The use of femoral stems with exchangeable necks in primary total hip arthroplasty increases the rate of revision

Graves, Stephen; Steiger, Richard de; Davidson, D C; Donnelly, William J.; Rainbird, Sophia; Lorimer, Michelle; Cashman, Kara; Vial, Raimundo

doi:10.1302/0301-620x.99b6.38020

Cited by 31 publications

(40 citation statements)

References 35 publications

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“…14 studies met the final criteria to be included in the systematic review. 21–34 Notably, 3 studies were excluded as they evaluated recalled implant designs. 35–37 The majority of papers included were case series ( n = 12) with the remaining two studies being national joint registry studies that included data on modular implants (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Systematic review of primary total hip arthroplasty using titanium-titanium modular-neck prostheses: the true risk of revision

et al. 2020

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Aims: Modular-neck femoral implants are used to enable more variability in femoral neck version, offset and length. It has been reported that these implants carry a higher rate of revision. The aim of this review was to assess the overall and cause-specific revision rate of titanium-titanium alloy modular-neck implants in primary total hip arthroplasty (THA). Methods: A systematic review was conducted following PRISMA guidelines and utilising multiple databases. All results were screened for eligibility. Studies published from 2000 onwards, using a current-generation, titanium-titanium, modular-neck implant were included. Overall and cause-specific revision rates were analysed, comparing to fixed-neck prostheses where applicable. Results: 920 studies were screened. After applying exclusion criteria, 23 were assessed in full and 14 included. These consisted of 12 case series and 2 joint registry analyses. 21,841 patients underwent a modular-neck implant with a weighted mean follow-up of 5.7 years, mean age of 62.4 years, and average body mass index (BMI) of 28.4kg/m2. The overall revision rate was 3.95% and 2.98% for modular and fixed-neck prostheses, respectively. For studies with >5 years follow-up the mean revision rate was 3.08%. There was no difference in cause-specific revision rates by implant design. Mean improvement in Harris Hip Score was 41.9. Conclusions: At medium-term, revision rates for titanium-titanium primary modular-neck THA are acceptable. These prostheses are a sensible management option in patients with considerable anatomical hip deformity not amenable to correction with standard fixed-neck implants. Patients of male gender, high BMI and requiring prostheses with a larger neck, offset or head are at higher risk of implant failure.

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Section: Resultsmentioning

confidence: 99%

Systematic review of primary total hip arthroplasty using titanium-titanium modular-neck prostheses: the true risk of revision

et al. 2020

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“…In THA femoral stems with modular exchangeable neck components had significantly lower 10-year survival rates in literature reviews and in registry data compared to primary THA implant survivorship for femoral mono-bloc stems [92,93].…”

Section: )mentioning

confidence: 97%

How to Proceed with Asymptomatic Modular Dual Taper Hip Stems in the Case of Acetabular Revision

Grupp

Baxmann²,

Jansson

et al. 2020

Materials

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How to proceed with a clinically asymptomatic modular Metha® Ti alloy stem with dual taper CoCr neck adapter in case of acetabular revision? To systematically answer this question the status of research and appropriate diagnostic methods in context to clinically symptomatic and asymptomatic dual taper stem-neck couplings has been evaluated based on a systematic literature review. A retrieval analysis of thirteen Metha® modular dual taper CoCr/Ti alloy hip stems has been performed and a rational decision making model as basis for a clinical recommendation was developed. From our observations we propose that in cases of acetabular revision, that for patients with a serum cobalt level of > 4 µg/L and a Co/Cr ratio > 3.6, the revision of the modular dual taper stem may be considered. Prior to acetabular revision surgery a systematic diagnostic evaluation should be executed, using specific tests such as serum metal (Co, Cr) ion analysis, plain antero-posterior and lateral radiographs and cross-sectional imaging modalities (Metal Artefact Reduction Sequence Magnetic Resonance Imaging). For an asymptomatic Metha® dual taper Ti alloy/CoCr stem-neck coupling at the stage of acetabular revision careful clinical decision making according to the proposed model should be followed and overreliance on any single examination should be avoided, considering the complete individual differential diagnosis and patient situation.

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“…The Registry evidence suggests that the continued use of femoral components with an exchangeable neck in primary THA undertaken for OA can no longer be justified. 18…”

Section: Prosthesis Outcomesmentioning

confidence: 99%

Orthopaedic registries: the Australian experience

Steiger

2019

EFORT Open Reviews

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The Australian Orthopaedic Association National Joint Replacement Registry first began data collection on 1 September 1999 and full nationwide implementation commenced in January 2003. The purpose of the Registry is to improve the quality of care for individuals receiving joint replacement surgery. The Registry enables surgeons, academic institutions, governments and industry to request specific data that are not available in published annual reports. There is an established system for identifying prostheses with a higher than anticipated rate of revision (HTARR) which was introduced in 2004. The higher rate of revision for the ASR Hip Resurfacing System was first identified by this process in 2007. There has been a reduction in revision hip and knee replacement over the years that the Registry has been in operation, and the addition of Patient Reported Outcome Measures (PROMs) and data linkage will enable more extensive analysis of joint replacement surgery in the future. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180071

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The use of femoral stems with exchangeable necks in primary total hip arthroplasty increases the rate of revision

Abstract: There appears to be little evidence to support the continued use of prostheses with an exchangeable neck in primary THA undertaken for OA. Cite this article: 2017;99-B:766-73.

Cited by 31 publications

References 35 publications

Systematic review of primary total hip arthroplasty using titanium-titanium modular-neck prostheses: the true risk of revision

Systematic review of primary total hip arthroplasty using titanium-titanium modular-neck prostheses: the true risk of revision

How to Proceed with Asymptomatic Modular Dual Taper Hip Stems in the Case of Acetabular Revision

Orthopaedic registries: the Australian experience

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