An Extended Trochanteric Osteotomy is Necessary for the Removal of Broken Modular Metaphyseal Engaging Femoral Stems

Authors

Robert G. Ricotti, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021; The George Washington University School of Medicine, 2300 I Street NW, Washington, DC, 20052. Electronic address: ricottir@hss.edu.
Nicholas C. Schiller, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021.
Isaiah Selkridge, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021.
Gwo-Chin Lee, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021.
Thomas P. Sculco, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021.
Peter K. Sculco, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021.

Document Type

Journal Article

Publication Date

6-17-2024

Journal

The Journal of arthroplasty

DOI

10.1016/j.arth.2024.06.018

Keywords

Extended trochanteric osteotomy; Fracture; Modular; Stem

Abstract

INTRODUCTION: Modular metaphyseal engaging (MME) femoral components in total hip arthroplasty (THA) allow optimized femoral length, offset, and anteversion and are useful in patients with unusual proximal femoral anatomy. Fretting, corrosion, and stem fractures above the modular sleeve are complications associated with these implants. The purpose of this study was to identify failure mechanisms of retrieved MME femoral components at our institution, identify all broken stem cases, and evaluate how often an extended trochanteric osteotomy (ETO) was required for removal. METHODS: All consecutively retrieved MME femoral components from September 2002 to May 2023 were reviewed. Patient demographics, procedure information, component specifications, indications for removal, and requirements for further revision surgery were reviewed. Descriptive statistics were calculated for the variables of interest. RESULTS: There were 131 retrieved MME components. The mean age at surgery was 59 years (range, 28 to 75), 49% were women, the mean body mass index (BMI) was 29.4 (range, 20.7 to 33.3), and the mean American Society of Anesthesiologists (ASA) score was 2.4 ± 0.5. There were 102 (78%) stems of one design (Stem A), and the remaining 29 (22%) were of a different design (Stem B). Of the 131 components, ten (7.6%) failed secondary to a stem fracture proximal to the modular sleeve. Regarding each MME stem design, 4 of 102 (4%) of Stem A and 6 of 29 (21% of Stem B) fractured. All broken stems required additional intervention for removal during revision THA, using an extended trochanteric osteotomy (N = 9) or cortical window (N = 1) in which an intraoperative proximal femoral fracture occurred. CONCLUSIONS: Broken MME stems present a challenge for orthopaedic surgeons during revision THA. When a stem fracture occurs above the ingrown sleeve, the distal splines may also have osseous interdigitation into the clothespin. Thus, when revising a broken MME stem, an ETO should be performed, and the segment should be long enough to allow distal access.

APA Citation

Ricotti, Robert G.; Schiller, Nicholas C.; Selkridge, Isaiah; Lee, Gwo-Chin; Sculco, Thomas P.; and Sculco, Peter K., "An Extended Trochanteric Osteotomy is Necessary for the Removal of Broken Modular Metaphyseal Engaging Femoral Stems" (2024). GW Authored Works. Paper 5086.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5086

Department

School of Medicine and Health Sciences Student Works