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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 10, 1333-1336.
doi: 10.1302/0301-620X.87B10.16528  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Fractures of distally-fixed femoral stems after revision arthroplasty

C. A. Busch, FRCS(Tr & Orth), Adult Reconstruction Fellow1; M. N. Charles, MD, Adult Reconstruction Fellow1; C. M. Haydon, HBSc, Clinical Assistant1; R. B. Bourne, MD, Professor1; C. H. Rorabeck, MD, Professor1; S. J. MacDonald, MD, Associate Professor1; and R. W. McCalden, MD, Associate Professor1

1 Division of Orthopaedic Surgery, London Health Sciences Centre, University Campus, London, Ontario, N65A 5A5, Canada.

Correspondence should be sent to Mr C. A. Busch at the Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Trust, Guildford Road, Chertsey, Surrey KT16 0PZ, UK; e-mail: cbusch9965{at}aol.com

We identified five (2.3%) fractures of the stem in a series of 219 revision procedures using a cementless, cylindrical, extensively porous-coated, distally-fixed femoral stem. Factors relating to the patients, the implant and the operations were compared with those with intact stems. Finite-element analysis was performed on two of the fractured implants.

Factors associated with fracture of the stem were poor proximal bone support (type III–type IV; p = 0.001), a body mass index > 30; (p = 0.014), a smaller diameter of stem (< 13.5 mm; p = 0.007) and the use of an extended trochanteric osteotomy (ETO 4/5: p = 0.028). Finite-element analysis showed that the highest stresses on the stem occurred adjacent to the site of the fracture. The use of a strut graft wired over an extended trochanteric osteotomy in patients lacking proximal femoral cortical support decreased the stresses on the stem by 48%.

We recommend the use of a strut allograft in conjunction with an extended trochanteric osteotomy in patients with poor proximal femoral bone stock.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General