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Fracture of a Cemented, Highly Polished, Collarless, Triple-Tapered, High-Nitrogen Stainless Steel Femoral StemA Case Report
John V. Tiberi, MD1; Andrew Spitzer, MD2; Guy Paiement, MD2
1 South Bay Orthopaedic Specialists, 23560 Crenshaw Boulevard, Suite 120, Torrance, CA 90505. E-mail address: jvtiberi@gmail.com
2 Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd., OC – 603, Los Angeles, CA 90048
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Investigation performed at the Orthopaedic Center, Cedars-Sinai Medical Center, Los Angeles, California

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Oct 23;3(4):e103 1-5. doi: 10.2106/JBJS.CC.L.00240
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Early cemented forged stainless steel and casted cobalt-chromium femoral components were susceptible to gross material failure1-7. Proposed risk factors include type of implant, surgical technique, and patient variables1-16. Advances in implant materials and design as well as surgical and cementing techniques have rendered implant fracture increasingly rare8. Modern high-nitrogen stainless steel (HNSS) alloys, such as ORTRON 90 (DePuy International, Leeds, United Kingdom), which is used in the C-STEM (DePuy, Warsaw, Indiana), are mechanically superior to previously used stainless steel alloys17. Although HNSS femoral stems are weaker than forged cobalt-chromium stems, they are widely used because of excellent clinical results and a dramatically lower cost16. Fractures of both types of stems are extremely rare but have recently been reported in the literature10,16. To our knowledge, this is the second reported case of a stem fracture in a C-STEM, a collarless, triple-tapered, highly polished cemented HNSS femoral stem16. The patient was informed that data concerning the case would be submitted for publication, and he provided consent.
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