Total hip arthroplasty monobloc stem neck rupture in patient with massive heterotopic ossifications: a case report and literature review

Total hip arthroplasty monobloc stem neck rupture in patient with massive heterotopic ossifications: a case report and literature review

Authors

  • Gianluca Canton Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)
  • Giovanni Barbo University of Trieste
  • Roberto Roberto Fattori Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)
  • Nicholas Nicholas Rasio Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)
  • Luigi Murena Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)

Keywords:

Total hip arthroplasty, Femoral prosthesis neck fracture, Heterotopic ossification.

Abstract

Background and aim of the work: Fractures of the femoral stem neck are a rare complication in hip prosthetic surgery, especially in non-modular components. The authors report a case associated with massive heterotopic ossifications, with the purpose to analyze risk factors and specific characteristics. Methods: A case of femoral monobloc stem neck rupture is described. A non-systematic literature review regarding risk factors for femoral stem neck fracture was conducted in the PubMed database. Results: We report the case of a 61-year-old male who underwent surgery to remove calcifications four years after THA. Four months later the patient reported acute pain in the left hip, arising after a combined movement of external rotation and axial load while standing on the left foot, in the absence of any prodromic symptom. On radiographs, a displaced fracture of the neck of the hip prosthesis was revealed, together with massive heterotopic ossifications. After THA revision the patient’s symptoms were resolved. Conclusions: Prosthetic femoral neck fractures are a rare complication. We suggest that this case represents a unique type of fatigue rupture, where neck length and the presence of massive heterotopic calcifications contributed to flexion forces, resulting in failure in the midpoint of the neck.

References

Clohisy JC, Calvert G, Tull F, McDonald D, Maloney WJ. Reasons for revision hip surgery: a retrospective review. Clin Orthop Relat Res. 2004 Dec;429:188–92.

Van Doesburg, P.G., van Langelaan, E.J., Apachitei, I. et al. Femoral prosthesis neck fracture following total hip arthroplasty — a systematic review. Arthroplasty 2, 28 (2020).

McTighe T, Brazil D, Keppler L, Keggi J, McPherson E. Metallic Modular Taper Junctions in Total Hip Arthroplasty. ReconRev [Internet]. 2015 Aug. 12 [cited 2022 Oct. 22];5(2)

Grupp TM, Weik T, Bloemer W, et al. Modular titanium alloy neck adapter failures in hip replacement-failure mode analysis and influence of implant material. BMC Muskulo- skelet Desord 2010; 11: 3-14.

Bitter T, Khan I, Marriott T, Lovelady E, Verdonschot N, Janssen D. A combined experimental and finite element approach to analyse the fretting mechanism of the head-stem taper junction in total hip replacement. Proc Inst Mech Eng H. 2017;231(9):862–70.

Jones DM, Marsh JL, Nepola JV, et al. Focal osteolysis at the junctions of a modular stainless-steel femoral intramedullary nail. J Bone Joint Surg Am 2001; 83: 537-48.

Lee SH, Brennan FR, Jacobs JJ, et al. Human monocyte/ macrophage response to cobalt-chromium corrosion prod- ucts and titanium particles in patients with total joint re-

placements. J Orthop Res 1997; 15: 40-9.

Murena L, Maritan G, Concina C, Scamacca V, Ratti C, Canton G. Fracture of Cobalt-Crome Modular Neck in Total Hip Arthroplasty. Acta Biomed [Internet]. 2019 Dec. 5 [cited 2021 Oct. 17];90(12-S):187-91.

Lee EW, Kim HT. Early fatigue failures of cemented, forged, cobalt-chromium femoral stems at the neck-shoulder junction. J Arthroplasty 2001;16:236.

VataniN,ComandoD,AcunaJ,PrietoD,CavigliaH.Faulty designincreasesthe risk of neck fracture in a hip prosthesis. Acta Orthop Scand 2002;73:513.

Bitter T, Khan I, Marriott T, Lovelady E, Verdonschot N, Janssen D. The effects of manufacturing tolerances and assembly force on the volumetric wear at the taper junction in modular total hip arthroplasty. Comput Methods Biomech Biomed Eng. 2019;17:1–12.

Berstock JR, Whitehouse MR, Duncan CP. Trunnion corrosion: what surgeons need to know in 2018. Bone Joint J. 2018;100-b(1 Supple A):44–9.

Siljander MP, Gehrke CK, Wheeler SD, Sobh AH, Moore DD, Flierl MA, et al. Does taper design affect taper fretting corrosion in ceramic-on-polyethylene total hip arthroplasty? A retrieval analysis. J Arthroplast. 2019;34(7S):S366– S372.e2.

Tucker K, Pickford M, Newell C, Howard P, Hunt LP, Blom AW. Mixing of components from different manufacturers in total hip arthroplasty: prevalence and comparative outcomes. Acta Orthop. 2015;86(6):671–7.

Mueller U, Panzram B, Braun S, Sonntag R, Kretzer JP. Mixing of head-stem components in Total hip Arthroplasty. J Arthroplast. 2018;33(3):945–51.

Ahrengart L, Lindgren U. Heterotopic bone after hip arthroplasty. Defining the patient at risk. Clin Orthop. 1993;293:153–159.

McCarthy EF, Sundaram M. Heterotopic ossification: a review. Skeletal Radiol. 2005;34:609–619.

Toom A, Haviko T, Rips L. Heterotopic ossification after total hip arthroplasty. Int Orthop. 2001;24(6):323–326.

Morrey BF, Adams RA, Cabanela ME. Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty. Clin Orthop. 1984;188:160–167.

Eggli S, Woo A. Risk factors for heterotopic ossification in total hip arthroplasty. Arch Orthop Trauma Surg. 2001;121(9):531–535.

Unger AC, Schulz AP, Peach A, Jurgens C, Renken FG. Modified direct anterior approach in minimally invasive hip hemiarthroplasty in a geriatric population: a feasibility study and description of the technique. Arch Orthop Trauma Surg. 2013;133(11):1509–16.

Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. J Bone Joint Surg Am 1973;55-A:1629.

Pohl, F., Seufert, J., Tauscher, A. et al. The Influence of Heterotopic Ossification on Functional Status of Hip Joint Following Total Hip Arthroplasty. Strahlenther Onkol 181, (2005);529–533.

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Published

23-06-2023

How to Cite

1.
Total hip arthroplasty monobloc stem neck rupture in patient with massive heterotopic ossifications: a case report and literature review. Acta Biomed [Internet]. 2023 Jun. 23 [cited 2024 Apr. 14];94(S2):e2023117. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/13888

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