Abstract
With the use of modern high-strength material, fracture of the femoral stem has become extremely rare in total hip arthroplasty. This case report describes the complete progression sequence of a fractured cobalt-chrome alloy stem, from implant failure to delayed periprosthetic fracture. We describe a 42-year-old patient with ankylosing spondylitis who received bilateral hip arthroplasty due to hip joint arthritis. Loosening of right acetabular component occurred 14 years later so the revision arthroplasty was performed. Extended trochanteric osteotomy technique was applied during operation. After 7 years, the patient presented to our clinic with progressive thigh soreness. The radiographs showed a broken stem with minimal displacement. Another one year later, the patient experienced delayed periprosthetic fracture after a low energy fall. Marked proximal femur bone loss and well-fixed distal stem was observed during the revision surgery. Revision was done with a fully-coated long stem with allograft impacted to restore proximal bone stock. The patient regained his ambulatory ability with the aid of a walker. This article highlights the importance of immediate revision surgery once the fractured stem is detected, even the patients have only minor symptoms. Clinicians should monitor high-risk patients with persistent thigh pain after total hip arthroplasty.