Uchiyama Katsufumi, Yamamoto Takeaki, Moriya Mitsutoshi, Fukushima Kensuke, Minegishi Yojiro, Takahira Naonobu, Takaso Masashi
Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan.
School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan.
Arthroplast Today. 2016 Oct 28;3(2):93-98. doi: 10.1016/j.artd.2016.09.004. eCollection 2017 Jun.
We present the case of a 46-year-old woman who underwent revision surgery approximately 4 years after total hip arthroplasty because of a fracture of the modular neck of a MODULUS femoral stem. The fractured surfaces of the retrieved implant were inspected using optical and scanning electron microscopy. Three-dimensional finite element analysis was also performed to identify the stresses that might have caused the failure. We concluded that active, obese patients who are implanted with a high-offset, small-sized modular component could experience stress-induced fractures of the modular neck, with proper fixation and osseointegration of the distal stem, especially if residual bone or tissue is present on the inner surface of the neck that could contribute to micromovement and decreased proximal fixation.
我们报告了一例46岁女性的病例，该患者在全髋关节置换术后约4年因MODULUS股骨柄模块化颈部骨折而接受翻修手术。使用光学显微镜和扫描电子显微镜对取出的植入物的骨折表面进行了检查。还进行了三维有限元分析，以确定可能导致失败的应力。我们得出结论，植入高偏心距、小尺寸模块化组件的活跃肥胖患者，尤其是在颈部内表面存在可能导致微动和近端固定减少的残余骨或组织的情况下，即使远端柄固定良好且骨整合良好，也可能发生模块化颈部的应力性骨折。
