15-year Survivorship of a Unique Dual-modular Femoral Stem in Primary Hip Arthroplasty

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2024 Apr 22

PMID 38649874

Authors

David F Scott

Kade Eppich

Edin Mehic

Celeste Gray

Crystal Lederhos Smith

Michael Johnston

Affiliations

Soon will be listed here.

Abstract

Background: Hip offset, version, and length are interdependent femoral variables which determine stability and leg length. Balancing these competing variables remains a core challenge in hip arthroplasty. The potential benefits of modular femoral stems have been overshadowed by higher rates of failure. The objective of this study was to assess the survivorship of a unique dual-modular femoral stem at an average 15-year follow-up period.

Methods: The records of all patients with osteoarthritis who underwent primary total hip arthroplasty with this device between 2004-2009 were reviewed. There were no exclusions for BMI or other factors. We examined the data with Kaplan-Meier survival analysis. The primary endpoint for survival was mechanical failure of the modular neck-body junction.

Results: The survivorship of this device in 172 subjects was 100% with none experiencing mechanical failure of the modular junction at an average of 15 years. 60 patients died of causes unrelated to their THA and 9 patients were lost to follow-up. There were three early (≤ 12 months) dislocations (1.7%), and seven total dislocations (4.1%). 16 patients underwent reoperations during the follow-up period, none for any complication of the modular junction. Radiographic results showed well-fixed femoral stems in all cases. There were no leg length discrepancies of greater than 10 mm, and 85% were within 5 mm.

Conclusion: There were no mechanical failures of the modular junction in any of the subjects over the average 15-year period, demonstrating that this dual-modular design is not associated with increased failure rates. We achieved a 1.7% early dislocation rate and a 4.1% total dislocation rate without any clinically significant leg length discrepancies.

References

Desai A, Dramis A, Board T . Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med. 2013; 6(4):336-41. PMC: 4094096. DOI: 10.1007/s12178-013-9180-0. View

Samuel L, Sultan A, Rabin J, Surace P, Yao B, Moskal J . Medical Malpractice Litigation Following Primary Total Joint Arthroplasty: A Comprehensive, Nationwide Analysis of the Past Decade. J Arthroplasty. 2019; 34(7S):S102-S107. DOI: 10.1016/j.arth.2019.02.066. View

Benazzo F, Rossi S, Cecconi D, Piovani L, Ravasi F . Mid-term results of an uncemented femoral stem with modular neck options. Hip Int. 2010; 20(4):427-33. DOI: 10.1177/112070001002000403. View

Mihalko W, Wimmer M, Pacione C, Laurent M, Murphy R, Rider C . How have alternative bearings and modularity affected revision rates in total hip arthroplasty?. Clin Orthop Relat Res. 2014; 472(12):3747-58. PMC: 4397767. DOI: 10.1007/s11999-014-3816-2. View

Lanting B, Teeter M, Vasarhelyi E, Ivanov T, Howard J, Naudie D . Correlation of corrosion and biomechanics in the retrieval of a single modular neck total hip arthroplasty design: modular neck total hip arthroplasty system. J Arthroplasty. 2014; 30(1):135-40. DOI: 10.1016/j.arth.2014.06.009. View

Ellman M, Levine B . Fracture of the modular femoral neck component in total hip arthroplasty. J Arthroplasty. 2011; 28(1):196.e1-5. DOI: 10.1016/j.arth.2011.05.024. View

Kwon Y, Fehring T, Lombardi A, Barnes C, Cabanela M, Jacobs J . Risk stratification algorithm for management of patients with dual modular taper total hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons and the Hip Society. J Arthroplasty. 2014; 29(11):2060-4. DOI: 10.1016/j.arth.2014.07.029. View

Meneghini R, Hallab N, Jacobs J . Evaluation and treatment of painful total hip arthroplasties with modular metal taper junctions. Orthopedics. 2012; 35(5):386-91. DOI: 10.3928/01477447-20120426-03. View

Patel A, Bliss J, Calfee R, Froehlich J, Limbird R . Modular femoral stem-sleeve junction failure after primary total hip arthroplasty. J Arthroplasty. 2008; 24(7):1143.e1-5. DOI: 10.1016/j.arth.2008.09.006. View

10.

Eslam Pour A, Schwarzkopf R, Patel K, Anjaria M, Lazennec J, Dorr L . Is Combined Anteversion Equally Affected by Acetabular Cup and Femoral Stem Anteversion?. J Arthroplasty. 2021; 36(7):2393-2401. PMC: 8197737. DOI: 10.1016/j.arth.2021.02.017. View

11.

Ogawa T, Takao M, Hamada H, Sakai T, Sugano N . Soft tissue tension is four times lower in the unstable primary total hip arthroplasty. Int Orthop. 2018; 42(9):2059-2065. DOI: 10.1007/s00264-018-3908-9. View

12.

Girard J, Lavigne M, Vendittoli P, Roy A . Biomechanical reconstruction of the hip: a randomised study comparing total hip resurfacing and total hip arthroplasty. J Bone Joint Surg Br. 2006; 88(6):721-6. DOI: 10.1302/0301-620X.88B6.17447. View

13.

Sotereanos N, Sauber T, Tupis T . Modular femoral neck fracture after primary total hip arthroplasty. J Arthroplasty. 2012; 28(1):196.e7-9. DOI: 10.1016/j.arth.2012.03.050. View

14.

Sculco P, Austin M, Lavernia C, Rosenberg A, Sierra R . Preventing Leg Length Discrepancy and Instability After Total Hip Arthroplasty. Instr Course Lect. 2016; 65:225-41. View

15.

Sariali E, Klouche S, Mouttet A, Pascal-Moussellard H . The effect of femoral offset modification on gait after total hip arthroplasty. Acta Orthop. 2014; 85(2):123-7. PMC: 3967252. DOI: 10.3109/17453674.2014.889980. View

16.

Turley G, Griffin D, Williams M . Effect of femoral neck modularity upon the prosthetic range of motion in total hip arthroplasty. Med Biol Eng Comput. 2014; 52(8):685-94. PMC: 4102828. DOI: 10.1007/s11517-014-1171-9. View

17.

Duwelius P, Hartzband M, Burkhart R, Carnahan C, Blair S, Wu Y . Clinical results of a modular neck hip system: hitting the "bull's-eye" more accurately. Am J Orthop (Belle Mead NJ). 2011; 39(10 Suppl):2-6. View

18.

Loiba V, Stucinskas J, Robertsson O, Wingstrand H, Tarasevicius S . The analysis of posterior soft tissue repair durability after total hip arthroplasty in primary osteoarthritis patients. Hip Int. 2015; 25(5):420-3. DOI: 10.5301/hipint.5000232. View

19.

Miki H, Sugano N . Modular neck for prevention of prosthetic impingement in cases with excessively anteverted femur. Clin Biomech (Bristol). 2011; 26(9):944-9. DOI: 10.1016/j.clinbiomech.2011.05.016. View

20.

Bokshan S, Ruttiman R, DePasse J, Eltorai A, Rubin L, Palumbo M . Reported Litigation Associated With Primary Hip and Knee Arthroplasty. J Arthroplasty. 2017; 32(12):3573-3577.e1. DOI: 10.1016/j.arth.2017.07.001. View