The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Cantilever Failure of Modular Uncemented Femoral Revision Stem in Patients with Poor Proximal Femoral Support; How to avoid it?

Document Type : RESEARCH PAPER

Authors
Rahul Mohan 1
Nithin Unnikrishnan 2
Ravindra Gudena 1
1 Mersey and West Lancashire Teaching Hospitals NHS Trust, United Kingdom
2 The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
10.22038/abjs.2023.75373.3485
Abstract
Objectives: Revision hip arthroplasty is a major surgical challenge and is even more difficult in cases 
with a deficient proximal femur. Modular uncemented cone body revision femoral stems were introduced 
as a solution. They have the advantage of optimising joint kinematics by allowing the variable degrees 
of version, offset and leg length. However, we noticed cantilever failure of such stems, particularly in 
patients with deficient proximal femoral support. Fatigue fracture of the revision femoral stems should 
raise questions about its use in patients with insufficient proximal femoral bone support.
Methods: We present a case series of five patients with the cantilever failure of Stryker restoration modular stem 
conical distal femur prosthesis. These cases were identified during a retrospective review of revision hip surgeries 
performed at our trust.
Results: The stem failed after an average of 22.6 months post-revision surgery. Primarily, poor proximal femur 
bone support with a well-fixed distal stem and secondarily high BMI led to this catastrophic failure in the absence of 
trauma. All five cases were re-revised to Stanmore proximal femoral replacement and achieved good functional 
outcomes after an average follow-up of seven years.
Conclusion: Proximal femoral bone support should be restored to prevent early cantilever failure of distally fixed 
proximal modular revision femoral stems. Consider a proximal femoral replacement if we cannot ensure proximal 
bone support.
 Level of evidence: IV
Keywords
Bone support
Cantilever failure
Deficient proximal femur
Modular stem
Proximal femoral replacement
Revision hip
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 4
April 2024
Pages 240-244

  • Receive Date 05 October 2023
  • Revise Date 16 January 2024
  • Accept Date 27 December 2023