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Fracture of the Modular Neck in Total Hip Arthroplasty.

Hernandez A, Gargallo-Margarit A, Barro V, Gallardo-Calero I, Sallent A - Case Rep Orthop (2015)

Bottom Line: Radiological examination confirmed a fracture of the modular neck.Through an extended trochanteric osteotomy the femoral component was removed, and a straight-stem revision prosthesis implanted.Various circumstances such as large femoral head with a long varus neck, corrosion, patient's BMI, and activity level may participate in creating the necessary environment for fatigue failure of the implant.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Surgery Department, Vall d'Hebron Hospital, 08035 Barcelona, Spain.

ABSTRACT
Modularity of the components in total hip arthroplasty has had an increase in popularity in the last decades. We present the case of a 53-year-old man with a history of avascular necrosis of the femoral head due to a hypophyseal adenoma. A total hip modular arthroplasty was implanted. Three and a half years after the surgery the patient attended the emergency room due to acute left hip pain with no prior traumatism. Radiological examination confirmed a fracture of the modular neck. A revision surgery was performed finding an important pseudotumoral well-organized periprosthetic tissue reaction. Through an extended trochanteric osteotomy the femoral component was removed, and a straight-stem revision prosthesis implanted. There are several potential advantages when using modularity in total hip arthroplasty that surgeons may benefit from, but complications have arisen and must be addressed. Various circumstances such as large femoral head with a long varus neck, corrosion, patient's BMI, and activity level may participate in creating the necessary environment for fatigue failure of the implant.

No MeSH data available.


Related in: MedlinePlus

Plain radiographs of the pelvis showing a straight Revitan revision prosthesis (Zimmer, Warsaw, IN) and a TMT revision cup (Zimmer, Warsaw, IN) with press fit and two cancellous screws; the trochanteric osteotomy was synthetized with 4 cerclage wires.
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fig3: Plain radiographs of the pelvis showing a straight Revitan revision prosthesis (Zimmer, Warsaw, IN) and a TMT revision cup (Zimmer, Warsaw, IN) with press fit and two cancellous screws; the trochanteric osteotomy was synthetized with 4 cerclage wires.

Mentions: Follow-up controls at three, six, and twelve months showed no radiological findings nor are any complaints from the patient documented. Three and a half years after the primary THA, the patient attended the emergency department due to acute left hip pain with no particular traumatism or abrupt movements. Radiological examination confirmed a fracture of the modular neck (Figure 1(b)). A revision surgery was performed; through a posterolateral approach a considerable pseudotumoral well-organized periprosthetic tissue reaction was found surrounding the joint; debridement was performed (Figure 2(a)). The pseudotumor did not infiltrate nor destroy any skeletal or muscular structures. The rupture of the modular neck was confirmed (Figure 2(b)). Failure of the implant seemed to have originated on the anterior aspect of the taper junction (Figure 2(c)). An extended trochanteric osteotomy was performed since the extraction of the remainder modular neck did not seem feasible. A straight Revitan revision prosthesis (Zimmer, Warsaw, IN) was placed and the osteotomy synthetized with 4 cerclage wires. Acetabular component was revised using a TMT revision cup (Zimmer, Warsaw, IN) with press fit and two cancellous screws (Figure 3).


Fracture of the Modular Neck in Total Hip Arthroplasty.

Hernandez A, Gargallo-Margarit A, Barro V, Gallardo-Calero I, Sallent A - Case Rep Orthop (2015)

Plain radiographs of the pelvis showing a straight Revitan revision prosthesis (Zimmer, Warsaw, IN) and a TMT revision cup (Zimmer, Warsaw, IN) with press fit and two cancellous screws; the trochanteric osteotomy was synthetized with 4 cerclage wires.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4525462&req=5

fig3: Plain radiographs of the pelvis showing a straight Revitan revision prosthesis (Zimmer, Warsaw, IN) and a TMT revision cup (Zimmer, Warsaw, IN) with press fit and two cancellous screws; the trochanteric osteotomy was synthetized with 4 cerclage wires.
Mentions: Follow-up controls at three, six, and twelve months showed no radiological findings nor are any complaints from the patient documented. Three and a half years after the primary THA, the patient attended the emergency department due to acute left hip pain with no particular traumatism or abrupt movements. Radiological examination confirmed a fracture of the modular neck (Figure 1(b)). A revision surgery was performed; through a posterolateral approach a considerable pseudotumoral well-organized periprosthetic tissue reaction was found surrounding the joint; debridement was performed (Figure 2(a)). The pseudotumor did not infiltrate nor destroy any skeletal or muscular structures. The rupture of the modular neck was confirmed (Figure 2(b)). Failure of the implant seemed to have originated on the anterior aspect of the taper junction (Figure 2(c)). An extended trochanteric osteotomy was performed since the extraction of the remainder modular neck did not seem feasible. A straight Revitan revision prosthesis (Zimmer, Warsaw, IN) was placed and the osteotomy synthetized with 4 cerclage wires. Acetabular component was revised using a TMT revision cup (Zimmer, Warsaw, IN) with press fit and two cancellous screws (Figure 3).

Bottom Line: Radiological examination confirmed a fracture of the modular neck.Through an extended trochanteric osteotomy the femoral component was removed, and a straight-stem revision prosthesis implanted.Various circumstances such as large femoral head with a long varus neck, corrosion, patient's BMI, and activity level may participate in creating the necessary environment for fatigue failure of the implant.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Surgery Department, Vall d'Hebron Hospital, 08035 Barcelona, Spain.

ABSTRACT
Modularity of the components in total hip arthroplasty has had an increase in popularity in the last decades. We present the case of a 53-year-old man with a history of avascular necrosis of the femoral head due to a hypophyseal adenoma. A total hip modular arthroplasty was implanted. Three and a half years after the surgery the patient attended the emergency room due to acute left hip pain with no prior traumatism. Radiological examination confirmed a fracture of the modular neck. A revision surgery was performed finding an important pseudotumoral well-organized periprosthetic tissue reaction. Through an extended trochanteric osteotomy the femoral component was removed, and a straight-stem revision prosthesis implanted. There are several potential advantages when using modularity in total hip arthroplasty that surgeons may benefit from, but complications have arisen and must be addressed. Various circumstances such as large femoral head with a long varus neck, corrosion, patient's BMI, and activity level may participate in creating the necessary environment for fatigue failure of the implant.

No MeSH data available.


Related in: MedlinePlus