Failure of a Modular Femoral Revision Stem in Hip Arthroplasty: A Rare Complication and Literature Review

Authors

• Osama Aldowekat, LSU Health Sciences Center - New OrleansFollow
• Jihad Al-Ajlouni, Jordan University Hospital, Amman, Jordan
• Taghleb Al-Awad, The University of Jordan, Amman, Jordan
• Malak Smida, The Royal College of Surgeon in Ireland, Ireland, Bahrain
• Zaid Ta'ani, The University of Jordan, Amman, Jordan

Document Type

Article

Publication Date

4-1-2026

Publication Title

Journal of Orthopaedic Case Reports

Abstract

INTRODUCTION: Zimmer modular revision (ZMR)® femoral stems are widely utilized in revision total hip arthroplasty (rTHA) due to their intraoperative customization that offers surgical flexibility in reconstructing complex hip joints. However, despite these advantages, the modular junction is prone to localized stress concentration, which may transfer cantilever loads distally. This mechanical environment possibly causes a fracture, often in the body-stem junction, where the cross-sectional area is reduced. Moreover, patient-based factors in addition to implant-related factors can both contribute to such rare but catastrophic failure. Factors such as bone quality, implant design, and surgical technique must be evaluated. These assessments will help in the formulation of a long-term management plan, along with a strategy to prevent this issue. CASE REPORT: In this report, we present a 70-year-old male patient with a past medical history of hypertension and a past surgical history of a left THA in 2011, a right THA in 2016, and a revision left THA using ZMR secondary to a periprosthetic fracture in 2021. In December 2023, he presented to the emergency department with a 2-day history of sudden atraumatic left groin pain. Imaging revealed a femoral stem fracture at the body-stem junction. CONCLUSION: Although rare, cantilever fatigue of the ZMR stem is a serious complication. It is linked to both patient related factors (advanced age, high BMI, poor proximal bone stock), and implant factors (shorter length, smaller diameter, extended offset), with failure oftern), with occurring at the body-stem junction.

First Page

29

Last Page

37

PubMed ID

41970795

Volume

16

Issue

4

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

Recommended Citation

Aldowekat, Osama; Al-Ajlouni, Jihad; Al-Awad, Taghleb; Smida, Malak; and Ta'ani, Zaid, "Failure of a Modular Femoral Revision Stem in Hip Arthroplasty: A Rare Complication and Literature Review" (2026). School of Medicine Faculty Publications. 4744.
https://digitalscholar.lsuhsc.edu/som_facpubs/4744
10.13107/jocr.2026.v16.i04.7026