Segmental fracture of the femoral stem of a low-friction arthroplasty. A case report

Fracture of the femoral stem of a cemented hip arthroplasty is a well documented complication. However, double or segmental fracture is extremely rare, with only one other case appearing in the literature. The authors report a second case and discuss its etiology. They stress the importance of prolonged careful review of patients following total hip arthroplasty in order to obviate complications.     

Fracture of the femoral alignment stem of a hip resurfacing arthroplasty. A case report

Metal-on-metal hip resurfacing arthroplasty has become increasingly popular for the treatment of osteoarthritis in a younger patient population. While the initial complication of femoral neck fracture is being addressed, we describe a fracture of the femoral alignment stem in a component two years from the primary procedure.     

Characteristic loosening of the distally straight cylindrical femoral stem

Background

The cemented femoral stem with a distally straight cylindrical shape was designed to fill the distal femoral canal to facilitate higher cement pressurization and stability. We examined the mid-term outcomes of a stem made of titanium alloy and the efficacy of this shape.

Methods

Four hundred and twenty-nine consecutive patients (505 hips), who underwent a total hip arthroplasty with the distally straight cylindrical stem made of titanium alloy as their primary hip arthroplasty at two institutes, were followed for a minimum 2 years. Loosening was defined as subsidence of over 3 mm, tilting of the femoral component, or fracture of the cement or the stem. A continuous radiolucent line along the entire interface was considered to indicate loosening, too. We examined the interface stresses on the distally straight cylindrical stem compared with a newly manufactured femoral prosthesis with a double-taper design using a finite element model study.

Results

The mean follow-up was 101.3 months after surgery. Thirty patients (30 hips) had aseptic loosening of the stems. Of these 30 hips, 18 had osteolysis, 17 showed subsidence, and 11 had cement fractures at the tip of the stem. These 11 hips had osteolysis and ectasia in the same place: the stem tip. The stem survival rate with stem loosening as the end-point was 94.4 % at 10 years and 66.9 % at 15 years. A finite element model study revealed higher stress around the tip of the cylindrical stem compared with that in the double-taper stem.

Conclusions

The straight cylindrical stem is potentially subject to early failure because of high stress around the tip of the stem, and showed a characteristic loosening with osteolysis and ectasia at the tip of the stem.     

Wear debris from bipolar femoral neck-cup impingement: A cause of femoral stem loosening

The source of wear debris in total hip arthroplasty may occur at various interfaces: metal-ultra-high molecular-weight polyethylene bearings, metal-cement micromotion, bone-cement interfaces, and implant coatings. Wear-induced osteolysis may result in a spectrum of radiographic changes from radiolucent lines to massive osteolysis. Subsequent loosening of the implant may occur and revision may be difficult because of bone deficiencies. Impingement of the femoral neck on the acetabular component may result in polyethylene and/or metal debris, leading to early femoral stem loosening. The five cases presented, involving six hips, illustrate how bipolar cup-stem impingement may result in significant wear-induced femoral osteolysis.     

Temporary total hip arthroplasty-like spacer for treating an infected periprosthetic femoral fracture using a long stem: A case report

IntroductionInfected periprosthetic femoral fractures are among the most complex and significant complications of total hip arthroplasty (THA). We report the novel use of a temporary THA-like spacer for treating an infected periprosthetic femoral fracture after revision surgery using a long stem.Case presentationWe present a 72-year-old woman sustained a left infected periprosthetic femoral fracture after revi - streptococci in the culture sample. On suspicion of a periprosthetic joint infection, we planned a two-stage procedure. We used a temporary THA-like spacer comprising the removed femoral long stem, which was autoclaved and then reimplanted, and applied a new polyethylene acetabular liner. Both components were cemented in place with antibioticloaded bone cement, without applying strong pressure. Pain control waseasily achieved postoperatively because the fracture had been stabilized early. The THA-like spacer was stable, and allowed a good range of motion without pain. She was allowed to move with a wheelchair and was walk with partial weight bearing without pain. Seven week after the initial THAlike spacer placement, we performed a revision THA after successful control of infection. At the 1-year follow-up, the patient remained free of infection.ConclusionsTemporary antibiotic-loaded cement-coated THA-like spacer using a long stem facilitated the eradication of infection, fracture stabilization, and enables partial weight bearing without pain.     

Delayed femoral shaft fracture secondary to nail gun injury: a case report

Nail gun injuries are common workplace occurrences among construction workers; however, delayed fractures of the femur after a nail gun injury are not found in the medical literature. We report the case of a patient who presented with such a fracture 3 days after accidentally firing a nail into his thigh. The patient was taken to the operating room for intramedullary nailing, irrigation and debridement, and antibiotic beads. Standard postoperative hospital care was provided, and after 2 days of intravenous antibiotics, the patient was returned to the operating room for removal of the antibiotic beads and a delayed primary closure. At the most recent follow-up, over 1 year postinjury, he had radiographic healing and was asymptomatic. Although it is difficult to predict whether the stress riser created by a nail gun injury will lead to a fracture, weight-bearing status and the aggressiveness of treatment to prevent infection are factors that need to be carefully considered in patients with this type of injury.     

Popliteal artery pseudo-aneurysm secondary to femoral osteochondroma: a case report and literature review

A case of pseudo-aneurysm of the popliteal artery secondary to an osteochondroma of the femur in a young adult is described.     

Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report

IntroductionThe thrust plate hip prosthesis (TPP; Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP.Presentation of caseWe report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip of the lateral plate without implant loosening. She underwent revision surgery with a long distally fixed intramedullary stem in conjunction with a plate and cable system. Three months after surgery, bone union was confirmed using radiography and the patient was clinically asymptomatic.DiscussionWe encountered three major problems while planning surgical treatment, these being, discontinuation of the TPP system, loss of proximal femoral cancellous bone, and difficulties with the type of subtrochanteric fracture. After considering these problems, we planned revision surgery using a long distally fixed intramedullary stem in conjunction with a plate and cable system.ConclusionThis case shows that sufficient implant preparation based on precise preoperative planning is necessary to obtain good clinical results for the surgical treatment of periprosthetic femoral fractures following THA with the use of a TPP.     

False aneurysm of the common femoral artery secondary to migration of a threaded acetabular component. A case report and review of the literature

A 66-year-old woman with severe rheumatoid arthritis had revision of a protrusio acetabuli component with a threaded socket. Subsequent anteromedial migration of the socket and thread laceration of the common femoral artery resulted in a pseudoaneurysm and massive pelvic erosion seven months later. Vascular reconstruction and excisional arthroplasty were necessary. Later, gracilis and gluteal muscle flaps were swung to fill the resultant pelvic cavity. The hip was nonreconstructable. Ten months later the wound healed and the patient was ambulating in a walker. This represents a previously unreported cause of vascular injury complicating total hip arthroplasty (THA). A comprehensive review of the English and European literature illustrates the various mechanisms of vascular trauma in this setting and provides a rational basis for prevention.     

Neuropathic sternoclavicular joint secondary to syringomyelia. A case report

A 14-year-old boy is presented with syringomyelia and a neuropathic sternoclavicular joint. Recognition of neuropathic arthropathy of the upper extremity is important when a massive, destructive joint lesion exists in a patient with syringomyelia.