Fracture of an Exeter Stem: A Case Report.

Abstract

Fractures of the Exeter stem (Stryker), a femoral hip implant, are rare occurrences. The original Exeter stem, introduced in 1970, had a prosthetic fracture rate of 3%1; improvements introduced in 1976 reduced this rate to 0.2%2. To the best of our knowledge, there is no literature detailing the rate of fracture of the current stem. The National Joint Registry for England, Wales and Northern Ireland (2013) reported stem fracture that necessitated revision in 2% of cases. The data do not include stem type or fracture position. On review of the literature, we found five cases of fracture of the stem body3-6. Another report described a fracture of the neck of the femoral stem, proximal to the shoulder where the inserter recess is located7. To the best of our knowledge, there have been no prior reports of a fracture at the trunnion-neck junction. We present the case of an elderly man with low functional demand and high body mass index (BMI) who had a catastrophic failure of an Exeter stem at the trunnion-neck junction. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A morbidly obese seventy-six-year-old man (weight, 141 kg; height, 177 cm; BMI, 45 kg/m2) sustained a fracture of the neck of the femoral stem because of a fall from standing height. Past history included multiple comorbidities and chronic pain from bilateral hip replacement, resulting in low functional demand. The patient, who initially had undergone arthroplasty for osteoarthritis, had had two revision surgeries prior to the fall. The first revision, …