grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-4625Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2025-184-6-95-101grekov-2751Research ArticleНАБЛЮДЕНИЯ ИЗ ПРАКТИКИOBSERVATION FROM PRACTICEПерелом бедренного компонента exeter v40Fracture femoral component exeter v40https://orcid.org/0000-0001-8392-5380ЦедА. Н.TsedA. N.

Цед Александр Николаевич, доктор медицинских наук, профессор, руководитель 2-го травматолого-ортопедического отделения НИИ хирургии и неотложной медицины

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Tsed Aleksandr N., Dr. of Sci. (Med.), Professor, Head of the 2nd Traumatology and Orthopedic Department, Research Institute of Surgery and Emergency Medicine

travma1@mail.ruhttps://orcid.org/0000-0002-7264-7861МуштинН. Е.MushtinN. E.

Муштин Никита Евгеньевич, кандидат медицинских наук, ассистент кафедры травматологии и ортопедии, врач – травматолог-ортопед 2-го травматолого-ортопедического отделения НИИ хирургии и неотложной медицины

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Mushtin Nikita E., Cand. of Sci. (Med.), Assistant of the Department of Traumatology and Orthopedics, Orthopedic Traumatologist of the 2nd Traumatology and Orthopedic Department, Research Institute of Surgery and Emergency Medicine

mushtin.nikita@yandex.ruhttps://orcid.org/0000-0002-1181-6545ШмелевА. В.ShmelevA. V.

Шмелев Антон Владимирович, кандидат медицинских наук, врач – травматолог-ортопед, зав. 2-м травматолого-ортопедическим отделением НИИ хирургии и неотложной медицины

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Shmelev Anton V., Cand. of Sci. (Med.), Orthopedic Traumatologist, Head of the 2nd Traumatology and Orthopedic Department, Research Institute of Surgery and Emergency Medicine

schmeljew@mail.ruhttps://orcid.org/0000-0003-4079-5541ДулаевА. К.DulaevA. K.

Дулаев Александр Кайсинович, доктор медицинских наук, профессор, заслуженный врач РФ, член АО «Травма России», руководитель отдела травматологии, зав. кафедрой травматологии и ортопедии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Dulaev Aleksandr K., Dr. of Sci. (Med.), Professor, Honored Physician of the Russian Federation, Member of «AO Trauma Russia», Head of the Department of Traumatology, Head of the Department of Traumatology and Orthopedics

akdulaev@gmail.comhttps://orcid.org/0000-0001-5521-7248СухоруковаЕ. Г.SukhorukovaE. G.

Сухорукова Елена Геннадьевна, кандидат медицинских наук, старший научный сотрудник научной лаборатории патоморфологии НКЦ патоморфологии 

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Sukhorukova Elena G., Cand. of Sci. (Med.), Senior Research Fellow, Scientific Laboratory of Pathomorphology, CRC Pathomorphology

len48@inbox.ruПервый Санкт-Петербургский государственный медицинский университет имени академика И. П. ПавловаРоссияPavlov UniversityRussian Federation202514022026184695101Copyright © Цед А.Н., Муштин Н.Е., Шмелев А.В., Дулаев А.К., Сухорукова Е.Г., 20262026Цед А.Н., Муштин Н.Е., Шмелев А.В., Дулаев А.К., Сухорукова Е.Г.Tsed A.N., Mushtin N.E., Shmelev A.V., Dulaev A.K., Sukhorukova E.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/2751

Частота переломов бедренных компонентов эндопротеза тазобедренного сустава колеблется в пределах 0,1–3,4 % и является крайне редким ортопедическим осложнением. В нашей клинике впервые был диагностирован перелом цементной ножки Exeter V40 через 3 года после имплантации.

ЦЕЛЬ – демонстрация перелома цементного бедренного компонента, а также научный анализ причин данного осложнения. Основными причинами развития данного осложнения послужили: излишний вес (ИМТ – 39 кг/см2), увеличенный офсет (головка 36 мм в диаметре, размером +10) бедренного компонента при относительно небольшом размере (Exeter V40 37,5 N2) и ранняя фреттинг-коррозия.

The incidence of fractures of the femoral components of a hip implants ranges from 0.1 to 3.4 % and is an extremely rare orthopedic complication. In our clinic, a fracture of the Exeter V40 cement stem was diagnosed for the first time 3 years after implantation.

OBJECTIVE – to demonstrate a fracture of the cement femoral component, as well as a scientific analysis of the causes of this complication. The main reasons for the development of this complication were: excess weight (BMI – 39 kg/cm2), increased offset (head 36 mm in diameter, size +10) of the femoral component with a relatively small size (Exeter V40 37.5 N2) and early fretting corrosion.

перелом цементной ножки Exeter V40фреттинг-коррозияосложнение эндопротезирования тазобедренного суставаревизионное эндопротезированиеExeter V40 cement stem fracturefretting corrosioncomplication of hip arthroplastyrevision arthroplastyReferencesLing R. S. M., Charity J., Lee A. J. C. et al. The long-term results of the original Exeter polished cemented femoral component: a followup report. J Arthroplasty. 2009. Vol. 24, № 4. P. 511–517. https://doi.org/10.1016/j.arth.2009.02.002.Ling R. S. M., Charity J., Lee A. J. C. et al. The long-term results of the original Exeter polished cemented femoral component: a follow-up report. J Arthroplasty. 2009;24(4):511–517. https://doi.org/10.1016/j.arth.2009.02.002.Charnley J. Total hip replacement by low-friction arthroplasty. Clin. Orhtop. 1970. Vol. 72. P. 7–21. https://doi.org/10.1097/01.bco.0000443748.36521.01.Charnley J. Total hip replacement by low-friction arthroplasty. Clin. Orhtop. 1970;72:7–21. https://doi.org/10.1097/01.bco.0000443748.36521.01.National Joint Registry 21st Annual Report 2024, UK. URL: https://reports.njrcentre.org.uk/Portals/0/PDFdownloads/NJR%2021st%20Annual%20Report%202024_Hips.pdf (accessed: 01.12.25).National Joint Registry 21st Annual Report 2024, UK. URL: https://reports.njrcentre.org.uk/Portals/0/PDFdownloads/NJR%2021st%20Annual%20Report%202024_Hips.pdf (accessed: 01.12.25).Australian Orthopaedic Association, National Joint Replacement Registry, Annual report 2024. AOA 2024. URL: https://aoanjrr.sahmri.com/documents/10180/1798900/AOANJRR+2024+Annual+Report.pdf/9d0bfe03-2282-8fc8-a424-b8d9abb82b1f?t=1727666185313 (accessed: 01.12.25).Australian Orthopaedic Association, National Joint Replacement Registry, Annual report 2024. AOA 2024. URL: https://aoanjrr.sahmri.com/documents/10180/1798900/AOANJRR+2024+Annual+Report.pdf/9d0bfe03-2282-8fc8-a424-b8d9abb82b1f?t=1727666185313 (accessed: 01.12.25).The Swedish Arthroplasty Register, Annual report 2024. URL: https://sar.registercentrum.se/download?fileUrl=https://registercentrum.blob.core.windows.net/sar/r/Swedish-Arthroplasty-Register-Annual-report-2024-ENG-CHsgLK06p.pdf (accessed: 01.12.25).The Swedish Arthroplasty Register, Annual report 2024. URL: https://sar.registercentrum.se/download?fileUrl=https://registercentrum.blob.core.windows.net/sar/r/Swedish-Arthroplasty-Register-Annual-report-2024-ENG-CHsgLK06p.pdf(accessed: 01.12.25).FDA. US Food and Drug Administration 2001. 510(k) Premarket Notification K011623: EXETER HIP SYSTEM WITH V40 TAPER. URL: http://www.accessdata.fda.gov/cdrh_docs/pdf/K011623.pdf (accessed: 01.12.25).FDA. US Food and Drug Administration 2001. 510(k) Premarket Notification K011623: EXETER HIP SYSTEM WITH V40 TAPER. URL: http://www.accessdata.fda.gov/cdrh_docs/pdf/K011623.pdf (accessed: 01.12.25).Sadoghi P., Pawelka W., Liebensteiner M. C. et al. The incidence of implant fractures after total hip arthroplasty. Int Orthop. 2014. Vol. 38, № 1. P. 39–46. https://doi.org/10.1007/s00264-013-2110-3.Sadoghi P., Pawelka W., Liebensteiner M. C. et al. The incidence of implant fractures after total hip arthroplasty. Int Orthop. 2014;38(1):39–46. https://doi.org/10.1007/s00264-013-2110-3.Turnbull G. S., Soete S., Akhtar M. A. et al. Risk factors for femoral stem fracture following total hip arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2024. Vol. 144. P. 2421–2428. https://doi.org/10.1007/s00402-024-05281-x.Turnbull G. S., Soete S., Akhtar M. A. et al. Risk factors for femoral stem fracture following total hip arthroplasty: a systematic review and metaanalysis. Arch Orthop Trauma Surg. 2024;144:2421–2428. https://doi.org/10.1007/s00402-024-05281-x.Lewinnek G. E., Lewis J. L., Tarr R. et al. Dislocations after total hipreplacement arthroplasties. Jbjs. 1978. Vol. 60, № 2. P. 217–220.Lewinnek G. E., Lewis J. L., Tarr R. et al. Dislocations after total hipreplacement arthroplasties. Jbjs. 1978;60(2):217–220.Рыков А. Г., Коршняк В. Ю., Кожевникова С. Ю. и др. Переломы модульных ножек эндопротезов тазобедренного сустава (ТБС). Особенности ревизионной хирургии. VIII Пироговский форум травматологов-ортопедов : Сборник материалов, Москва, 15–16 ноября 2023 года. Казань: Медицинский издательский дом «Практика», 2023. С. 268– 269. URL: https://pirogovforum.com/video/repository/113000000589295618436610974565687312_a627379f.pdf (дата обращения: 01.12.25).Rykov A. G., Korshnyak V. Yu., Kozhevnikova S. Yu. et al. Fractures of modular stems of hip joint endoprostheses. Features of revision surgery / VIII Pirogov Forum of Traumatologists and Orthopedists: Collection of materials, Moscow, November 15-16, 2023. Kazan: Medical Publishing House “Praktika”, 2023. pp. 268–269. (In Russ.). URL: https://pirogovforum.com/video/repository/113000000589295618436610974565687312_a627379f.pdf (accessed: 01.12.25).Merini A., Viste A., Desmarchelier R., Fessy M.-H. Cementless Corailtm femoral stems with laser neck etching: Long-term survival, rupture rate and risk factors in 295 stems. Orthopaedics & Traumatology: Surgery & Research. 2016. Vol. 102, № 1. P. 71–76. ISSN 1877-0568. https://doi.org/10.1016/j.otsr.2015.10.009.Merini A., Viste A., Desmarchelier R., Fessy M.-H. Cementless Corailtm femoral stems with laser neck etching: Long-term survival, rupture rate and risk factors in 295 stems. Orthopaedics & Traumatology: Surgery & Research. 2016;102(1):71–76. ISSN 1877-0568. https://doi.org/10.1016/j.otsr.2015.10.009.Кирпичев И. В., Бражкин С. Е., Васин И. В. Клинический случай перелома бедренного компонента эндопротеза тазобедренного сустава. Вестник Ивановской медицинской академии. 2020. Т. 25, № 3–4. С. 45–47.Kirpichev I. V., Brazhkin S. E., Vasin I. V. Clinical case of fracture of the femoral component of a hip joint endoprosthesis. Bulletin of the Ivanovo Medical Academy. 2020;25(3–4):45–47. (In Russ.).Krüger D. R., Guenther K. P., Deml M. C. et al. Mechanical failure of 113 uncemented modular revision femoral components. Bone Joint J. 2020. Vol. 102. P. 573–579. https://doi.org/10.1302/0301-620X.102B5.BJJ-2019-1333.R2.Krüger D. R., Guenther K. P., Deml M. C. et al. Mechanical failure of 113 uncemented modular revision femoral components. Bone Joint J. 2020;102:573–579. https://doi.org/10.1302/0301-620X.102B5.BJJ-2019-1333.R2.Turnbull G. S., Soete S., Akhtar M. A. et al. Risk factors for femoral stem fracture following total hip arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2024. Vol. 144. P. 2421–2428. https://doi.org/10.1007/s00402-024-05281-x.Turnbull G. S., Soete S., Akhtar M. A. et al. Risk factors for femoral stem fracture following total hip arthroplasty: a systematic review and metaanalysis. Arch Orthop Trauma Surg. 2024;144:2421–2428. https://doi.org/10.1007/s00402-024-05281-x.Thompson J. W., Corbett J., Bye D. et al. Analysis of the Exeter V40 femoral stem prosthesis fracture: systematic review and single centre case series. Bone & joint open. 2021. Vol. 2, № 6. P. 443–456. https://doi.org/10.1302/2633-1462.26.BJO-2021-0025.R1.Thompson J. W., Corbett J., Bye D. et al. Analysis of the Exeter V40 femoral stem prosthesis fracture: systematic review and single centre case series. Bone & joint open. 2021;2(6):443–456. https://doi.org/10.1302/2633-1462.26.BJO-2021-0025.R1.Bolland B. J. R. F., Wilson M. J., Howell J. R. et al. An analysis of reported cases of fracture of the universal Exeter femoral stem prosthesis. J Arthroplasty. 2017. Vol. 32, № 4. P. 1318–1322. https://doi.org/10.1016/j.arth.2016.09.032.Bolland B. J. R. F., Wilson M. J., Howell J. R. et al. An analysis of reported cases of fracture of the universal Exeter femoral stem prosthesis. J Arthroplasty. 2017;32(4):1318–1322. https://doi.org/10.1016/j.arth.2016.09.032.Davies B. M., Branford White H. A., Temple A. A series of four fractured Exeter™ stems in hip arthroplasty. Ann R Coll Surg Engl. 2013. Vol. 95, № 8. P. 130–132. https://doi.org/10.1308/rcsann.2013.95.8.e1.Davies B. M., Branford White H. A., Temple A. A series of four fractured Exeter™ stems in hip arthroplasty. Ann R Coll Surg Engl. 2013;95(8):130–132. https://doi.org/10.1308/rcsann.2013.95.8.e1.Woodbridge A. B., Hubble M. J., Whitehouse S. L. et al. The Exeter short revision stem for Cement-in-Cement femoral revision: a five-to-twelve-year review. J Arthroplasty. 2019. Vol. 34, № 7S. P. S297–S301. https://doi.org/10.1016/j.arth.2019.03.035.Woodbridge A. B., Hubble M. J., Whitehouse S. L. et al. The Exeter short revision stem for Cement-in-Cement femoral revision: a five-totwelve-year review. J Arthroplasty. 2019;34(7S):S297–S301. https://doi.org/10.1016/j.arth.2019.03.035.Matar H. E., Selvaratnam V., Board T. N. et al. Fractured femoral stems in primary and revision hip arthroplasties revisited: Wrightington experience. J Arthroplasty. 2020. Vol. 35, № 5. P. 1344–1350. https://doi.org/10.1016/j.arth.2020.01.020.Matar H. E., Selvaratnam V., Board T. N. et al. Fractured femoral stems in primary and revision hip arthroplasties revisited: Wrightington experience. J Arthroplasty. 2020;35(5):1344–1350. https://doi.org/10.1016/j.arth.2020.01.020.Wroblewski B. M. Fractured stem in total hip replacement. A clinical review of 120 cases. Acta Orthop Scand. 1982. Vol. 53, № 2. P. 279–284. https://doi.org/10.3109/17453678208992216.Wroblewski B. M. Fractured stem in total hip replacement. A clinical review of 120 cases. Acta Orthop Scand. 1982;53(2):279–284. https://doi.org/10.3109/17453678208992216.Reito A., Eskelinen A., Pajamäki J., Puolakka T. Neck fracture of the Exeter stem in 3 patients, Acta Orthopaedica. 2016. Vol. 87, № 2. P. 193–196. https://doi.org/10.3109/17453674.2015.1112188.Reito A., Eskelinen A., Pajamäki J., Puolakka T. Neck fracture of the Exeter stem in 3 patients, Acta Orthopaedica. 2016;87(2):193–196. https://doi.org/10.3109/17453674.2015.1112188.Wylde C. W., Jenkins E., Pabbruwe M., Bucher T. Catastrophic failure of the Accolade I hip arthroplasty stem: a retrieval analysis study. Hip International. 2020. Vol. 30, № 4. P. 481–487. https://doi.org/10.1177/1120700020919665.Wylde C. W., Jenkins E., Pabbruwe M., Bucher T. Catastrophic failure of the Accolade I hip arthroplasty stem: a retrieval analysis study. Hip International. 2020;30(4):481–487. https://doi.org/10.1177/1120700020919665.

The authors declare that there are no conflicts of interest present.