Cementless modular neck stems: are they a safe option in primary total hip arthroplasty?

Pelayo-de-Tomás, José Manuel; Rodrigo-Pérez, J.L.; Novoa-Parra, C.D.; Lizaur-Utrilla, Alejandro; Morales-Suárez-Varela, María; Blas-Dobón, José Antonio

doi:10.1007/s00590-017-2071-0

Cited by 13 publications

(7 citation statements)

References 35 publications

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“…Five studies 24 , 26 , 31 , 41 , 42 reported cobalt and chromium ion serum levels in ng/ml, that are summarized in Table 4 . Only one paper 41 evaluated systemic metal ion levels in a homogenous series of patients after implantation of a mixed-alloy modular neck hip prosthesis (Symbios SPS, Ti stems coupled to Co-Cr necks) compared to those of two control groups: a group of patients having received the non-modular neck version of the same stem (Ti6Al4V) and a group of patients without any metal implant.…”

Section: Resultsmentioning

confidence: 99%

Modular neck stems in total hip arthroplasty: current concepts

et al. 2021

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Modular neck (MN) implants can restore the anatomy, especially in deformed hips such as sequelae of development dysplasia. Early designs for MN implants had problems with neck fractures and adverse local tissue, so their use was restricted to limited indications. Results of the latest generation of MN prostheses seem to demonstrate that these problems have been at least mitigated. Given the results of the studies presented in this review, surgeons might consider MN total hip arthroplasty (THA) for a narrower patient selection when a complex reconstruction is required. Long MN THA should be avoided in case of body mass index > 30, and should be used with extreme caution in association with high offset femoral necks with long or extra-long heads. Cr-Co necks should be abandoned, in favour of a titanium alloy connection. Restoring the correct anatomic femoral offset remains a challenge in THA surgeries. MN implants have been introduced to try to solve this problem. The MN design allows surgeons to choose the appropriate degree and length of the neck for desired stability and range of motion. Cite this article: EFORT Open Rev 2021;6:751-758. DOI: 10.1302/2058-5241.6.200064

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Section: Resultsmentioning

confidence: 99%

Modular neck stems in total hip arthroplasty: current concepts

et al. 2021

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“…In recent years, some studies have reported satisfactory results using dual modular stems in primary THAs [ 106 , 107 , 108 ]. Specific dual modular stems offer a better reconstruction of hips that deviate from standard anatomy when compared to a monoblock arthroplasty system with different offset options [ 109 ].…”

Section: Discussionmentioning

confidence: 99%

Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches

2021

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Titanium (Ti) alloys have been proven to be one of the most suitable materials for orthopaedic implants. Dual modular stems have been introduced to primary total hip arthroplasty (THA) to enable better control of the femoral offset, leg length, and hip stability. This systematic review highlights information acquired for dual modular Ti stem complications published in the last 12 years and offers a conclusive discussion of the gathered knowledge. Articles referring to dual modular stem usage, survivorship, and complications in English were searched from 2009 to the present day. A qualitative synthesis of literature was carried out, excluding articles referring solely to other types of junctions or problems with cobalt-chromium alloys in detail. In total, 515 records were identified through database searching and 78 journal articles or conference proceedings were found. The reasons for a modular neck fracture of a Ti alloy are multifactorial. Even though dual modular stems have not shown any clinical benefits for patients and have been associated with worse results regarding durability than monolithic stems, some designs are still marketed worldwide. Orthopaedic surgeons should use Ti6Al4V dual modular stem designs for primary THA in special cases only.

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“…There were 25 case reports 16–40 and 7 clinical studies. 5,7,41–45 Figure 1 demonstrates the study selection process based on PRISMA guidelines. 2 authors independently assessed the potential risk of bias of the included clinical studies based on MINORS criteria.…”

Section: Resultsmentioning

confidence: 99%

“…3 out of 7 were considered as low risk of bias, 7,43,45 while 4 out of 7 as high risk of bias. 5,41,42,44 The latter was considered as high due to retrospective design, inadequate blinding of endpoints and low rate of patients.…”

Section: Resultsmentioning

confidence: 99%

Fracture of femoral neck in modular total hip arthroplasty: a systematic review of the literature

Solou,

Panagopoulos,

Tatani

et al. 2023

HIP International

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Background: Modular femoral stems have the advantage of anatomic hip reconstruction by restoring the femoral offset thus minimising the bearing surface wear, implant loosening and dislocation. Aim: This study aims to investigate the existing literature on modular neck fractures, to identify predisposing factors and guide the decision-making process in the management of these difficult cases. Methods: A systematic literature review was conducted until July 2022. PRISMA guidelines were followed, eligibility criteria were set, and methodology assessment of included studies was conducted based on MINORS criteria, size and primary outcome. Data were extracted and analysed thoroughly. Results: 5657 studies were initially screened; the full texts of 124 records were assessed and finally, 32 reports were included. There were 7 clinical studies and 25 case reports. A total of 4825 patients (5204 hips) with a mean age 62.38 years and a mean BMI 29.06 kg/m2 were analysed in the 7 clinical studies. The reported overall weighted revision rate was 0.86%, while the weighted mean modular neck fracture rate was 0.26%. The usual history was sudden experience of hip pain and instability. The average time interval to neck fracture was 4.57 (range 3–4.7) years and a long modular neck was identified in 91.17% of them. Data from case reports showed a mean age and average BMI of 55.85 and 31.63 kg/m2. 82.35% of the patients were male. Necks were fractured after an average time interval of 64.5 ± 8.8 months. Conclusions: The incidence of modular neck fracture is significant. The profile of a male, obese patient with a long modular neck increased risk of neck fracture. Microstructural investigation of the retrieved implants demonstrated a higher incidence of fracture line in the base of the neck junction and at its anterolateral distal part. Surgeons should be aware of this complication while using or revising such protheses.

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Cementless modular neck stems: are they a safe option in primary total hip arthroplasty?

Cited by 13 publications

References 35 publications

Modular neck stems in total hip arthroplasty: current concepts

Modular neck stems in total hip arthroplasty: current concepts

Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches

Fracture of femoral neck in modular total hip arthroplasty: a systematic review of the literature

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