Stem fracture incidence in Trapezoidal-28 stainless steel hip arthroplasty

From 1970 to March 1978, 716 forged stainless steel Trapezoidal-28 (T-28) total hip arthroplasties were performed at the authors' institution with a follow-up period from one to 15 years (mean, 64 months). There were 13 (1.8%) stem fractures and one (0.1%) neck fracture. Average time to fracture was 95 months. All fractures occurred in stems implanted before 1976, using early femoral acrylic stem fixation techniques. Stem fracture was related to time of surgery, stem size, patient height, patient weight (for males), and patient age. Survivorship analysis predicted an overall ten-year fracture rate of 4%, and a ten-year rate of 5% for T-28 stems implanted before 1976. There have been no reported fractures in the 204 T-28 stainless steel prostheses implanted since 1976. The mean patient follow-up period for the T-28 stems implanted after 1975 was 52 months, and only 16 patients have been followed for nine years or more. Thus, a longer patient follow-up period is needed in the post-1975 group in order to determine the long-term fracture rate in this group. However, the major difference between this group and the early group is the use of an improved cementation technique, as well as the use of larger prostheses when possible. There was no material or manufacturing change until the introduction of the TR-28 prostheses in 1978.