title: Catastrophic Femoral Neck Failure after THA with the Accolade(®) I Stem in Three Patients.
abstract: METHODS
  We report a series of three femoral stem failures, each occurring at the head-neck junction, with all patients experiencing limited and painful ambulation, leading to subsequent revision arthroplasty. All patients were male with high-offset femoral stems and increased head lengths, and each had undergone primary THA at a minimum of 7 years before presentation (average, 94 months). There were no associated deep infections or cases of aseptic loosening in the cohort.
  
  
  METHODS
  There is a paucity of similar reports in the literature regarding femoral stem failure at the head-neck junction. When failures of titanium stems have been reported, failure has been attributed to material design and geometry, laser etching, overload, implant alignment, and patient characteristics.
  
  
  CONCLUSIONS
  Catastrophic failures of femoral stems at the head-neck junction are a rare cause for revision after THA. Component material and design, surgical technique, and patient factors may contribute.
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Spanyer
authors.affiliation: Department of Internal Medicine, St. Joseph Mercy Health System, 5301 E. Huron River Drive, Ypsilanti, MI, 48197, USA. jennifer.e.hines@gmail.com.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hines
authors.affiliation: University of Louisville School of Medicine, Louisville, KY, USA.
authors.forename: Christopher Maxwell
authors.initials: CM
authors.lastname: Beaumont
authors.affiliation: Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA.|Norton Healthcare, Louisville, KY, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yerasimides
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D001696:Biomechanical Phenomena; D020878:Device Removal; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome