title: Catastrophic failure of 4 cobalt-alloy Omnifit hip arthroplasty femoral components.
abstract: BACKGROUND
  Femoral component neck fracture is an uncommon type of failure in total hip arthroplasty. We present a report on 4 retrieved cobalt-chrome femoral components that fractured at the neck, where we investigated the mechanisms of failure.
  
  
  METHODS
  The 4 retrieved implants were analyzed with regard to their macro- and microstructures and the fracture surfaces were examined using electron microscopy. The medical record of each patient was also examined for any history of complications prior to failure of the implant.
  
  
  RESULTS
  These fractures occurred immediately adjacent to the base of the modular head. Skirted modular heads were used in 3 of the 4 failed components. This constructs promotes corrosion. Cyclic fatigue-loading in combination with the material factors of course grain microstructure and extensive carbide precipitation along the grain boundaries were also identified as the cause of implant failure.
  
  
  CONCLUSIONS
  Our findings suggest that a solution annealing step could be introduced into the manufacturing process to improve the microstructure of the cobalt chrome alloy. We also advise caution in using a skirted modular head in combination with a device of known suboptimum microstructure, for a greater margin of safety.
authors.affiliation: Fremantle Orthopaedic Unit, University of Western Australia, Fremantle Hospital, Western Australia, Australia.
authors.forename: Li-On
authors.initials: LO
authors.lastname: Lam
authors.forename: Karl
authors.initials: K
authors.lastname: Stoffel
authors.forename: Alan
authors.initials: A
authors.lastname: Kop
authors.forename: Eric
authors.initials: E
authors.lastname: Swarts
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002858:Chromium Alloys; D003035:Cobalt; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D011475:Prosthesis Failure; D013314:Stress, Mechanical; D013718:Tensile Strength; D013997:Time Factors
chemical_list: D002858:Chromium Alloys; D003035:Cobalt