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. 2005 Oct;87(10):1333-6.
doi: 10.1302/0301-620X.87B10.16528.

Fractures of distally-fixed femoral stems after revision arthroplasty

C A Busch  1 , M N Charles, C M Haydon, R B Bourne, C H Rorabeck, S J Macdonald, R W McCalden
Affiliations

Fractures of distally-fixed femoral stems after revision arthroplasty

C A Busch et al. J Bone Joint Surg Br. 2005 Oct.

Abstract

We identified five (2.3%) fractures of the stem in a series of 219 revision procedures using a cementless, cylindrical, extensively porous-coated, distally-fixed femoral stem. Factors relating to the patients, the implant and the operations were compared with those with intact stems. Finite-element analysis was performed on two of the fractured implants. Factors associated with fracture of the stem were poor proximal bone support (type III-type IV; p = 0.001), a body mass index > 30; (p = 0.014), a smaller diameter of stem (< 13.5 mm; p = 0.007) and the use of an extended trochanteric osteotomy (ETO 4/5: p = 0.028). Finite-element analysis showed that the highest stresses on the stem occurred adjacent to the site of the fracture. The use of a strut graft wired over an extended trochanteric osteotomy in patients lacking proximal femoral cortical support decreased the stresses on the stem by 48%.We recommend the use of a strut allograft in conjunction with an extended trochanteric osteotomy in patients with poor proximal femoral bone stock.

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