Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Dec 20, 2023; 13(5): 502-509
Published online Dec 20, 2023. doi: 10.5662/wjm.v13.i5.502
Successful hip revision surgery following refracture of a modern femoral stem using a cortical window osteotomy technique: A case report and review of literature
Carlos M Lucero, Juan B Luco, Agustin Garcia-Mansilla, Pablo A Slullitel, Gerardo Zanotti, Fernando Comba, Martin A Buttaro
Carlos M Lucero, Gerardo Zanotti, Fernando Comba, Martin A Buttaro, Centro de Cadera "Sir John Charnley", Instituto de Ortopedia y Traumatologia Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Capital federal C1198AAW, Buenos Aires, Argentina
Juan B Luco, Instituto de Ortopedia y Traumatologia Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires C1198AAW, Buenos Aires, Argentina
Agustin Garcia-Mansilla, Pablo A Slullitel, Centro de Cadera "Sir John Charnley", Instituto de Ortopedia y Traumatología, “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires C1198AAW, Buenos Aires, Argentina
Author contributions: Garcia-Mansilla A collected the images and was a major contributor to the manuscript; Luco JB obtained consent from the patient and contributed to the editing of the manuscript; Buttaro M contributed to the editing of the manuscript and was the main supervisor of the project; All authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Juan B Luco, MD, Instituto de Ortopedia y Traumatologia Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Peron 4190, Ciudad Autonoma de Buenos Aires C1198AAW, Buenos Aires, Argentina. bautista.luco@hospitalitaliano.org.ar
Received: May 24, 2023
Peer-review started: May 24, 2023
First decision: August 10, 2023
Revised: August 26, 2023
Accepted: September 11, 2023
Article in press: September 11, 2023
Published online: December 20, 2023
Abstract
BACKGROUND

The ExeterTM Universal cemented femoral component is widely used for total hip replacement surgery. Although there have been few reports of femoral component fracture, removal of a broken femoral stem can be a challenging procedure.

CASE SUMMARY

A 54-year-old man with a Dorr A femur sustained a refracture of a primary ExeterTM stem, two years after receiving a revision using a cement-within-cement technique (CWC) through an extended trochanteric osteotomy (ETO). The technical problems related to the CWC technique and the ETO played a major role in the stem fatigue refracture. We performed revision surgery and removed the distal cement using a cortical femoral window technique, followed by re-implantation with an uncemented, modular, distally-fixed uncemented stem. The patient experienced an uneventful postoperative recovery.

CONCLUSION

Re-fracture of a modern femoral ExeterTM stem is a rare event, but technical complications related to revision surgery can lead to this outcome. The cortical window osteotomy technique can facilitate the removal of a broken stem and cement, allowing for prosthetic re-implantation under direct vision and avoiding ETO-related complications.

Keywords: Exeter stem, Femoral stem breakage, Femoral osteotomy, Total hip arthroplasty, Case seport

Core Tip: We analyzed the causes of failure in a patient with an Exeter stem refracture, and discussed how to resolve it using a known but little used technique. When removing a broken stem, a window osteotomy facilitates the extraction of the distal cement and allows for prosthetic reimplantation, thereby minimizing the complications of an extended osteotomy. Finally, this preoperative technique, if correctly planned, can be performed by using ordinary instruments and does not consume host bone. This technique should be an addition to the armamentarium of a revision hip surgeon when faced with the challenge of extracting a fracture cemented femoral stem.