Catastrophic Femoral Neck Failure after THA with the Accolade® I Stem in Three Patients

Case Description We report a series of three femoral stem failures, each occurring at the head-neck junction, with all patients experiencing limited and painful ambulation, leading to subsequent revision arthroplasty. All patients were male with high-offset femoral stems and increased head lengths, and each had undergone primary THA at a minimum of 7 years before presentation (average, 94 months). There were no associated deep infections or cases of aseptic loosening in the cohort. Literature Review There is a paucity of similar reports in the literature regarding femoral stem failure at the head-neck junction. When failures of titanium stems have been reported, failure has been attributed to material design and geometry, laser etching, overload, implant alignment, and patient characteristics. Purpose and Clinical Relevance Catastrophic failures of femoral stems at the head-neck junction are a rare cause for revision after THA. Component material and design, surgical technique, and patient factors may contribute.