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Failure Mode Analysis of an Exeter Stem Fracture Initiated at the Introducer Hole: Time for a Design Change?

ABSTRACT: The fracturing of a hip prosthesis stem at its neck, in the absence of a trauma, is an extremely rare but serious adverse event. The patient in our case was young, active, and tall, thereby putting high mechanical loads on the prosthesis. Radiographs of the initial procedure and blood and synovium analysis showed no abnormalities. Analysis of the stem revealed niobium-rich precipitates, that is, alloy artifacts, at the introducer stud hole. The mechanically vulnerable location of the introducer stud hole, combined with alloy artifacts at that location and high mechanical stress, ultimately led to failure of the prosthesis. As younger and heavier patients will demand hip arthroplasty in the future, simple stem design adaptations should be considered to prevent stem fractures at the introducer stud hole.

SUBMITTER: Jeuken RM

PROVIDER: S-EPMC8551419 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Failure Mode Analysis of an Exeter Stem Fracture Initiated at the Introducer Hole: Time for a Design Change?

Jeuken Ralph M RM Fransz Duncan P DP Geers Marc G D MGD van Maris Marc P F H L MPFHL Ten Broeke René H M RHM

Arthroplasty today 20211004

The fracturing of a hip prosthesis stem at its neck, in the absence of a trauma, is an extremely rare but serious adverse event. The patient in our case was young, active, and tall, thereby putting high mechanical loads on the prosthesis. Radiographs of the initial procedure and blood and synovium analysis showed no abnormalities. Analysis of the stem revealed niobium-rich precipitates, that is, alloy artifacts, at the introducer stud hole. The mechanically vulnerable location of the introducer ...[more]

PMID: 34746345

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Project description:BackgroundPelvic ring-comminuted transforaminal sacral fracture injuries are rotationally and vertically unstable and have a high rate of failure.ObjectiveOur study purpose was to use three-dimensional (3D) optical tracking to detect onset location of bone-implant interface failure and measure the distances and angles between screws and line of applied force for correlation to strength of pelvic fracture fixation techniques.Methods3D relative motion across sacral-rami fractures and screws relative to bone was measured with an optical tracking system. Synthetic pelves were used. Comminuted transforaminal sacral-rami fractures were modelled. Each pelvis was stabilised by either (1) two iliosacral screws in S1, (2) one transsacral screw in S1 and one iliosacral screw in S1 and (3) one trans-alar screw in S1 and one iliosacral screw in S1; groups 4-6 consisted of fixation groups with addition of anterior inferior iliac pelvic external fixator. Eighteen-instrumented pelvic models with right ilium fixed simulate single-leg stance. Load was applied to centre of S1 superior endplate. Five cycles of torque was initially applied, sequentially increased until permanent deformation occurred. Five cycles of axial load compression was next applied, sequentially increased until permanent deformation occurred, followed by axial loading to catastrophic failure. A Student t test was used to determine significance (p < 0.05).ResultsThe model, protocol and 3D optical system have the ability to locate how sub-catastrophic failures initiate. Our results indicate failure of all screw-based constructs is due to localised bone failure (screw pull-in push-out at the ipsilateral ilium-screw interface, not in sacrum); thus, no difference was observed when not supplemented with external fixation.ConclusionInclusion of external fixation improved resistance only to torsional loading.Translational potential of this articlePatients with comminuted transforaminal sacral-ipsilateral rami fractures benefit from this fixation.

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Failure Mode Analysis of an Exeter Stem Fracture Initiated at the Introducer Hole: Time for a Design Change?

Publications

Failure Mode Analysis of an Exeter Stem Fracture Initiated at the Introducer Hole: Time for a Design Change?

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