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Fracture of a Tapered Femoral Neck After Total Hip Arthroplasty: A Case Report.

Fracture of the femoral component after total hip arthroplasty is an uncommon event according to Swedish registry data1 and retrospective data in the United States2. Early monoblock components demonstrated fatigue fracturing through the implant stem3-5. Fracture through the tapered femoral neck is extremely rare, although it has been reported6-10. We describe a case of fracture through the tapered neck of a cementless femoral component that had been coupled with a skirted femoral head with a high neck length.

The patient was informed that data concerning the case would be submitted for publication, and she provided consent.

A sixty-one-year-old woman had undergone primary total hip arthroplasty with an uncemented prosthesis for osteoarthritis of the left hip in February 2004. The procedure had been performed at an outside institution. A modified Hardinge approach had been used. The components included a Meridian (Howmedica) uncemented size-4 femoral stem, a 32-mm femoral head with a +16-mm skirted neck length, a Trident (Howmedica) 54-mm hemispherical acetabular shell, and a 54/32-mm 10° liner. The femoral stem and head were both composed of forged Vitallium, an alloy consisting of 60% cobalt, 20% chromium, and 5% molybdenum, among other substances. This stem was only available in a standard offset and had a 30-mm neck length and a neck-shaft angle of 132°. The tapered neck was a V40 taper.

As was routine for the surgeon who had performed the index procedure, the anterior third of the abductor was elevated off of the greater trochanter for exposure, and then repaired with two screw anchors. The index operative report stated that a skirted head with a +16-mm neck length was required to provide appropriate soft-tissue tension and stability of the construct. Documentation from the outside hospital did not mention a preoperative …