The Journal of Arthroplasty
Volume 23, Issue 2 , Pages 188-196, February 2008

Fractures of Modern High Nitrogen Stainless Steel Cemented Stems:

Cause, Mechanism, and Avoidance in 14 Cases

  • Piers J. Yates, MBBS(Hons), BSc(Hons), MRCS FRCS(Tr & Orth)

      Affiliations

    • Corresponding Author InformationReprint requests: Piers J Yates, MBBS(Hons), BSc(Hons), MRCS FRCS(Tr & Orth), Perth Orthopaedic Institute, Nedlands, Perth 6009, Western Australia.
    • Perth Orthopaedic Institute, Nedlands, Perth, Western Australia
    • ,
  • Nasir A. Quraishi, FRCS

      Affiliations

    • Ipswich Hospital, Suffolk, United Kingdom
    • ,
  • Allan Kop, PhD, MSc

      Affiliations

    • Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia
    • ,
  • Donald W. Howie, PhD, FRACS

      Affiliations

    • Royal Adelaide Hospital, Adelaide, South Australia
    • ,
  • Clare Marx, FRCS

      Affiliations

    • Ipswich Hospital, Suffolk, United Kingdom
    • ,
  • Eric Swarts, BSc

      Affiliations

    • Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia

Received 21 April 2006; accepted 10 December 2006. published online 10 October 2007.

Abstract 

We present 14 cases of fracture of modern, high-nitrogen, stainless steel stems. Our clinical and radiological data suggest that heavy patients with small stems and poor proximal support are at risk for fracturing their implants. “Champagne-glass” canals can lead to the use of smaller stems often placed in varus, which can lead to cantilever bending and fatigue failure in the distal half of the stem. Metallurgical assessment of the retrieved high-nitrogen, stainless steel stems reveals microstructural inconsistencies that may contribute to their failure. Based on our findings, careful consideration and attention to technique is required when using stainless steel stems in patients with high body mass index or high weight. Technique is particularly important in femurs with champagne-glass canals.

Key words: stainless steel, hip arthroplasty, fracture, high nitrogen, cement

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 No benefits or funds were received in support of the study.

PII: S0883-5403(06)00885-0

doi:10.1016/j.arth.2006.12.051

The Journal of Arthroplasty
Volume 23, Issue 2 , Pages 188-196, February 2008

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