Fracture of Femoral Prostheses in Total Hip Replacement

The clinical features are presented of 17 fractured Charnley femoral prostheses occurring over a period of about ten years and arising from some 6,500 operations, with more than a 3 1/2 year follow-up. The patients especially at risk are males weighing over 170 lb (75.5 kg) and from these is an obvious need for a heavier design of prosthesis. Whereas the overall fracture rate is only 0.23 per cent, the rate for males over 196 lb (88 kg) is 6.0 per cent. It is believed that defective surgical technique, in failing to provide adequate support by cement to the concavity of the upper levels of the prosthesis is probably the main cause of fracture and reasonably good cement technique explains why the fracture rate is not higher in the present series. Indications for improving cement technique are outlined.