Failure of the femoral stem: A case series of intra-prosthetic fractures and proposed classification system

IF 1.8 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2026-05-01 Epub Date: 2026-02-07 DOI:10.1016/j.jor.2026.02.035

R. Woods, A. Price, T. Donovan, S.R. Kearns, C.G. Murphy, G.A. Sheridan

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引用次数: 0

Abstract

Background

Femoral implant failure is an uncommon but significant complication in orthopaedic surgery associated with significant patient morbidity. This study presents a case series of femoral implant fractures treated at a single institution between 2007 and 2024, alongside a review of the relevant literature, to identify possible risk factors.

Methods

A retrospective analysis of patients with femoral implant fractures was, over a 17-year period, conducted at a single academic institution. Data collected included patient demographics, implant type, time to failure, treatment approach and postoperative outcomes. A literature review was performed to contextualise findings within existing research. We also propose a pragmatic and reproducible classification system based on anatomical location of the fractures within the stem.

Results

A total of fourteen cases were identified across the defined study period with implant fractures occurring at a mean of 129 months postoperatively. The mean age of patients in this study was 71.76. Seven of the fourteen cases involved polished taper slip (PTS) stems, while twelve of the fourteen intra-prosthetic fractures occurred around cemented stems. The most frequent fracture sites were the middle third of the stem. Each of the cases were treated with revision arthroplasty. Postoperative complications and functional outcomes varied based on fracture type and patient factors. Four types of fracture are described based on the fracture location – Type A-D.

Conclusion

Femoral implant fractures remain a challenging issue in orthopaedic surgery. Identifying risk factors and optimising implant selection and surgical technique are crucial for complication prevention. This case series highlights key patterns and management strategies, contributing to the growing body of evidence on implant longevity and failure mechanisms. Further research is needed to improve early detection and intervention strategies for at-risk patients. A simple, pragmatic, location-based classification system could improve communication and standardisation of revision strategies.

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股骨干骨折：假体内骨折病例系列及分类系统建议

背景：股骨假体失败是骨科手术中一种罕见但重要的并发症，与患者的发病率相关。本研究介绍了2007年至2024年间在一家机构治疗的股骨植入物骨折病例系列，并对相关文献进行了回顾，以确定可能的危险因素。方法回顾性分析某学术机构17年来股骨植入物骨折患者。收集的数据包括患者人口统计学、种植体类型、失败时间、治疗方法和术后结果。对现有研究中的发现进行了文献综述。我们还提出了一个实用的和可重复的分类系统，基于骨折在茎内的解剖位置。结果在研究期间共发现14例假体骨折，平均术后129个月发生假体骨折。本研究患者的平均年龄为71.76岁。14例中有7例涉及抛光锥形滑移（PTS）柄，而14例假体内骨折中有12例发生在骨水泥柄周围。最常见的骨折部位是椎弓根中部的三分之一。所有病例均行关节翻修成形术。术后并发症和功能结果因骨折类型和患者因素而异。根据裂缝位置分为四种类型——A-D型。结论股骨假体骨折仍然是骨科手术中一个具有挑战性的问题。确定危险因素，优化种植体选择和手术技术是预防并发症的关键。本病例系列强调了关键模式和管理策略，为种植体寿命和失败机制提供了越来越多的证据。需要进一步的研究来改进对高危患者的早期发现和干预策略。一个简单的、实用的、基于位置的分类系统可以改善复习策略的交流和标准化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.