Abstract
Background
The periprosthetic fracture of cemented polished tapered stems is occasionally called
a “unique” or “axe splitter” fracture. However, there has been insufficient evidence
regarding the association between the radiographic findings prior to incidence and
this cumbersome fracture. To determine if there are any radiographic interpretations
associated with this fracture pattern, we report the five SC-stem cases with total
hip arthroplasty.
Methods
We investigate the patient characteristics and serial radiographs of five fracture
cases and evaluate the time-dependent specific radiographical changes around the stem
between pre-arthroplasty and fracture.
Results
Fractures developed at 3.5–6.4 years after surgery with low-grade injury or with no
particular incentive. Femoral cortical hypertrophy at the distal medial side around
the stem was observed in all cases before the development of fractures, at 2–6 years
after primary surgery. The duration between cortical hypertrophy appearance to the
development of fracture was 0.4–3.1 years.
Conclusions
The appearance of this zone-specific cortical hypertrophy might play a key role in
the occurrence of periprosthetic fractures. Further studies with larger sample sizes
should be conducted to elucidate this eccentric periprosthetic fracture.
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References
- Epidemiology of periprosthetic fracture of the femur in 32,644 primary total hip arthroplasties: a 40 year experience.Bone Joint Lett J. 2016 Apr; 98: 461-467
- Incidence and future projections of periprosthetic femoral fracture following primary total hip arthroplasty: an analysis of international registry data.J Long Term Eff Med Implants. 2015 Jan; 25: 269-275
- Mortality after periprosthetic fracture of the femur.J Bone Joint Surg Am. 2007 Dec; 89: 2658-2662
- Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the Nordic Arthroplasty Register Association database.J Bone Joint Surg Am. 2014 Oct; 96 (1-7): e167
- Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture?.Bone Joint Lett J. 2017 Jan; 99: 50-59
- The Exeter V40 cemented femoral component at a minimum 10-year follow-up: the first 540 cases.Bone Joint Lett J. 2018 Jul; 100: 1002-1009
- Not all cemented hips are the same: a register-based (NJR) comparison of taper-slip and composite beam femoral stems.Acta Orthop. 2019 Mar; 90: 214-219
- The influence of cemented femoral stem choice on the incidence of revision for periprosthetic fracture after primary total hip arthroplasty: an analysis of National Joint Registry data.Bone Joint Lett J. 2016 Oct; 98: 1347-1354
- A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement.Injury. 2011 Nov; 42: 1271-1276
- Principles of managing Vancouver type B periprosthetic fractures around cemented polished tapered femoral stems.Eur J Orthop Surg Traumatol. 2017 May; 27: 477-482
- Breaking bad: a comparative descriptive analysis of periprosthetic fractures around cemented and uncemented femoral stems.J Arthroplasty. 2019 Aug; 34: 1783-1786
- An atypical periprosthetic fracture in collarless, polished, tapered, cemented stems of total hip arthroplasty: a report of five SC-stem cases and literature review.J Orthop Sci. 2021 May; https://doi.org/10.1016/j.jos.2021.04.003
- Periprosthetic fracture torque for short versus standard cemented hip stems: an experimental in vitro study.J Arthroplasty. 2014 May; 29: 1067-1071
- Can larger bodied cemented femoral components reduce periprosthetic fractures? A biomechanical study.Arch Orthop Trauma Surg. 2015 Feb; 135: 517-522
- Biomechanical comparison of periprosthetic femoral fracture risk in three femoral components in a Sawbone Model.J Arthroplasty. 2020 Jul; 36: 387-394
- Risk factors for revision of polished taper-slip cemented stems for periprosthetic femoral fracture after primary total hip replacement: a registry-based cohort study from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.J Bone Joint Surg Am. 2020 Sep; 102: 1600-1608
- Femoral head autografting with total hip arthroplasty for lateral acetabular dysplasia. A 12-year experience.Clin Orthop Relat Res. 1990 Jun; 255: 173-185
- Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review.J Bone Jt Surg Br. 1992 May; 74: 385-389
- Fractures of the femur after hip replacement.Instr Course Lect. 1995 Jan; 44: 293-304
- Experience with the Exeter total hip replacement since 1970.Orthop Clin N Am. 1988 Jul; 19: 477-489
- Multi-center study of use of the Exeter stem in Japan: evaluation of 1000 primary THA.J Orthop Sci. 2012 Jul; 17: 370-376
- Modes of failure” of cemented stem-type femoral components.Clin Orthop Relat Res. 1979 Jun; 141 (-): 17-27
- Loosening of the femoral component after use of the medullary-plug cementing technique. Follow-up note with a minimum five-year follow-up.J Bone Joint Surg Am. 1986 sep; 68: 1064-1066
- Is the so-called ’French paradox’ a reality? long-term survival and migration of the Charnley-Kerboull stem cemented line-to-line.J Bone Joint Surg Br. 2010 Mar; 92: 342-348
- Randomised controlled trial comparing early migration of two collarless polished cemented stems using radiostereometric analysis.J Bone Joint Surg Br. 2010 Jul; 92: 935-940
- Relationship between the surface roughness of material and bone cement: an increased “polished” stem may result in the excessive taper-slip.Materials. 2021 Jul; 14https://doi.org/10.3390/ma14133702
- Prospective, comparative study of cemented, smooth-surfaced titanium stems and polish-surfaced, stainless steel stems at a minimum follow-up of 10 years.Eur J Orthop Surg Traumatol. 2020 Apr; 30: 501-512
- The effects of patient characteristics and stem alignment on distal femoral cortical hypertrophy after cemented polished tapered stem implantation.Eur J Orthop Surg Traumatol. 2020 May; 30: 559-567
- The classic: on the theory of fracture healing.Clin Orthop Relat Res. 2010 Feb; 468: 1052-1055
Article info
Publication history
Published online: September 28, 2022
Accepted:
September 2,
2022
Received in revised form:
August 20,
2022
Received:
July 19,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
