Modular Stems: Advantages and Current Role in Primary Total Hip Arthroplasty

Abstract

Using modular femoral stems in total hip arthroplasty enables surgeons to make fine adjustments to individual joints and offers intraoperative flexibility. The concept of modularity has been developed in numerous shapes, resulting in a vast range of options. Among them, the greatest achievement has been made for prostheses with modular proximal sleeves. The use of these implants has resulted in excellent mid- to long-term results in a number of cases. Although the use of tapered stems with a broaching technique is gaining popularity in straightforward primary surgeries, modular femoral implants are still associated with a number of potential challenges (e.g., developmental dysplasia of the hip, infection sequelae, and skeletal dysplasia). Based on published results, it is advisable to consider it as an option for complicated cases where the proximal femur is severely deformed.

Total Hip Arthroplasty With Subtrochanteric Shortening Osteotomy in Patients With High Hip Dislocation Secondary to Childhood Septic Arthritis: A Matched Comparative Study With Crowe IV Developmental Dysplasia

“…Highly dislocated hips after childhood infection are generally associated with severe anatomic distortion, which makes it difficult to identify exact anatomic structures and locations of the original hip centers [5,22,38]. Severe adhesions surrounding the joint are often the results of previous arthrotomy or draining of sinus tracks [14]. In this situation, extensive soft tissue release is necessary for surgical exposure and manipulation of the implants.…”

“…There were 12 men (12 hips, 19.3%) and 46 women (48 hips, 80.7%) with a mean age of 41.3 (range 16-69) years. The mean body mass index was 22.9 kg/ m 2 (range 15.8-35.1), and the mean duration of follow-up was 12.3 years (range [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Direct Anterior Approach in Crowe Type III‐IV Developmental Dysplasia of the Hip: Surgical Technique and 2 years Follow‐up from Southwest China

“…A standard proximal broaching and distal reaming process is performed according to the instructions of the modular component 8,11 . Two pitfalls should be mentioned here: one is that the successful implantation of a modular femoral prosthesis such as the S-rom always requires more elevation and lateral translation of the proximal femur than that of a regular stem.…”

“…Although there are well-established concepts and practices for regular DAA, high-dislocated DDH, defined as type III-IV in the Crowe system 4 , is typically considered the true contraindication for DAA because of considerable challenges and controversies caused by factors such as multiple planar deformities 5 , complex lumbar-pelvis-hip pathology 6 , special reconstruction and correction techniques 7 , and modular stem implant difficulties 8 . However, there is a high demand for DAA in our patients diagnosed with Crowe type III-IV DDH, which motivated our exploration of this unknown area, despite very few studies and instructions being available and scant evidence that supports the currently claimed outcome.…”

Evaluation of pull‐off strength and seating displacement of sleeved ceramic revision heads in modular hip arthroplasty

“…Modular hip implants have been used for the treatment of hip osteoarthritis since the 1970s . Modularity at the head‐taper junction provides surgeons the flexibility to select different femoral head materials, diameters, and length offsets to best meet their patient's needs.…”