Modular Well-Fixed Hip Revision Stem Fracture: A Case Report and Literature Review

Document Type : CASE REPORT

Authors

1 Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

2 Department of Orthopedics and Trauma Surgery, ASST Rhodense, Ospedale Salvini, Garbagnate Milanese, Milano, Italy

10.22038/abjs.2024.80313.3666

Abstract

This study presents a case of repeated prosthetic fracture in a modular hip prosthesis in a 56-year-old 
male patient.After the initial implantation of a modular total hip prosthesis in 2006, the patient 
experienced two instances of prosthetic implant fracture over seventeen years. In this study, we analyz e 
the clinical case, explore potential underlying causes of this complication, and delve into current 
indications and strategies for the revision of fractured prosthesis stems. The discussion is informed by 
a literature review and underscores the significance of selecting appropriate revision techniques to 
address this challenge.
 Level of evidence: III

Keywords

Main Subjects


1. Gautam D, Malhotra R. Total Hip Arthroplasty with Modular 
Stem for Dysplastic Hips in South Asian Population. Arch 
Bone Jt Surg. 2019; 7(6):506-513.
2. Solarino G, Vicenti G, Carrozzo M, Ottaviani G, Moretti B, 
Zagra L. Modular neck stems in total hip arthroplasty: current 
concepts. EFORT Open Rev. 2021; 6(9):751-758. doi: 
10.1302/2058-5241.6.200064.
3. Pelayo-de-Tomás JM, Rodrigo-Pérez JL, Novoa-Parra CD, 
Lizaur-Utrilla A, Morales-Suárez-Varela M, Blas-Dobón JA. 
Cementless modular neck stems: are they a safe option in 
primary total hip arthroplasty? Eur J Orthop Surg Traumatol. 
2018; 28(3):463-469. doi: 10.1007/s00590-017-2071-0.
4. Morlock MM, Hube R, Wassilew G, Prange F, Huber G, Perka C. 
Taper corrosion: a complication of total hip arthroplasty. 
EFORT Open Rev. 2020; 5(11):776-784. doi: 10.1302/2058-
5241.5.200013.
5. Graves SE, de Steiger R, Davidson D, et al. The use of femoral 
stems with exchangeable necks in primary total hip 
arthroplasty increases the rate of revision. Bone Joint J. 2017; 
99-B (6):766-773. doi: 10.1302/0301-620X.99B6.38020.
6. Mohan R, Unnikrishnan N, Gudena R. Cantilever Failure of 
Modular Uncemented Femoral Revision Stem in Patients with 
Poor Proximal Femoral Support; How to avoid it? Arch Bone 
Jt Surg. 2024; 12(4):240-244. doi: 10.22038/ABJS.2023.75373.3485.
7. Sivananthan S, Lim CT, Narkbunnam R, Sox-Harris A, 
Huddleston JI 3rd, Goodman SB. Revision Hip Arthroplasty 
Using a Modular, Cementless Femoral Stem: IntermediateTerm Follow-Up. J Arthroplasty. 2017; 32(4):1245-1249. doi: 
10.1016/j.arth.2016.10.033.
8. Valtanen RS, Hwang KL, Amanatullah DF, Huddleston JI 3rd, 
Maloney WJ, Goodman SB. Revision Hip Arthroplasty Using a 
Modular, Cementless Femoral Stem: Long-Term Follow-Up. J 
Arthroplasty. 2023; 38(5):903-908. doi: 
10.1016/j.arth.2022.12.018.
9. Skendzel JG, Blaha JD, Urquhart AG. Total hip arthroplasty 
modular neck failure. J Arthroplasty. 2011; 26(2):338.e1-
338.e3384. doi: 10.1016/j.arth.2010.03.011.
10. Wright G, Sporer S, Urban R, Jacobs J. Fracture of a modular 
femoral neck after total hip arthroplasty: a case report. J Bone 
Joint Surg Am. 2010; 92(6):1518-1521. doi: 
10.2106/JBJS.I.01033.
11. Papaioannou I, Repantis T, Baikousis A, Korovessis P. Late 
Onset Disassembly of a Modular Neck-stem Component after 
Cementless Hip Replacement without Dislocation: A Case 
Report and Review of Literatures. Hip Pelvis. 2018; 
30(3):190-195. doi: 10.5371/hp.2018.30.3.190.
12. Zajc J, Predan J, Gubeljak N, Moličnik A, Fokter SK. Modular 
femoral neck failure after revision of a total hip arthroplasty: 
a finite element analysis. Eur J Orthop Surg Traumatol. 2019; 
29(3):717-723. doi: 10.1007/s00590-018-2314-8.
13. Kouzelis A, Georgiou CS, Megas P. Dissociation of modular 
total hip arthroplasty at the neck-stem interface without 
dislocation. J Orthop Traumatol. 2012; 13(4):221-224. doi: 
10.1007/s10195-011-0172-9.
14. Gallart X, Claret G, Garcia S, Fernández-Valencia JA, Riba J. 
Rupture of Extensively Porous Coated Stems. - A Case Series 
of 2 Patients. J Orthop Case Rep. 2014; 4(3):36-39. doi: 
10.13107/jocr.2250-0685.192. 
15. Canton G, Barbo G, Roberto Fattori R, Nicholas Rasio N, 
Murena L. Total hip arthroplasty monobloc stem neck 
rupture in patient with massive heterotopic ossifications: a 
case report and literature review. Acta Biomed. 2023; 
94(S2):e2023117. doi: 10.23750/abm.v94iS2.13888.
16. Akrawi H, Magra M, Shetty A, Ng A. A modified technique to 
extract fractured femoral stem in revision total hip 
arthroplasty: A report of two cases. Int J Surg Case Rep. 2014; 
5(7):361-364. doi: 10.1016/j.ijscr.2014.04.003.
17. Graulich TJ, Graeff P, Heidenblut T, Krettek C, Liodakis E. 
Revision of a Fractured Titanium Modular Revision Hip Stem 
Without Removal of the Well-Fixed Part of the Stem: A New 
Approach Using a Cemented Tube. Arthroplast Today. 2020; 
6(3):363-368. doi: 10.1016/j.artd.2020.04.018.
18. Pelayo-de-Tomás JM, Rodrigo-Pérez JL, Novoa-Parra CD, 
Lizaur-Utrilla A, Morales-Suárez-Varela M, Blas-Dobón JA. 
Cementless modular neck stems: are they a safe option in 
primary total hip arthroplasty? Eur J Orthop Surg Traumatol. 
2018; 28(3):463-469. doi: 10.1007/s00590-017-2071-0.
19. Benazzo F, Rossi SM, Cecconi D, Piovani L, Ravasi F. Mid-term 
results of an uncemented femoral stem with modular neck 
options. Hip Int. 2010; 20(4):427-433. doi: 
10.1177/112070001002000403.
20. Prudhon JL, Tardy N. Extended trochanteric osteotomy: 
comparison of 3 modes of fixation: metallic wires, cables, 
plate, about a series of 157 cases. SICOT J. 2018; 4:21. doi: 
10.1051/sicotj/2018017.
21. Sundaram K, Siddiqi A, Kamath AF, Higuera-Rueda CA. 
Trochanteric osteotomy in revision total hip arthroplasty. 
EFORT Open Rev. 2020; 5(8):477-485. doi: 10.1302/2058-
5241.5.190063.
22. Mahmood S, Muffly BT, Bradbury TL. The "Inside-Out" 
Anterior Osteotomy of the Proximal Femur via the Direct 
Anterior Approach in Revision Hip Arthroplasty. Arthroplast 
Today. 2023; 24:101219. doi: 10.1016/j.artd.2023.101219.
23. Solou K, Panagopoulos A, Tatani I, Megas P. Fracture of 
femoral neck in modular total hip arthroplasty: a systematic 
review of the literature. Hip Int. 2024; 34(3):409-420. doi: 
10.1177/11207000231211253.
24. Sukopp M, Taylor D, Forst R, Seehaus F. Femoral Stem 
Fracture in Hip Revision Arthroplasty: A Systematic 
Literature Review of the Real-World Evidence. Z Orthop 
Unfall. 2022; 160(2):160-171. doi: 10.1055/a-1348-2873.