Prosthetic Neck Fracture in Exeter V40 Stems: A Report of Two Cases and Review of Literature.

This report contains 2 acute fractures of the Exeter V40 stem with 2 different types of neck fracture, one at the subcapital level and another at the base of the neck. A review of relevant literature provides an insight into a similar pattern of failures reported in a certain subset of cases. We hypothesize that for high-BMI cases, attention to proper preoperative templating is mandatory. The operating surgeon should try to restore offset without having to use a long head in this subgroup of patients. We feel that trying to compensate for the offset with a long head may lead to high-stress concentration in the neck. This, in turn, may be responsible for the failure of the stem, as seen in the reported cases. We advocate, based on the literature, the need to recreate the offset carefully with as big a stem as possible to avoid these unique and rare complications. Reducing such failures may further improve the overall survivorship of the V40 Exeter stem.