Reported here are four fractured femoral components from a consecutive
series of 200 total hip reconstructions. All four had been placed in
patients who weighed ninety-one kilograms or more and who were more than
1.8 meters tall. In each patient, roentgenograms made prior to the time of
failure of the prosthesis revealed roentgenographic lucency, which was
interpreted as cement failure. Metallurgical examination revealed fatigue
failure and some abnormality in each prosthetic stem. Review of all 200
total hip replacements suggested that there was failure to position the
prosthesis in strong valgus in there four hips and in thirty others. In the
four failures, the contributing influences of large size of patients,
inadequate valgus positioning of the prosthesis, inadequate support by
cement, and metallurgical inadequacies of the prosthesis used are
discussed.