Charnley reports 17 fatigue fractures of cemented femoral prostheses from his series of ~6,500 primary total hip replacements, investigating whether fracture results from implant/metallurgical defects or surgical technique errors, and identifying which patient characteristics and operative factors predict failure.
In any heavy male patient (>170 lb / 75.5 kg) undergoing cemented THR, this paper demands attention to two modifiable failure mechanisms: ensure complete cement fill at the proximal medial concavity with calcar curettage to remove soft cancellous bone, and place the stem in valgus with ~5° anteversion to prevent direct metal-bone contact — the same technical principles that drove development of modern stem sizing protocols for high-demand patients.
Charnley reports 17 fatigue fractures of cemented femoral prostheses from his series of ~6,500 primary total hip replacements, investigating whether fracture results from implant/metallurgical defects or surgical technique errors, and identifying which patient characteristics and operative factors predict failure.
In any heavy male patient (>170 lb / 75.5 kg) undergoing cemented THR, this paper demands attention to two modifiable failure mechanisms: ensure complete cement fill at the proximal medial concavity with calcar curettage to remove soft cancellous bone, and place the stem in valgus with ~5° anteversion to prevent direct metal-bone contact — the same technical principles that drove development of modern stem sizing protocols for high-demand patients.