Bilateral Universal Exeter™ Femoral Stem Fracture

Total hip arthroplasty(THA) in dysplastic hips involves technical difficulties due to impaired anatomy. Specially designed implants are needed for dysplastic hips. Usage of these implants with appropriate material and design features reduces the pain in this group of patients and increases the standard of life. Improper implant selection causes various complications. The presented case is about a 62-year-old female patient who was operated bilaterally for coxarthrosis secondary to developmental hip dysplasia. She had minimal complaints during her last outpatient follow-up. Radiographs revealed a fracture of the simultaneous bilateral femoral stem.

Seventeen years ago, a 45-year-old lady was admitted to our hospital due to coxarthrosis secondary to developmental hip dysplasia. In six months interval, she underwent bilateral THA with Exeter™ Universal Hip system.She had re-operated on her 3rd year because of right femoral stem fracture.Since then, she has beenexamined at the outpatient clinic regularly on1-year-based intervals. There was no trauma or obvious activity experienced. Radiographs of the pelvis and bilateral femur were obtained, andit was demonstrated that both femoral stems were broken. Both fractured stems were removed by extended femoral osteotomy via a lateral approach.Intraoperative examination revealedthat the right acetabular component was well-fixed, but there was a loosening of the left acetabularcomponent. The acetabular revision was performed to the left side. Echelon cementless revision hip system (Smith and Nephew) was used for the right and left sides. The patient was stood-up on the first post-operative day and weight-bearing was permitted as much as tolerated. At the end of 6 weeks, full weight bearing was permitted. She was returned to her routine daily life activities after 4 months.

After the acquisition of Howmedica by Stryker in 1998, the taper in the Exeter stem was modified, and a new Exeter V40 stem concept was introduced in 2001, but still in literature, we could comeacross stem fracture cases. We may not eliminate all prosthetic fractures, but we may reduce them as low as possible by doing appropriate cementing, placing the stem in proper alignment and for us, the most important one is pre-operative templating. Spending some time in front of X-rays and choosing the appropriate size of a stem is the most helpful step while eliminating the prosthetic fractures.