Perforation of the femoral shaft by the prosthetic stem as a
complication of total hip replacement is not well described in the
literature. We studied twelve patients with this complication in order to
define the predisposing factors, optimum management, and long-term outcome.
Each patient was found to have one or more of the following factors: female
sex, osteoporosis, previous fracture, or previous surgery. Once the
complication was recognized, management consisted of protected
weight-bearing for six weeks. All but two of the patients were asymptomatic
after an average follow-up of five years. Judging from the long-term
roetgenographic follow-up, penetration of the femoral shaft does not appear
to seriously compromise the fixation of the femoral component.