Background: As lifelong sports participation increases, degenerative cervical disorders are becoming more relevant in older athletes. However, postoperative implant-related complications in highly active elderly swimmers have rarely been reported. Aim: To report a case of implant failure following occipitocervical fixation for atlantoaxial subluxation in a masters swimmer and discuss possible contributing factors. Methods: An 80-year-old male masters swimmer presented with bilateral hand numbness, upper-extremity weakness, impaired dexterity, hyperreflexia, and spastic gait. Dynamic radiographs demonstrated atlantoaxial instability, and CT myelography revealed spinal cord compression at the C1 level. Because conservative treatment with a cervical collar failed and gait disturbance progressed, posterior occipitocervical fixation from the occiput to C3 with bone grafting was performed. Results: Postoperatively, neurological symptoms improved and the patient was discharged with a cervical collar. He resumed swimming within a few months after surgery despite instructions to avoid neck rotation. At 3 months postoperatively, bilateral C3 screw breakage was identified. However, he remained asymptomatic, and no alignment deterioration was observed. After discontinuing crawl swimming and limiting activity to water walking, he showed a favorable clinical course. At 2.5 years postoperatively, partial bony fusion was present, alignment was maintained, gait was independent, and upper-extremity symptoms had improved. Conclusions: In this case, implant failure was likely associated with stress concentration at the distal end of the fixation construct and repetitive cervical motion during swimming, resulting in metal fatigue. Even in elderly patients, high physical activity should be carefully considered when planning postoperative rehabilitation and return-to-sport guidance.
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