Neck fracture of the Exeter stem in 3 patients

© 2015 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (https://creativecommons.org/licenses/by-nc/3.0) DOI 10.3109/17453674.2015.1112188 The patients Patient 1 (Figure 1) A 63-year-old woman (height 1.70 m, weight 92 kg, BMI 31) with developmental dysplasia of both hips underwent bilateral hybrid total hip replacement (THR) using the cemented Exeter V40 stem (offset 44 mm, size 3) and uncemented Trident PSL (Stryker) with alumina-on-alumina ceramic bearing (Biolox Forte; Ceramtec, Plochingen, Baden-Württemberg, Germany) at our hospital in 2004. A ceramic femoral head with a diameter of 36 mm and offset of +5 mm was used. Shortterm functional outcome was excellent. 5 years and 3 months later, the patient tripped on a flat floor and fell down, and was unable to move her left leg due to severe pain. Plain radiographs revealed a neck fracture in the Exeter stem. She underwent revision surgery, during which both the remnant of the Exeter stem and the uncemented acetabular component were found to be well fixed. A posterior notch distal to the fracture line was seen in the stem, indicating neck-cup impingement. The fractured stem was removed and a new short (125-mm) Exeter Revision stem (offset 44 mm, size 0) was cemented into the well-retained cemented mantle. The well-fixed cup was retained. However, both the ceramic liner and the femoral head were replaced with new ones that corresponded with the original liner and the head, both in diameter and in offset.