Failure of a Modular Hip Implant at the Stem-Sleeve Interface

Abstract

In the current era of total hip arthroplasty (THA), orthopedic surgeons have several fixation options at their disposal. The modern monoblock prosthesis, introduced by Dr. Sir John Charnley, has seen many modifications since its inception in the 1970s and continues to be the most commonly used prosthesis style for primary and revision THA. Proximal modular sleeve technology was introduced in 1967 by Konstantin Sivash, modifying his original 1956 Sivash Stem design. The design is now known as the S-ROM, and although design modifications continue to date, the fundamental structure of the S-ROM remains essentially unchanged. Several other proximal modular prostheses are now currently available for use in THA. Although this similarity in design enables considerable surgical flexibility, it also links their potential for catastrophic failure. This aim of this article was to present a brief history of proximal modularity in THA and to add to the small body of literature regarding catastrophic failure in modular hip implants, including its proposed etiologies including micromotion, fretting and corrosion.

Fracture of an S-ROM stem at the sleeve-stem junction

“…The present study presents a fatigue fracture of the stem at the sleeve-stem junction in an S-ROM System. This mechanism of failure has been reported previously [8], [9]. Although an infrequent occurrence of this implant, its continued reporting deserves further investigation.…”

“…But recent reports on the modular stem Emperion System (Smith and Nephew, Memphis, TN) demonstrated a stem fracture rate of 1.5% (8 of 547), and this stem has since been removed from commercial use [7]. The present study reports a similar failure mechanism at the sleeve-stem junction in a S-ROM Modular Hip System (DePuy Orthopedics Inc., Warsaw, IN) and includes a comprehensive review of the literature on S-ROM stem fractures [7], [8], [9], [10], [11]. The paper also discusses the proposed failure mechanism, potential risk factors, and surgical management of this complication.…”

“…[8]16 × 11 × 15036 + 616B Large ZTT36 + 6 Co-Cr56 PinnacleMetalFatigueStem-sleeve5010932.57MacroscopicMehran et al. [9]18 × 13 × 16036 + 8L18F Large ZTTn/a54 HowmedicaPolyethyleneFatigueStem-sleeve61n/an/a9n/aWaly et al. [10]14 × 936 STD14B28 ceramic48 PinnacleCeramicFatigueStem-sleeve6470287Large corrosion pitShah et al.…”

“…[18]11.6an/an/an/an/an/aFatigueStem-sleeve6912831.6a5Severe

STD, standard; DOS, date of surgery.

a

Values for all 7 cases reported by Huot Carlson et al. [7], [8], [9], [10], [11], [18].

…”

Stem-Sleeve Junction Failure of a Modular Femoral Hip System: a Retrieval Analysis

“…These mechanical failures occurred secondary to crevice corrosion, which created a microenvironment predisposing to fatigue fracture. While a few reports have been published documenting stem fracture within the stem-sleeve junctions [18,25,26], these reports lacked examination of patient-or implant-related factors that contributed to stem failure. In the present study, we report a case of an S-ROM® fracture (S-ROM®, DePuy Synthes, Warsaw, IN) within the modular sleeve in an adult female patient following a primary total hip arthroplasty.…”