Aim: To calculate the incidence and timing of metal failure in endoprostheses used for bone tumour reconstructions and to analyse the mode of failure.

Methods: A retrospective analysis was performed on 468 endoprostheses with an average follow-up of 50 months. The explanted prostheses were studied to determine the mode of failure and the design and material features that might have contributed to the failure.

Results: There were 18 mechanical failures of metal. A total of 19 cases were revised for loosening one of which was noted to have a metal fracture pending at the time of the revision. There were three cases of failure of the coupling between components of modular systems. All of the remaining cases (16) were in the lower limb and these failed by fracture of the metal. The fractures occurred at an average of 92 months. The majority of the fractures that were seen were simple fatigue fractures but in three cases other types of failure were also involved. There were no fatigue fractures in forged cobalt chrome components. Fatigue fracture of the cast cobalt chrome implants could always be attributed to a local stress riser or a local area of high stress due to features of the design. Fatigue fractures of titanium implants were often related to notching.

Discussion: The large skeletal defects left by resection of bone tumours can often be reconstructed with endo-prostheses. The mechanical demands on these implants are great resulting in a relatively high incidence of metal failure. Improvements in design and materials can minimise these failures.