FATIGUE FRACTURE OF THE LOGICA CEMENTED STEM – CLINICAL AND MECHANICAL ANALYSIS

Authors

  • Marian Melisik, MD., PhD. University Department of Orthopaedic Surgery, University Hospital Martin, Slovakia
  • prof., Peter Palcek, Ing, PhD. Department of Materials Engineering, Faculty of Mechanical Engineering, University of Zilina, Univerzitna 8215, 010 26, Zilina, Slovak Republic
  • Libor Necas, MD., PhD. University Department of Orthopaedic Surgery, University Hospital Martin, Slovakia
  • Martin Zofcak, MD. Department of Orthopaedic Surgery, Hospital Michalovce, Spitalska 2, Michalovce, 071 01, Slovak Republic
  • Michal Al-Khouri, MD, University Department of Orthopaedic Surgery, University Hospital Martin, Slovakia
  • assoc. prof. Maros Hrubina, MD., Ph.D. University Department of Orthopaedic Surgery, University Hospital Martin, Slovakia https://orcid.org/0000-0003-0755-5570

DOI:

https://doi.org/10.14311/CTJ.2026.56.01

Abstract

Fracture of a cemented femoral stem is a relatively rare but serious complication of total hip arthroplasty (THA). This study aimed to perform a clinical and biomechanical analysis of six cases of fractured cemented stems to identify the risk factors associated with this type of failure. A retrospective analysis was conducted on six patients with documented stem fractures. Data collected included patient demographics (age, sex, BMI), implant details (stem size, head diameter), and the time from primary surgery to failure. Explanted stems underwent macroscopic evaluation, chemical analysis, and structural assessment using scanning electron microscopy (SEM). All fractured stems were the smallest available sizes (0 or 01) and were paired with XL or XXL femoral heads. The average time from implantation to revision surgery was 88 months (range: 70–102 months). The average BMI was 27.9 kg/m² (range: 20.3–31.1 kg/m²). Macroscopic examination revealed fatigue fractures covering more than 80% of the load-bearing cross-section. Chemical analysis showed that the implants consisted of two distinct materials: the head (AISI 316L steel) and the stem (06Cr18Ni11Nb alloy, AISI 347). Alloy analysis confirmed that the chemical composition largely met standard requirements, except for elevated manganese (Mn) levels and suboptimal niobium (Nb) content, likely due to processing issues. Fractography demonstrated crack initiation in high-stress areas (thread region), with signs of corrosion fatigue and secondary cracking contributing to the failure. Fatigue failure of cemented stems is a rare event. Identified risk factors include small-sized stems combined with larger femoral heads, which increase postoperative offset and biomechanical stress. Material issues, including substandard alloy composition and processing defects, combined with electrochemical interactions between different materials, further predispose these stems to failure.

Author Biographies

  • Marian Melisik, MD., PhD., University Department of Orthopaedic Surgery, University Hospital Martin, Slovakia

    aJessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic

    bUniversity Department of  Orthopaedic Surgery, University Hospital Martin, Kollarova 2,  Martin, 036 59, Slovak Republic

  • prof., Peter Palcek, Ing, PhD., Department of Materials Engineering, Faculty of Mechanical Engineering, University of Zilina, Univerzitna 8215, 010 26, Zilina, Slovak Republic

    cDepartment of Materials Engineering, Faculty of Mechanical Engineering, University of Zilina, Univerzitna 8215, 010 26, Zilina, Slovak Republic

  • Libor Necas, MD., PhD., University Department of Orthopaedic Surgery, University Hospital Martin, Slovakia

    University Department of Orthopaedic Surgery, University Hospital Martin, Slovakia

  • Martin Zofcak, MD., Department of Orthopaedic Surgery, Hospital Michalovce, Spitalska 2, Michalovce, 071 01, Slovak Republic

    dDepartment of Orthopaedic Surgery, Hospital Michalovce, Spitalska 2, Michalovce, 071 01, Slovak Republic

  • Michal Al-Khouri, MD,, University Department of Orthopaedic Surgery, University Hospital Martin, Slovakia

    University Department of Orthopaedic Surgery, University Hospital Martin, Slovakia

  • assoc. prof. Maros Hrubina, MD., Ph.D., University Department of Orthopaedic Surgery, University Hospital Martin, Slovakia

    aJessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic

    bUniversity Department of  Orthopaedic Surgery, University Hospital Martin, Kollarova 2,  Martin, 036 59, Slovak Republic

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Published

2026-03-05

Issue

Vol. 56 (2026): Current Issue

Section

Original Research

License

Copyright (c) 2026 Marian Melisik, MD., PhD., prof., Peter Palcek, Ing, PhD., Libor Necas, MD., PhD., Martin Zofcak, MD., Michal Al-Khouri, MD,, assoc. prof. Maros Hrubina, MD., Ph.D.

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