative cortical-bone thickness, the preoperative cancellous-bone quality...

  • Survival of Polished Compared with Precoated Roughened Cemented Femoral Components. Lachiewicz, Paul F.; Kelley, Scott S.; Soileau, Elizabeth S. // Journal of Bone & Joint Surgery, American Volume;Jul2008, Vol. 90-A Issue 7, p1457 

    Background: The optimal surface finish for cemented femoral components remains controversial. The purpose of this randomized clinical trial was to compare the survival of two femoral components with similar geometry but substantially different surface finishes. Methods: During a five-year...

  • Relationship of body mass index to early complications in hip replacement surgery. Patel, A.; Albrizio, M. // International Orthopaedics;Aug2007, Vol. 31 Issue 4, p439 

    The purpose of this study was to evaluate the relationship between body mass index and early complications following total hip replacements. Five hundred and fifty patients who underwent primary total hip replacement were recruited. All these patients were subjected to a pre-operative assessment...

  • Metal-on-Metal Hip Resurfacing for Obese Patients. Le Duff, Michel J.; Amstutz, Harlan C.; Dorey, Frederick J. // Journal of Bone & Joint Surgery, American Volume;Dec2007, Vol. 89-A Issue 12, p2705 

    Background: The effect of obesity on the outcomes of metal-on-metal resurfacing arthroplasty is not currently known. In this study, we assessed the influence of body mass index on the survival of a metal-on-metal hybrid hip resurfacing prosthesis by comparing the clinical results of patients...

  • Morbid Obesity: A Significant Risk Factor for Failure of Two-Stage Revision Total Hip Arthroplasty for Infection. Houdek, Matthew T.; Wagner, Eric R.; Watts, Chad D.; Osmon, Douglas R.; Hanssen, Arlen D.; Lewallen, David G.; Mabry, Tad M. // Journal of Bone & Joint Surgery, American Volume;2/18/2015, Vol. 97 Issue 4, p326 

    Background: Morbid obesity (BMI [body mass index], ⩾40 kg/m2) is associated with a higher risk of complications, including infection and implant failure, following primary total hip arthroplasty. The purpose of this study was to compare the results of two-stage revision total hip...

  • Effects of Age and Body Mass Index on the Results of Transtrochanteric Rotational Osteotomy for Femoral Head Osteonecrosis. Yong-Chan Ha; Hee Joong Kim; Shin-Yoon Kim; Ki-Choul Kim; Young-Kyun Lee; Kyung-Hoi Koo // Journal of Bone & Joint Surgery, American Volume;3/16/2011 Supplement, Vol. 93-A, p75 

    BACKGROUND: Advanced-stage osteonecrosis and a large area of necrotic bone are known risk factors for failure of transtrochanteric rotational osteotomy of the hip in patients with osteonecrosis. The purpose of this study was to determine whether there are other risk factors for failure of this...

  • Similar Clinical Outcomes for THAs With and Without Prior Periacetabular Osteotomy. Amanatullah, Derek; Stryker, Louis; Schoenecker, Perry; Taunton, Michael; Clohisy, John; Trousdale, Robert; Sierra, Rafael // Clinical Orthopaedics & Related Research;Feb2015, Vol. 473 Issue 2, p685 

    Introduction: Some patients opt to undergo conversion to a THA for continued pain or progression of hip arthritis after periacetabular osteotomy. Whether patients are at greater risk for postoperative complications, revision THA, poor clinical outcomes, or compromised radiographic results after...

  • Effects of Age and Body Mass Index on the Results of Transtrochanteric Rotational Osteotomy for Femoral Head Osteonecrosis. Yong-Chan Ha; Hee Joong Kim; Shin-Yoon Kim; Ki-Choul Kim; Young-Kyun Lee; Kyung-Hoi Koo // Journal of Bone & Joint Surgery, American Volume;Feb2010, Vol. 92-A Issue 2, p314 

    Background: Advanced-stage osteonecrosis and a large area of necrotic bone are known risk factors for failure of transtrochanteric rotational osteotomy of the hip in patients with osteonecrosis. The purpose of this study was to determine whether there are other risk factors for failure of this...

  • One-stage cementless revision arthroplasty for infected hip replacements. Yoo, Jeong; Kwon, Young; Koo, Kyung-Hoi; Yoon, Kang; Kim, Young-Min; Kim, Hee // International Orthopaedics;Oct2009, Vol. 33 Issue 5, p1195 

    We hypothesised that one-stage cementless revision hip arthroplasty may have advantages and a role in the treatment of selected patients with an infected hip replacement. We retrospectively reviewed all patients with an infected hip replacement treated with one-stage revision using cementless...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics