FRACTURE OF AN EXETER™ V40™ STEM THROUGH THE INSERTION GUIDE HOLE AND REVISION USING CEMENT-IN-CEMENT TECHNIQUE
AbstractFracture of the Exeter™ V40™ stem is uncommonly reported in the literature. The cement-in-cement femoral revision is a described technique for revising well-cemented femoral components during revision hip arthroplasty. We present our experience using this technique in managing a fractured Exeter™ V40™ stem. There have been 24 reported Exeter™ V40™ stem fractures: 12 at the body and 12 at the neck. 3 of the reported fracture at the neck cases have occurred at the superior aspect of the neck-shaft junction which is an unusual site for failure of this stem. Our patient’s fracture pattern matches this unusual presentation. This report has added to the limited evidence indicating the area around the insertion guide hole as a potential site through which stem fracture may begin and propagate inferiorly. The cement-in-cement technique may be successfully employed in managing Exeter™ V40™ stem fractures, without need for extended trochanteric osteotomy or cortical window.
Westerman RW, Whitehouse SL, Hubble MJW, Timperley AJ, Howell JR, Wilson MJ. The Exeter V40 cemented femoral component at a minimum 10-year follow-up. Bone Joint J 2018;100-B(8):1002–9.
Davies BM, Branford White HA, Temple A. A series of four fractured Exeter™ stems in hip arthroplasty. Ann R Coll Surg Engl 2013;95(8):e130–2.
Hamlin K, MacEachern CF. Fracture of an Exeter Stem: A Case Report. JBJS Case Connect 2014;4(3):e66–3.
Rokkum M, Bye K, Hetland KR, Reigstad A. Stem fracture with the Exeter prosthesis. 3 of 27 hips followed for 10 years. Acta Orthop Scand 1995;66(5):435–9.
Yates PJ, Quraishi NA, Kop A, Howie DW, Marx C, Swarts E. Fractures of modern high nitrogen stainless steel cemented stems: cause, mechanism, and avoidance in 14 cases. J Arthroplasty 2008;23(2):188–96.
Swarts E, Kop A, Jones N, Keogh C, Miller S, Yates P. Microstructural features in fractured high nitrogen stainless steel hip prostheses: a retrieval study of polished, tapered femoral stems. J Biomed Mater Res A 2008;84(3):753–60.
Garala K, Laios T, Lawrence T. A report of 3 cases of Exeter V40 Stem fracture and explanation of possible causes. Hip Int 2018;28(6):Np1–5.
Reito A, Eskelinen A, Pajamäki J, Puolakka T. Neck fracture of the Exeter stem in 3 patients: A cause for concern? Acta Orthop 2016;87(2):193–6.
O'Neill GK, Maheshwari R, Willis C, Meek D, Patil S. Fracture of an Exeter ‘Cement in Cement’ Revision Stem: A Case Report. HIP Int 2011;21(5):627–9.
Facek M, Khatib Y, Swarts E. Prosthetic Fracture of a Cemented Exeter Femoral Stem (Case Report). Jt Implant Surg Res Found - Reconstr Rev 2016;6(4):35–9.