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. 2015:2015:416102.
doi: 10.1155/2015/416102. Epub 2015 Jul 6.

A Dual Biomechanical Failure: Exeter Stem and Pubic Rami Insufficiency Fracture, following Hybrid Total Hip Arthroplasty

Inderpaul Samra  1 , Christos Paliobeis  1
Affiliations

A Dual Biomechanical Failure: Exeter Stem and Pubic Rami Insufficiency Fracture, following Hybrid Total Hip Arthroplasty

Inderpaul Samra et al. Case Rep Orthop. 2015.

Abstract

Introduction. Incidence of Exeter stem fracture is extremely uncommon. Pubic rami insufficiency fractures following arthroplasty are also rare. To our knowledge no cases of spontaneous stem failure with previous insufficiency fractures have yet been reported. Case Presentation. This report describes a case of spontaneous fracture through a cemented Exeter stem in a 66-year-old patient who had previously undergone a hybrid total hip replacement and was found to have bifocal pubic rami insufficiency fractures. The patient presented 18-year postprimary surgery with spontaneous fracture of the middle third of the cemented femoral stem and adjacent proximal femur. Conclusion. This report demonstrates a unique case of Exeter stem fracture with previous pelvic insufficiency fractures. The case adds to the rare occurrences of Exeter stem failure in the literature and highlights the risk of potential insufficiency fractures in patients undergoing total hip replacement.

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Figures

Figure 1
Figure 1
AP radiographs of the pelvis showing (a) bifocal pubic rami fractures at age 58; (b) healing fractures aged 61 (3 years later).
Figure 2
Figure 2
AP and Judet radiograph of the pelvis showing fracture through the left femoral stem prior to retrieval.
Figure 3
Figure 3
Postoperative AP and lateral films with revision “restoration” Stryker stem.
See this image and copyright information in PMC

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