Non-contemporaneous bilateral stem fractures occurring after staged bilateral hip revision using extensively porous-coated cylindrical femoral stems: a case report

BACKGROUND: Distally fixed cylindrical femoral stems extensively coated with porous materials are widely used in revision and total hip arthroplasty surgeries. Stem fracture is an uncommon complication; few case reports have been published. CASE PRESENTATION: We report the case of a 51-year-old male exhibiting extensively porous-coated cylindrical femoral stems fracture after staged bilateral hip revision. His body mass index was 24.22 kg/m(2). The major risk factor was poor proximal bony support; and femoral stems with smaller diameter. CONCLUSIONS: Certain patients are at high risk of non-contemporaneous, bilateral femoral stem fractures. It remains unclear whether fracture of the contralateral femoral stem is an inevitable fatigue fracture or reflects the increased weight imposed on the contralateral hip after the first revision. We recommend that a strut bone graft be placed to support the proximal bone, and that non-modular tapered femoral stems be employed in such patients.