Fracture of the Modular Neck in Total Hip Arthroplasty.

A Hernandez,V Barro,A Sallent,A Gargallo-Margarit,I Gallardo-Calero

doi:10.1155/2015/591509

Abstract

Modularity of the components in total hip arthroplasty has had an increase in popularity in the last decades. We present the case of a 53-year-old man with a history of avascular necrosis of the femoral head due to a hypophyseal adenoma. A total hip modular arthroplasty was implanted. Three and a half years after the surgery the patient attended the emergency room due to acute left hip pain with no prior traumatism. Radiological examination confirmed a fracture of the modular neck. A revision surgery was performed finding an important pseudotumoral well-organized periprosthetic tissue reaction. Through an extended trochanteric osteotomy the femoral component was removed, and a straight-stem revision prosthesis implanted. There are several potential advantages when using modularity in total hip arthroplasty that surgeons may benefit from, but complications have arisen and must be addressed. Various circumstances such as large femoral head with a long varus neck, corrosion, patient's BMI, and activity level may participate in creating the necessary environment for fatigue failure of the implant.

Highlights

Modularity of the components in total hip arthroplasty has had an increase in popularity in the last decades [1, 2]
A total hip arthroplasty of the left hip was performed in 2009 using a Profemur Modular stem and Conserve Cup (Wright Medical Technology, Inc., 5677 Airline Road, Arlington, TN 38002) with a long modular titanium neck with 8 degrees of varus, metal on metal bearing surface, and a 50 mm femoral head
Anteversion, and length is crucial for soft tissue balance, decreasing impingement, and restoring the hip’s rotational center [7]

Summary

Introduction

Modularity of the components in total hip arthroplasty has had an increase in popularity in the last decades [1, 2]. Complications have been reported in the literature, which confer modularity some disadvantages that ought to be taken into consideration. Crevice and galvanic corrosion, component loosening, and fracture have all been associated with modularity. The use of large diameter metal on metal bearing has been reported as a source of corrosion and a source of metal debris [5, 6]. Midterm results in modularity have reported some complications and the issue is not without controversy [7,8,9,10]. There have been a few cases reported on fracture at the modular neck-stem taper junction [11, 12]

Case Report

Findings

Discussion