Fracture of cobalt chrome, fully-coat beaded femoral revision long stem, a clinical outcomes study

Background: Femoral bone loss during revision total hip arthroplasty poses a challenging problem. Bypass fixation over the diaphysis has achieved clinical success in cases of proximal femoral bone loss. Fracture of cementless, fully bead-coated femoral stem is an uncommon complication. The purpose of this study is to analyze the patients with and without fracture stem and find out the possible risk factors. Methods: From 2006 to 2012, a total of 251 revision long stems (Zimmer, Warsaw, IN) were implanted. In the same period, 17 broken stems that underwent treatment were included for analysis. Patients' demographic data, pattern of femoral bone loss, stem size, medial calcar support in the proximal region of the stem, and the timing of stem breakage were collected and analyzed. Results: The stem size in patients with a broken stem was smaller (p < 0.001), and medial calcar defect was 12.4% and 100% (p < 0.001), respectively. The bone defect was greater in broken group (p = 0.024). The mean duration between revision surgery and stem breakage was 58.07 ± 36.98 months. Smaller stem size, greater bone defect, and inadequate medial calcar bone support were major risk factors for stem breakage. Conclusions: Bypass fixation in the distal diaphysis with a long stem prosthesis without adequate bone support over medial calcar area may cause stress concentration in the long stem and a fatigue fracture. Use of a smaller prosthesis is the major risk of stem broken. It is essential to repair the proximal femoral bone deficiency and implant selection for better metaphyseal engagement to prevent further stem complications. Level of evidence: Level III, case control study.