Neck modularity in total hip arthroplasty: a retrospective study of nine hundred twenty-eight titanium neck implants with a maximum follow-up of eighteen years

Maniscalco, Pietro; Quattrini, Fabrizio; Ciatti, Corrado; Ghidoni, Laura; Ghidoni, Giuseppe; Burgio, Valeria; Pogliacomi, Francesco; Vaienti, Enrico; Ceccarelli, Francesco

doi:10.1007/s00264-020-04686-8

Cited by 16 publications

(20 citation statements)

References 27 publications

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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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Section: Discussionmentioning

confidence: 99%

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

2021

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“…On the contrary, similar outcomes were highlighted in the paper by Di Martino et al about the use of modular stems in development dysplasia of the hip [8]. As demonstrated in other papers, DT implants did not provide any consistent advantage in terms of dislocations and instability [15,16]. This is a very relevant issue, as modular implants were developed with the aim to improve soft tissue tension and hip biomechanics: theoretically, a lower rate of dislocations would have ensued [17].…”

Section: Discussionmentioning

confidence: 61%

Comparison of single taper and dual taper versions of the same stem design in total hip arthroplasty for primary osteoarthritis

et al. 2023

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Background In total hip arthroplasty (THA), the outcomes of single taper (ST) and dual taper (DT) versions of the same stem design have been scarcely studied. A registry study comparing ST and DT versions of the same stem design was designed, aiming to assess: (1) the survival rates and the hazard ratios for failure; (2) the survival rates and the hazard ratios for failure using stem-focused endpoints. Material and methods A regional arthroplasty registry was interrogated about stem designs with ST and DT versions in cementless THAs performed for primary osteoarthritis. Only the same cup and ceramic-on-ceramic bearings were included: the DT stems had a titanium-on-titanium modularity. Demographic and implant features were recorded. Survival rates and hazard ratios were evaluated and compared. Stem-focused endpoints were also investigated. Results A total of 5359 THAs were included, with three stem designs. The two versions of every stem showed different demographics and implant-related features: ST versions were preferentially implanted in heavier young men. For each stem, the two versions had similar survival rates at 5 years (p = 0.076; p = 0.319; p = 0.616) and similar adjusted hazard ratios for failures (p = 0.084; p = 0.308; p = 0.729). When stem-focused endpoints were adopted, the ST and DT versions of the three stems achieved similar survival rates (p = 0.710; p = 0.784; p = 0.983) and similar adjusted hazard ratios (p = 0.647; p = 0.858; p = 0.787). Three neck breakages occurred (0.0007% of all the modular implants). Conclusions ST and DT versions of the same stem design did not show any differences in terms of survival rates and hazard ratios for failures at 5 years. LEVEL OF EVIDENCE: IV.

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“…18,19 The registry involves 68 orthopaedic facilities. 18,19 All surgeons performing primary arthroplasty or revision surgeries are required to fill in the RIPO form, specifying the clinical condition of patients, devices (batch and code) and surgical technique (approach and fixation). The registry collects a database with a reported capture rate of 98%.…”

Section: Methodsmentioning

confidence: 99%

“…The registry collects a database with a reported capture rate of 98%. 18,19 The 2% of missing data are due to the lack of adherence. 18,19 The RIPO registry was asked about all the primary cementless THAs performed in the Emilia-Romagna region from January 2000 to December 2018.…”

Section: Methodsmentioning

confidence: 99%

Titanium modular stems in total hip arthroplasty due to developmental dysplasia: a registry comparison with single-taper implants

et al. 2022

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Introduction: The routine use of proximal femoral modularity was discouraged in total hip arthroplasties (THAs). However, titanium dual-taper (DT) implants may provide some advantages over single-taper (ST) stems in cases of complex deformity. A registry study comparing ST and DT stems in dysplasia was designed, aiming to assess: (1) survival rates at long-term; (2) reasons for revision; (3) the profile of failed implants. Methods: The arthroplasty registry RIPO was investigated for cementless THAs performed for dysplasia since 2000. ST implants were compared to titanium-on-titanium DT stems. Demographics and implant features were collected. Survival rates and reasons for revision were compared. The profile of DT stem failures in dysplasia was defined. Results: 6429 implants were included in the study, 3642 ST and 2787 DT. The demographic and implant features of the 2 cohorts were not comparable. The DT cohort achieved higher survival rates at long-term (93.9% vs. 91.6%, p = 0.018). DT implants showed a higher rate of implant breakage (0.6%, p = 0.011) and a lower rate of aseptic loosening ( p = 0.005). There were no differences in terms of revisions for dislocation. No metallosis occurred. There were more revisions in DT implants in males <65 years, with a 28-mm head size or smaller. Conclusions: Modularity did not result in lower survival rates in dysplastic patients and may even reduce the rate of aseptic loosening in comparison to ST stems. The rate of implant breakage is not negligible. Younger males are not good candidates for titanium DT stems.

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Neck modularity in total hip arthroplasty: a retrospective study of nine hundred twenty-eight titanium neck implants with a maximum follow-up of eighteen years

Cited by 16 publications

References 27 publications

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

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

Comparison of single taper and dual taper versions of the same stem design in total hip arthroplasty for primary osteoarthritis

Titanium modular stems in total hip arthroplasty due to developmental dysplasia: a registry comparison with single-taper implants

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