Geometric Discontinuities | Stress Risers | Kt Factor | Design Optimization
- Stress concentration: localized stress elevation at geometric discontinuities
- Kt factor = (local peak stress) / (nominal stress) - typically 3-10x
- Sharp corners worse than rounded (infinite Kt theoretically at sharp point)
- Screw holes in plates are stress concentrators (Kt ~3) - common fracture site
- Minimizing stress concentrations critical for fatigue resistance
- “Plate fractures occur at screw holes due to stress concentration
- “Thread root radius critical for screw fatigue strength
- “Fillet radii reduce stress concentration (smooth transitions)
- “Elliptical holes better than circular for stress distribution
Local stress elevation at geometric discontinuities. Kt factor = (local peak stress) / (nominal stress). Circular hole: Kt = 3 (stress 3x higher at hole edge than remote stress).
Plate fractures at screw holes, screw breakage at thread roots, notch sensitivity in fatigue. Stress concentrations are crack initiation sites for fatigue failures.
Sharp corners have infinite theoretical Kt. Rounding corners (fillet radius) dramatically reduces stress concentration. Larger radius = lower Kt.
Minimize discontinuities, use fillet radii, avoid sharp corners, orient holes perpendicular to loading, use graduated transitions. Prevention better than strength.
Overview and Fundamentals

Stress concentration is the amplification of stress that occurs at geometric discontinuities in a loaded structure. When a uniformly loaded component contains a hole, notch, sharp corner, or other geometric irregularity, the stress locally increases to values significantly higher than the nominal (average) stress.
This phenomenon is critical in orthopaedic implant design because stress concentrations are the primary sites for fatigue crack initiation. Understanding and minimizing stress concentrations is essential for implant longevity.
Historical Context: The concept of stress concentration was first rigorously developed by Inglis (1913) and later expanded by Griffith (1921) in seminal work on fracture mechanics. Inglis showed mathematically that an elliptical hole in a plate concentrates stress at its tips, with the concentration factor depending on the hole's aspect ratio.
Explains: plate fractures at screw holes in delayed unions; screw breakage at thread roots; stem fractures at geometry changes; modular junction failures. Prevention through design (fillets, gradual transitions) more effective than using stronger materials.
Principles and Mechanisms
The Stress Concentration Factor (Kt)
The stress concentration factor Kt quantifies the severity of stress amplification:
Kt = (σ_max local) / (σ_nominal)
Where:
- σ_max local = maximum stress at the discontinuity
- σ_nominal = average (nominal) stress in the cross-section away from the discontinuity
- Kt Value
- Kt = 3
- Clinical Example
- Screw holes in compression plates
- Mitigation
- Use elliptical holes oriented properly
- Kt Value
- Kt = 5-10+
- Clinical Example
- Poorly designed implant corners
- Mitigation
- Add fillet radius to round corners
- Kt Value
- Kt = 1.2-1.5
- Clinical Example
- Well-designed stem tapers
- Mitigation
- Optimize radius for geometry
- Kt Value
- Kt → ∞ (infinite)
- Clinical Example
- Surface defects from manufacturing
- Mitigation
- Polish surfaces, quality control
Factors Affecting Kt
Key Principles:
- Geometry, not material - Kt depends on shape, not material properties
- Sharpness - Sharp discontinuities have higher Kt than gradual changes
- Radius effect - Larger fillet radii dramatically reduce Kt
- Orientation - Hole perpendicular to loading has lower Kt
- Size relative to component - Larger holes relative to component width have higher Kt
Mathematical Relationships
- Kt = 3 (at the hole edge perpendicular to loading)
- Kt = 1 + 2(a/b)
- Where a = semi-major axis (perpendicular to load), b = semi-minor axis
- As b → 0 (crack-like), Kt → ∞
- Kt decreases as fillet radius increases
- Charts (Peterson's Stress Concentration Factors) provide values for specific geometries
The stress concentration factor Kt is a geometric property only - it does not depend on the material. A steel plate and a titanium plate with identical geometry will have identical Kt values. However, materials differ in their notch sensitivity (how they respond to stress concentrations), which is a separate material property.
Notch Sensitivity
While Kt is geometry-dependent, the effective stress concentration factor (Kf) accounts for material notch sensitivity:
Kf = 1 + q(Kt - 1)
Where q = notch sensitivity factor (0 to 1):
- q = 0: material insensitive to notches (ductile, wrought alloys)
- q = 1: fully notch sensitive (brittle materials, cast alloys)
Most metals have q = 0.6-0.9, meaning they partially "feel" the stress concentration.
The Radius-of-Curvature Form of the Inglis Equation
Everything this topic asserts about sharpness — that a larger fillet radius lowers Kt and that a perfectly sharp corner has an infinite Kt — flows from a single equation that the Inglis (1913) analysis makes explicit but which is usually quoted only in its aspect-ratio form. For an elliptical hole with semi-axis a perpendicular to the load and semi-axis b parallel to the load, the peak stress at the tip is σ_max = σ_nominal × (1 + 2a/b), so:
Kt = 1 + 2(a/b)
The tip of that ellipse — the point facing into the load where stress peaks — has a radius of curvature ρ = b²/a. Substituting eliminates b and rewrites Kt purely in terms of the flaw depth a and the tip radius ρ:
Kt = 1 + 2√(a/ρ)
This radius-of-curvature form is what actually governs implant design:
- A circular hole has a = b, so ρ = a and Kt = 1 + 2 = 3 — recovering the Kirsch result.
- As the tip radius ρ approaches zero (a crack or sharp scratch), Kt grows without bound — the quantitative basis for the statement that sharp corners have an infinite Kt.
- Because Kt scales with the square root of (a/ρ), the tip radius dominates the outcome: rounding a near-zero notch root to a finite fillet radius collapses Kt far more effectively than shortening the flaw does.
Clinically this is why re-radiusing a thread root or a plate corner is the single highest-yield design lever, and why a fine machining scratch (a tiny ρ paired with a small a, yet still a large √(a/ρ)) remains dangerous. The engineering practice of drilling a rounded "stop hole" at the end of a propagating crack works by the same equation — it replaces a near-zero tip radius with a finite one, dropping the local Kt. The moment a true sharp crack exists, Kt is abandoned and the crack is described instead by the stress-intensity factor K, with the fatigue-crack process (Paris law, crack growth, beach marks) developed in the fatigue-failure and implant-fracture-biomechanics topics; Kt governs the elastic stress state at a rounded notch, K governs propagation of a sharp crack.
Kt = 1 + 2√(a/ρ): the stress concentration at a notch is set by its tip radius ρ, not by the material. Enlarging the fillet radius lowers the peak stress at the notch identically for every alloy — a geometric fix that no increase in yield strength can substitute for, and the quantitative reason a well-designed titanium part outlasts a poorly designed high-strength one.
Gross-Section versus Net-Section: Why 'Kt = 3' Is Only the Starting Point
The value Kt = 3 for a circular hole is the Kirsch solution for an infinite plate — one whose width is very much larger than the hole — and it is referenced to the gross remote stress. Real bone plates are finite in width, which changes the number in the way the topic hints at when it states that larger holes relative to plate width raise Kt.
When a hole removes material, the remaining ligament (the net section) must carry the whole load over a smaller area, so the net-section nominal stress is higher than the gross:
- Gross nominal: σ_gross = P / (W × t)
- Net nominal: σ_net = P / ((W − d) × t)
where W = plate width, d = hole diameter, t = thickness and P = applied load. Kt therefore has two conventions: Ktg references the peak stress to σ_gross, whereas Ktn references the same peak stress to σ_net, and the two relate by Ktn = Ktg × (W − d)/W.
As the hole grows relative to the plate width (increasing the d/W ratio), the gross-referenced Ktg rises above 3 — because the peak stress climbs faster than the gross stress — while the net-referenced Ktn falls toward about 2. For a central hole with d/W of 0.5, standard finite-width charts (Peterson's) give a Ktn of roughly 2.1 and hence a Ktg of about 4.2; only when the hole is very small compared with the width do both converge on the textbook value of 3.
This resolves the topic's repeated claim that larger holes relative to width increase Kt: the gross peak stress rises because the hole concentration and the net-section reduction stack together. The practical messages are that a screw hole occupying a large fraction of the plate width, closely spaced holes, or an over-drilled hole all push the true peak stress well beyond the nominal three-times figure, and that the fatigue-critical material is the ligament between the hole edge and the plate margin, not the plate as a whole.
Quote Kt = 3 as the idealised circular-hole factor, then qualify it: it assumes the plate is wide compared with the hole and is referenced to gross stress. In a finite-width plate the gross peak-stress factor exceeds 3, and the load is funnelled through the reduced net section — so undersized plates and large or closely spaced holes concentrate stress more than the textbook value implies.
Geometric Sources of Stress Concentration
Common Geometric Stress Risers
- Screw holes in plates create Kt = 3 at hole edges
- Larger holes relative to plate width increase Kt
- Elliptical holes oriented parallel to load have lower Kt than circular
- Sharp V-notches have Kt = 5-10 depending on depth and angle
- Thread roots in screws act as sharp notches (Kt = 3-5)
- Surface scratches and machining marks create micro-notches
- Sharp corners have theoretically infinite Kt
- Abrupt cross-section changes (shoulders) are stress risers
- Step transitions worse than gradual tapers
Classification of Stress Concentrators
Classification by Geometry Type
Type 1: Holes
- Circular holes: Kt = 3 (classic Kirsch solution)
- Elliptical holes: Kt depends on aspect ratio and orientation
- Screw holes in plates are primary clinical example
Type 2: Notches
- V-notches: Kt = 5-10 based on notch angle and depth
- U-notches (rounded): Lower Kt than sharp V-notches
- Thread roots: Sharp or rounded depending on design
Type 3: Surface Defects
- Cracks: Kt approaches infinity at crack tip
- Scratches: Surface scratches act as micro-cracks
- Corrosion pits: Create local stress risers
- Typical Kt
- 3
- Clinical Example
- Screw holes in plates
- Typical Kt
- 5-10
- Clinical Example
- Poorly designed corners
- Typical Kt
- 1.2-1.5
- Clinical Example
- Well-designed transitions
- Typical Kt
- Infinite
- Clinical Example
- Surface scratches, manufacturing defects
Differential: Distinguishing Failure Mechanisms
In a viva, the examiner wants you to separate stress concentration (a geometric stress riser) from the other mechanisms it is confused with. They overlap - stress concentration is usually the initiator, fatigue the process - but the discriminators differ.
- Defining feature
- Local elastic stress rise at a geometric discontinuity
- How to tell it apart
- Geometry-dependent, material-independent; an instantaneous stress state
- Typical clinical clue
- Failure originates exactly at a hole, notch, thread root or taper edge
- Defining feature
- Progressive cracking under cyclic load below yield
- How to tell it apart
- Time/cycle-dependent process; needs a crack initiation site (often a stress riser)
- Typical clinical clue
- Beach marks on fractography; failure after weeks-months of loading
- Defining feature
- A pre-existing sharp crack, described by stress intensity factor K
- How to tell it apart
- Use K = Y sigma root(pi a), not Kt, once a real crack exists
- Typical clinical clue
- Manufacturing crack, deep scratch, or propagated fatigue crack
- Defining feature
- Micromotion plus electrochemical attack at an interface
- How to tell it apart
- Needs an interface and motion; surface pitting/oxide debris present
- Typical clinical clue
- Modular taper, plate-screw interface, fretting scars and debris
- Defining feature
- Bone resorption from load bypassing bone via a stiff implant
- How to tell it apart
- A bone remodelling phenomenon, not an implant stress riser
- Typical clinical clue
- Calcar/cortical thinning around a stiff stem, not implant breakage
- Defining feature
- Single supra-physiologic load exceeding strength
- How to tell it apart
- One event, ductile dimpling on fractography, no beach marks
- Typical clinical clue
- Fall or trauma; immediate failure, not cyclic
Management Algorithm
Complications from Stress Concentration
Clinical Manifestations of Stress Concentration Failures
- Occur at screw holes (Kt = 3) in setting of delayed/nonunion
- Fatigue crack initiates at hole edge after thousands of loading cycles
- Prevention: achieve bony union before plate fatigue life exceeded
- Occurs at thread root (stress concentrator)
- First engaged thread most common breakage site
- Modern rounded thread design reduces risk
- At geometry transitions (collar-stem junction)
- At modular junctions (head-neck taper)
- Associated with undersized stems, high activity patients
- Location
- Through screw hole
- Mechanism
- Kt = 3, fatigue crack from hole edge
- Location
- Thread root
- Mechanism
- Kt = 3-5, cyclic bending
- Location
- Geometry transition
- Mechanism
- Abrupt change + cyclic loading
Outcomes and Implant Longevity
Impact on Clinical Outcomes
- Overall plate fracture rate less than 5% with appropriate use
- Higher in delayed union (15-20%) and nonunion (25-35%)
- Proximal femur and tibial plateau high-risk locations
- Modern screws with optimized thread design: less than 1% breakage
- Higher with locking screws in comminuted fractures (2-5%)
- Usually occurs after partial union with asymmetric loading
- Well-designed implants with proper surgical technique: greater than 95% success
- Stress concentration management is integral to implant design
- Understanding principles allows prediction and prevention of failure
Clinical Monitoring and Prevention
Postoperative Surveillance
- Serial X-rays to assess fracture healing progression
- Monitor for early implant loosening or hardware prominence
- Signs of impending failure: lucency around screws, plate bending
- Protected weight-bearing until bony union achieved
- Activity restrictions in high-demand patients with large implants
- Education about importance of fracture healing timeline
- New onset pain at hardware site
- Swelling or palpable hardware prominence
- Loss of fracture reduction on imaging
Clinical Applications
Plate and Screw Failures
Plate Fracture Mechanism at Screw Holes
Fracture bending loads transmitted through plate. Stress distributed across plate cross-section.
At screw hole, local stress is 3x nominal stress (Kt = 3). Highest stress at hole edges perpendicular to plate axis.
After thousands of loading cycles, micro-crack initiates at high-stress region if fracture not healed.
Crack grows incrementally with each cycle (Paris law). Stress intensity increases as crack lengthens.
Critical crack length reached. Rapid fracture through remaining cross-section.
Screw Breakage at Thread Roots:
- Thread root is sharp notch (Kt = 3-5)
- Cyclic loading causes fatigue crack initiation
- Breakage typically at first thread engaged in bone
- Modern screws have rounded thread roots (lower Kt)
Implant Design Considerations
- Collar-to-stem junction is stress riser if transition abrupt
- Modular junctions (head-neck) have stress concentration at taper
- Stem fractures often initiate at geometry changes
- Solution: gradual tapers, polished surfaces, optimized fillet radii
- Threaded screw holes create multiple stress concentrators
- Dynamic compression plates may be slightly less prone to fatigue
- Working length affects stress distribution
Design Optimization Strategies
Strategies to Minimize Stress Concentration:
- Use fillet radii at all corners and transitions
- Avoid sharp edges and abrupt geometry changes
- Orient holes and slots optimally relative to load direction
- Gradual tapers rather than steps
- Surface polishing to remove micro-defects
- Quality control to detect manufacturing scratches
Analysis Methods for Stress Concentration
Engineering Analysis Methods
- Kirsch solution: Kt = 3 for circular hole in infinite plate under uniaxial tension
- Inglis solution: Kt = 1 + 2(a/b) for elliptical hole
- Peterson's charts: Graphical solutions for common geometries
- Computational method for complex geometries
- Mesh refinement critical near stress concentrators
- Used in modern implant design and optimization
- Strain gauges: Measure surface strain near discontinuities
- Photoelasticity: Visualize stress distribution in models
- Fatigue testing: Determine actual fatigue life under cyclic loading
Design Strategies to Minimize Stress Concentration
Fundamental Design Principles
- Add generous radii at all corners and transitions
- Larger radius = lower Kt (exponential relationship)
- Minimum radius guidelines exist for each geometry type
- Avoid abrupt cross-section changes
- Use tapers rather than steps
- Shoulder angle optimization reduces stress peaks
- Polish surfaces to remove micro-defects
- Quality control to detect manufacturing scratches
- Electropolishing for critical fatigue areas
- Mechanism
- Spreads stress over larger area
- Kt Reduction
- 50-80% reduction possible
- Mechanism
- Eliminates abrupt change
- Kt Reduction
- 30-50% reduction
- Mechanism
- Removes micro-notches
- Kt Reduction
- 10-20% improvement in fatigue life
- Mechanism
- Aligns with load direction
- Kt Reduction
- 20-30% reduction
Implant Design Applications
Plate and Screw Design
- Screw hole placement to minimize stress concentration interaction
- Working length affects stress distribution across plate
- Locking vs compression plate design differences
- Thread root radius critical for fatigue strength
- Modern screws use rounded V-thread (buttress thread superior)
- Self-tapping vs non-self-tapping thread geometry
- Empty screw holes are still stress concentrators
- Plate bending creates stress concentration at bend
- Scratches from insertion instruments create surface defects
Guidelines, Registries & Global Practice
Standards, Registries and Global Epidemiology
- ISO 7206 (hip stem and neck fatigue), ISO 14242 (THA wear simulation), ISO 14801 (dental/implant fatigue), ASTM F1820 / F2580 (modular taper, neck fatigue) - all mandate cyclic fatigue testing at geometric stress risers
- Regulatory pathways (US FDA 510(k)/PMA, EU MDR CE mark, Australia TGA, Japan PMDA) require a fatigue/stress-concentration design dossier - the requirement is global, not country-specific
- Implant breakage is rare overall but reliably flagged by national joint registries - NJR (UK), AJRR (US), AOANJRR (Australia), SHAR (Sweden), NZJR (New Zealand)
- Modular-neck stems (e.g. recalled large-taper designs) showed elevated revision for fracture/fretting in multiple registries, prompting market withdrawals
- Plate/screw fatigue failure is a recognised mode in nonunion and high-load anatomic sites (distal femur, proximal tibia)
- Plate fracture overall rate is low (a few percent) but rises sharply with delayed/nonunion and high body mass; screw breakage is uncommon with modern rounded thread roots
Controversies and Areas of Uncertainty
Locking screws add multiple threaded stress concentrators, yet locked constructs can fail more abruptly with little warning. Whether locked or dynamic compression plating is more fatigue-tolerant depends heavily on working length and bridging span - the construct geometry, not the plate type alone, drives peak stress.
Modular neck-stem junctions improve intra-operative versatility but introduce an extra taper stress concentrator vulnerable to fretting fatigue. Several large-taper designs were withdrawn after registry-flagged fractures. The balance of versatility against added failure risk remains contested.
FEA peak stress at a notch is mesh-sensitive and can diverge at a perfectly sharp corner (theoretically infinite). Whether reported "peak stress" reflects reality or mesh artefact is debated; fatigue-life prediction often relies on validated notch/critical-distance methods rather than raw peak stress.
Shot peening and electropolishing improve fatigue life by inducing compressive residual stress and removing micro-notches, but the in-vivo durability of these benefits under corrosion and fretting is not fully established.
MCQ Practice Points
Q: What does stress concentration factor (Kt) represent? A: Ratio of local peak stress to nominal stress. Kt = (σ_max local) / (σ_nominal). For circular hole, Kt = 3, meaning stress is 3x higher at hole edge.
Q: What is the stress concentration factor for a circular hole in a plate under tension? A: Kt = 3 - Local stress at hole edge is 3 times the nominal stress in the plate. This is why plates fracture at screw holes.
Q: Why are sharp corners worse than rounded corners for stress concentration? A: Sharp corners have higher Kt values (approaching infinite for perfectly sharp points). Adding fillet radius reduces Kt significantly. Larger radius = lower Kt.
Q: Does using a stronger material reduce stress concentration factor? A: No - Kt is geometry-dependent only. A steel plate and titanium plate with identical geometry have identical Kt. Material selection affects strength and fatigue limit, not Kt itself.
Q: Why do plates typically fracture at screw holes rather than between holes? A: Stress concentration (Kt ≈ 3) at screw holes creates local stress 3x higher than between holes. Fatigue crack initiates where stress is highest.
At a Glance
Stress concentration is the localized elevation of stress at geometric discontinuities, quantified by the Kt factor (local peak stress/nominal stress)—typically 3-10× higher at stress risers. A circular hole has Kt = 3, meaning stress at the hole edge is 3× higher than remote stress. Sharp corners have theoretically infinite Kt; rounding corners (fillet radii) dramatically reduces stress concentration. Clinical implications include plate fractures at screw holes (stress concentrators) and screw breakage at thread roots. Stress concentrations are crack initiation sites for fatigue failure. Design mitigation includes fillet radii, smooth transitions, surface polishing, and avoiding abrupt geometric changes.
HONSTStress Concentration Factors
Hook:Be HONEST about stress concentrations in implant design!
FILLETReducing Stress Concentration
Hook:Use FILLET radii to reduce stress concentration!
Exam Viva Scenarios
Practise clinical reasoning and management decisions out loud
“Examiner shows radiograph of fractured plate at screw hole and asks about stress concentration.”
“Examiner: 'You are designing a new hip stem. How would you minimize stress concentration to prevent fatigue fracture?'”
“Examiner: 'A cast cobalt-chrome component and a wrought titanium component have the same notch geometry. Will they fail at the same applied stress? Explain Kt versus Kf.'”
Definition and Kt Factor
- Stress concentration = local stress elevation at geometric discontinuities
- Kt = (local peak stress) / (nominal stress)
- Circular hole: Kt = 3 (stress 3x higher at edge)
- Sharp notch: Kt = 5-10+ (worse than hole)
- Kt is GEOMETRY dependent, NOT material dependent
Common Stress Concentrators
- Holes (screw holes in plates) - Kt ≈ 3
- Sharp corners and notches - Kt = 5-10+
- Thread roots (screws) - Kt = 3-5
- Cracks and scratches - Kt → infinity
- Modular junctions - taper geometry matters
Clinical Failures
- Plate fracture at screw holes (delayed union)
- Screw breakage at thread roots
- Stem fracture at geometry transitions
- All are stress concentration + fatigue
- Prevention: achieve union before fatigue damage
Mitigation Strategies
- Add fillet radii to round corners (larger radius better)
- Avoid sharp edges and abrupt changes
- Polish surfaces to remove micro-defects
- Orient holes perpendicular to loading direction
- Gradual tapers, no steps in geometry
Evidence Base
Peterson's Stress Concentration Factors
- Comprehensive reference for Kt values for virtually all geometric configurations
- Circular hole in plate: Kt = 3 under uniaxial tension
- Sharp notch: Kt = 5-10+ depending on notch angle and depth
- Fillet radius dramatically reduces Kt - charts provided for design optimization
Inglis - Stresses in a Plate Due to the Presence of Cracks and Sharp Corners
- First mathematical analysis of stress concentration around holes and cracks
- Showed elliptical hole concentrates stress at tips: Kt = 1 + 2(a/b)
- As hole approaches crack shape (b→0), Kt approaches infinity
- Foundation for fracture mechanics developed by Griffith
Failure analysis of a retrieved locking compression plate
- Retrieved LCP (AO 32-A1 femoral fracture) failed by fatigue fracture due to nonunion - metallurgy met ASTM standards (not a material defect)
- Fractography: fatigue crack originated at the narrow side of a screw hole; broad side showed final overload crack growth
- FEA: increasing plate working length (distance between innermost screws) lowered peak construct stress
- Maximum stress consistently localised at the screw hole regardless of polyaxial screw angle; -10 degrees gave the most even stress distribution
Long versus short working length distal femoral locking plates (RCT)
- Randomised controlled trial, 61 extra-articular distal femur fractures (long vs short working length titanium LCP)
- Union: 93.3% (long) versus 61.2% (short), p=0.01
- Plate breakage in 3/31 and screw breakage in 2/31 short-working-length cases; zero implant failures in the long-working-length group (p=0.0001)
- Longer working length distributes bending stress over more plate, lowering peak stress at any single screw hole
Modular neck material and assembly method affect fatigue life
- In-vitro testing reproduced the in-vivo modular neck fracture path: distal-lateral neck surface to proximal-medial taper entry (stress concentration at the taper)
- All hand-assembled Ti6Al4V necks failed at 7.0 kN; impact-assembled Ti6Al4V and all CoCrMo necks survived
- Ti6Al4V was more fatigue-susceptible than CoCrMo at the modular junction
- Impact assembly raised both fatigue life and distraction (pull-off) force
Taper junction contamination and assembly reduce junction strength
- Contamination of modular taper (bone/blood), especially with incomplete assembly, increased neck rotation (35.3 vs 2.4 degrees), micromotion (67.8 vs 5.1 micrometres) and axial subsidence (all p less than 0.001)
- Increased micromotion at the taper drives fretting corrosion and accelerates fatigue crack initiation at the stress-concentrating junction
- Need for multiple turns when tightening the locking screw flags intra-operative contamination
- Correct cleaning plus pre-tensioned assembly restored junction strength
Modular neck-stem junction breakage in total hip arthroplasty
- Reported fracture of the female (stem-side) part of a modular neck-stem Morse taper junction
- Risk factors: active, overweight male with a long varus neck (high bending moment at the taper)
- Fretting corrosion plus material fatigue at the added modular interface implicated
- Revision required extended trochanteric osteotomy and a long stem