Fracture of Uncemented Revision Femoral Stems in three Arthroplasty Patients: A Case Series with three different brands

INTRODUCTION: Fracture of stems in primary total hip arthroplasty is a known complication and has been attributed to varus positioning, excessive weight of the patient, resorption of the femoral calcar and failure of the cement mantle. Fractures in uncemented revision femoral stems are rare and are attributed to reduction in proximal support either in the form of bone loss or an extended trochanteric osteotomy [ETO] against a distally well- fixed stem. Also, undersized stems and high BMI to increase the risk of stem fracture. CASE REPORT: We report 3 cases of uncemented revision stem fractures. Case 1 is a 77 year old male, Case 2 is a 71- year-old female, case 3 an 82-year-old male. All three patients had significant proximal femoral osteolysis. All three had an extended trochanteric osteotomy for the revision surgery. The hips had remained in-situ for 4, 2 and 5 years respectively prior to fracture. CONCLUSION: When planning complex revision cases involving long uncemented stems, attention should be given to the above-mentioned variables. ETO non-union and proximal bone loss play an important role in stem fractures. Stem failure can occur irrespective of the make, and factors such as adequate stem size and good diaphyseal fit are non negotiable.