title: Implant Fracture after Long-Stemmed Cemented Hemiarthroplasty for Oncologic Indications.
abstract: Although a long-stemmed cemented hemiarthroplasty is frequently recommended for oncologic lesions of proximal femur, we have observed an alarming number of spontaneous stem fractures. The purpose of this retrospective study was to identify the associated risk factors for stem fractures in a study cohort of 60 (61 prostheses) during 1983-2007. At a mean follow-up of 41 months, 4/61 (6.6%) stems had fractured after a mean of 36 (12-92) months after surgery. All failed implants were Osteonics Omnifit (4/27; 14.8%) and multivariate analysis did not show any correlation with other studied variables. While the failures were successfully salvaged by conversion to a modular proximal femoral replacement, any implant failure in this population is devastating. Spontaneous onset of thigh pain in patients with long stems, particularly if associated with other risk factors, should raise suspicion of a fatigue fracture of the stem.
authors.affiliation: Department of Orthopaedics and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, New York 11203; Department of Orthopedic Oncology, Washington Hospital Center, 110 Irving Street, Washington DC 20010.
authors.forename: Aditya V
authors.initials: AV
authors.lastname: Maheshwari
authors.affiliation: Department of Orthopedic Oncology, Washington Hospital Center, 110 Irving Street, Washington DC 20010; Department of Orthopaedics, Howard University Hospital, 2041 Georgia Avenue, Washington DC 20060.
authors.forename: Corey
authors.initials: C
authors.lastname: Gilbert
authors.affiliation: Department of Orthopedic Oncology, Washington Hospital Center, 110 Irving Street, Washington DC 20010.
authors.forename: Jenna
authors.initials: J
authors.lastname: Noveau
authors.affiliation: Department of Orthopaedics and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, New York 11203.
authors.forename: Robert
authors.initials: R
authors.lastname: Pivec
authors.affiliation: Department of Orthopedic Oncology, Washington Hospital Center, 110 Irving Street, Washington DC 20010.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Henshaw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000556:secondary / Q000601:surgery*; D005260:Female; D005266:Femoral Neoplasms / Q000601:surgery*; D005500:Follow-Up Studies; D062785:Hemiarthroplasty / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013848:Thigh; D055815:Young Adult
chemical_list: D001843:Bone Cements