Femoral stem fractures after primary and revision hip replacements: A single-center experience
Alper Köksal1, Ali Öner1, Osman Çimen1, Osman Emre Aycan1, Hakan Akgün1, Furkan Yapıcı2, Yalkın Çamurcu2
1Department of Orthopedics and Traumatology, Istanbul Metin Sabancı Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
2Department of Orthopedics and Traumatology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
Keywords: Femoral stem, stem fracture, stem revision, total hip arthroplasty.
Objectives: This study aims to present our experience in the management of fractured femoral stems after primary and revision hip replacements by evaluating the clinical and radiographic characteristics and determining the effectiveness of the extraction methods.
Patients and methods: A total of 15 patients (5 males, 10 females; mean age 65.9 years; range, 49 to 87 years) who underwent revision hip replacement due to a fractured femoral stem between January 2005 and December 2019 were included in this retrospective study. The mechanisms and risk factors for failure as well as methods applied to extract fractured stem were analyzed through clinical and radiographic data.
Results: Nine patients had fractured cemented femoral stems, while six patients had fractured fully porous coated cementless revision stems. Lack of proximal buttress in distally fixed femoral stems was detected in 11 patients and identified as the predominant mechanism resulting in fracture. The proximal extraction method with conventional revision instrumentation, the cortical window technique, and extended trochanteric osteotomy (ETO) were used in three, seven, and five cases, respectively.
Conclusion: Our results demonstrated that the lack of proximal buttress is the most common reason for femoral stem fracture. Moreover, the proximal extraction method was mostly ineffective in fully porous femoral stems. A step-by-step approach should be considered for the extraction of a broken stem. The cortical window method can be considered as the second step if proximal extraction methods fail, and ETO should be considered at the last step if all techniques fail.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.