Laser etching causing fatigue fracture at the neck–shoulder junction of an uncemented femoral stem: A case report

Jang, Bob; Kanawati, Andrew; Brazil, Declan; Bruce, Warwick

doi:10.1016/j.jor.2013.04.007

Cited by 15 publications

(10 citation statements)

References 9 publications

(3 reference statements)

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“…Extractions of such broken hip stems during revision surgery are extensive and may require Cases of implant fatigue due to laser etching were previously reported where Woolson et al [20] showed fractures of cemented cobalt chromium stem components. Furthermore, fractures in cobalt-chromium and titanium alloyed hip implants at the laser etched sites of femoral necks and stems were published [8,18,21]. To our knowledge, this is the first study of femoral stem fracture of TMZF alloy hip implants due to laser etching.…”

Section: Discussionmentioning

confidence: 92%

Laser engravings as reason for mechanical failure of titanium-alloyed total hip stems

Kluess

Steinhauser

Joseph

et al. 2015

Arch Orthop Trauma Surg

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Section: Discussionmentioning

confidence: 92%

Laser engravings as reason for mechanical failure of titanium-alloyed total hip stems

Kluess

Steinhauser

Joseph

et al. 2015

Arch Orthop Trauma Surg

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“…Therefore, the radius of the notch is, as a geometrical function, important [42]. Jang et al demonstrated that thermal damage of laser etching on hip implants led to their early fracture [43]. Huber et al [25] and Konrads et al [26] reported a decrease in the fatigue life of Ti hip implants due to the thermal damage of electrocautery.…”

Section: Discussionmentioning

confidence: 99%

Impact of Electrocautery on Fatigue Life of Spinal Fusion Constructs—An In Vitro Biomechanical Study

et al. 2019

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Instrumentation failure in the context of spine surgery is attributed to cyclic loading leading to formation of fatigue cracks, which later propagate and result in rod fracture. A biomechanical analysis of the potential impact of electrocautery on the fatigue life of spinal implants has not been previously performed. The aim of this study was to assess the fatigue life of titanium (Ti) and cobalt-chrome (CoCr) rod-screw constructs after being treated with electrocautery. Twelve spinal constructs with CoCr and Ti rods were examined. Specimens were divided into four groups by rod material (Ti and CoCr) and application of monopolar electrocautery on the rods’ surface (control-group and electrocautery-group). Electrocautery was applied on each rod at three locations, then constructs were cyclically tested. Outcome measures were load-to-failure, total number of cycles-to-failure, and location of rod failure. Ti-rods treated with electrocautery demonstrated a significantly decreased fatigue life compared to non-treated Ti-rods. Intergroup comparison of cycles-to-failure revealed a significant mean decrease of almost 9 × 105 cycles (p = 0.03). No CoCr-rods failed in this experiment. Electrocautery application on the surface of Ti-rods significantly reduces their fatigue life. Surgeons should exercise caution when using electrocautery in the vicinity of Ti-rods to mitigate the risk of rod failure.

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“…Several other risk factors for stem breakage have previously been identified including laser etching of the stem and other potential mechanical stress risers. 14,[42][43][44][45] A further commonly cited risk factor is component varus positioning. 15,39,46 While the majority of cemented stem breakages reported in the literature are in the mid-third region, there are some reports of cemented stems breaking through the neck.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for femoral stem breakage: an analysis of the AOANJRR results

et al. 2019

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Introduction: Breakage of the femoral stem component of a total hip replacement is now uncommon but continues to be seen with certain stem designs and in certain patient groups. Data previously published on this topic has been limited, either gathered from a single surgeon or centre, or included only a single stem design. Methods: We reviewed the data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), identified and analysed 143 stem breakages over a period of 16 years, covering 44 different stem designs. Results: Our data confirms previously published findings that risk factors for stem breakage include patient age at implantation of under 70, male gender, as well as the use of exchangeable necks. We found no association with initial diagnosis, or type of acetabular component implanted. We did however also find, excluding exchangeable neck designs, that after 4.5 years a cemented stem had a significantly higher risk of breakage then a cementless stem. Discussion: To our knowledge this is the 1st paper to suggest cemented fixation as a specific risk factor for stem breakage. The analysis of rare complications such as stem breakage is only possible through large data collection systems such as the AOANJRR. Whilst there have been recent advances in materials and manufacturing techniques, we recommend that surgeons are aware of all the specific risks when considering implant choices for individual patients.

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Laser etching causing fatigue fracture at the neck–shoulder junction of an uncemented femoral stem: A case report

Cited by 15 publications

References 9 publications

Laser engravings as reason for mechanical failure of titanium-alloyed total hip stems

Laser engravings as reason for mechanical failure of titanium-alloyed total hip stems

Impact of Electrocautery on Fatigue Life of Spinal Fusion Constructs—An In Vitro Biomechanical Study

Risk factors for femoral stem breakage: an analysis of the AOANJRR results

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