Abstract
Background
Fracture of the femoral stem in total hip arthroplasty (THA) is a rare complication. We have encountered 2 cases of neck fractures of the femoral stem occurring 9 and 12 years after THA. Morphological and biomechanical analysis were performed to investigate the mechanism of these fractures.
Method
A titanium alloy femoral stem having a slot with sharp corners (R = 0.2 mm) at the neck had been implanted in both cases. Fracture surfaces were examined by use of scanning electron microscopy (SEM). Stress concentration was simulated by using a finite element method (FEM) to compare slots with sharp (R = 0.2 mm) and smooth (R = 2 mm) corners.
Results
Study of the retrieved stems revealed that neck fractures had occurred at the distal end of the slot in both cases. SEM revealed numerous fine fissures extending from the anterolateral edge, striations on the middle of the fracture surface, and dimples on the posteromedial surface, suggesting that the fractures had occurred from the anterolateral aspect toward the posteromedial aspect because of metallic fatigue. FEM analysis showed that mechanical stress was concentrated at the distal and anterolateral corners of the slot. Under 3500-N loading force, the stress at the sharp corner was 556 MPa, which was approximately twofold that at the smooth corner and exceeded the fatigue strength of titanium alloy.
Conclusion
These findings showed that the sharp corner of slot increased stress concentrations at the anterolateral aspect and led to the neck fractures.
Similar content being viewed by others
References
Charnley J. Fracture of femoral prostheses in total hip replacement. A clinical study. Clin Orthop Relat Res. 1975;111:105–20.
Martens M, Aernoudt E, de Meester P, Ducheyne P, Mulier JC, de Langh R, Kestelijn P. Factors in the mechanical failure of the femoral component in total hip prosthesis: report of six fatigue fractures of the femoral stem and results of experimental loading tests. Acta Orthop Scand. 1974;45(5):693–710.
Vatani N, Comando D, Acuña J, Prieto D, Caviglia H. Faulty design increases the risk of neck fracture in hip prosthesis. Acta Orthop Scand. 2002;73(5):513–7.
Grivas TB, Savvidou OD, Psarakis SA, Bernard PF, Triantafyllopoulos G, Kovanis I, Alexandropoulos P. Neck fracture of a cementless forged titanium alloy femoral stem following total hip arthroplasty: a case report and review of the literature. J Med Case Rep. 2007;6(1):174–80.
Dangles CJ, Altstetter CJ. Failure of the modular neck in a total hip arthroplasty. J Arthroplasty. 2010 Oct; 25(7):1169.e5-7.
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):1518–21.
Nakashima Y, Sato T, Yamamoto T, Motomura G, Ohishi M, Hamai S, Akiyama M, Hirata M, Hara D, Iwamoto Y. Results at a minimum of 10 years of follow-up for AMS and PerFix HA-coated cementless total hip arthroplasty: impact of cross-linked polyethylene on implant longevity. J Orthop Sci. 2013;18(6):962–8.
Nakashima Y, Hayashi K, Inadome T, Uenoyama K, Hara T, Kanemaru T, Sugioka Y, Noda I. Hydroxyapatite-coating on titanium arc sprayed titanium implants. J Biomed Mater Res. 1997;35(3):287–98.
Duda GN, Schneider E, Chao EY. Internal forces and moments in the femur during walking. J Biomech. 1997;30(9):933–41.
Edwards WB, Gillette JC, Thomas JM, Derrick TR. Internal femoral forces and moments during running: implications for stress fracture development. Clin Biomech (Bristol, Avon). 2008 Dec; 23(10):1269-1278.
Magnissalis EA, Zinelis S, Karachalios T, Hartofilakidis G. Failure analysis of two Ti-alloy hip arthroplasty femoral stems fractured in vivo. J Biomed Mater Res B Appl Biomater. 2003;66(1):299–305.
Gilbert JL, Buckley CA, Jacobs JJ, Bertin KC, Zernich MR. Intergranular corrosion-fatigue failure of cobalt-alloy femoral stems. A failure analysis of two implants. J Bone Joint Surg Am. 1994;76(1):110–5.
Lee EW, Kim HT. Early fatigue failures of cemented, forged, cobalt chromium femoral stems at the neck shoulder junction: a case report. J Arthroplasty. 2001;16(2):236–8.
Heck DA, Partridge CM, Reuben JD, Lanzer WL, Lewis CG, Keating EM. Prosthetic component failures in hip arthroplasty surgery. J Arthroplasty. 1995;10(5):575–80.
Burstein AH, Wright TM. Neck fractures of femoral prostheses. A report of two cases. J Bone Joint Surg Am. 1985;67(3):497–9.
Rand JA, Chao EY. Femoral implant neck fracture following total hip arthroplasty. A report of three cases. Clin Orthop Relat Res. 1987;221:255–9.
Aspenberg P, Kolmert L, Person L, Onnerfalt R. Fracture of hip prostheses due to inadequate welding. Acta Orhop Scand. 1987;58(5):479–82.
Jang B, Kanawati A, Brazil D, Bruce W. Laser etching causing fatigue fracture at the neck-shoulder junction of an uncemented femoral stem: A case report. J Orthop. 2013;10(2):95–8.
Collier JP, Mayor MB, Jensen RE, Surprenant VA, Surprenant HP, McNamar JL, Belec L. Mechanisms of failure of modular prostheses. Clin Orthop Relat Res. 1992;285:129–39.
Botti TP, Gent J, Martell JM, Manning DW. Trunion Fracture of a Fully Porous-Coated Femoral Stem. Case report. J Arthroplasty. 2005;20(7):943–5.
Morgan-Hough CV, Tavakkolizadeh A, Purkayastha S. Fatigue failure of the femoral component of a cementless total hip arthroplasty. J Arthoplasty. 2004;19(5):658–60.
Unnanuntana A, Chen DX, Unnanuntana A, Wright TM. Trunnion fracture of the Anatomic Medullary Locking A Plus femoral component. J Arthroplasty 2011;26(3):504.e13–16.
Skendzel JG, Blaha JD, Urquhart AG. Total hip arthroplasty modular neck failure. J Arthroplasty. 2011; 26(2):338.e1–4.
Sotereanos NG, Sauber TJ, Tupis TT. Modular femoral neck fracture after primary total hip arthroplasty. J Arthroplasty. 2013; 28(1):196.e7–9.
Ellman MB, Levine BR. Fracture of the modular femoral neck component in total hip arthroplasty. J Arthroplasty. 2013 Jan; 28(1):196.e1-5.
Grupp TM, Weik T, Bloemer W, Knaebel HP. Modular titanium alloy neck adapter failures in hip replacement–failure mode analysis and influence of implant material. BMC Musculoskelet Disord. 2010;4(11):3–14.
Takahashi K, Sato E. Influence of Surface Treatments on Fatigue Strength of Ti6Al4 V Alloy. Material Transactions. 2010;51:694–8.
Welsch G, Boyer R, Collings EW. Materials Properties Handbook: Titanium Alloys. ASM International: Almere; 1993. p. 553.
Oshkour AA, Abu Osman NA, Yau YH, Tarlochan F, Abas WA. Design of new generation femoral prostheses using functionally graded materials: a finite element analysis. Proc Inst Mech Eng H. 2013;227(1):3–17.
Acknowledgement
This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (no. 24592268) and in part by Kyocera Co., Ltd.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
About this article
Cite this article
Yoshimoto, K., Nakashima, Y., Nakamura, A. et al. Neck fracture of femoral stems with a sharp slot at the neck: biomechanical analysis. J Orthop Sci 20, 881–887 (2015). https://doi.org/10.1007/s00776-015-0745-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00776-015-0745-1