Hip Pelvis.  2018 Sep;30(3):147-155. 10.5371/hp.2018.30.3.147.

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

• Park CW
• Lim SJ
• Park YS

• KMID: 2419509
• DOI: http://doi.org/10.5371/hp.2018.30.3.147

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.

Keyword

Hip replacement arthroplasty; Modular stem

MeSH Terms

Arthroplasty, Replacement, Hip*
Femur
Hip
Joints
Pliability
Prostheses and Implants
Surgeons

Figure

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  Fig. 1 Stems with modular necks. (A) M/L Kinective stem (Courtesy of Zimmer Orthopaedics, Warsaw, IN, USA). (B) Rejuvenate prosthesis (Courtesy of Stryker Orthopaedics, Mahwah, NJ, USA).

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  Fig. 2 Prosthesis with mid-stem modularity. (A) Restoration modular stem (Courtesy of Stryker Orthopaedics, Mahwah, NJ, USA). (B) Revitan revision stem (Courtesy of Zimmer Orthopaedics, Warsaw, IN, USA).

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  Fig. 3 Implants with modular proximal sleeves. (A) Modified Sivash stem. (B) S-ROM modular stem (Courtesy of DePuy Orthopaedics, Warsaw, IN, USA).

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  Fig. 4 (A) Preoperative anteroposterior radiograph of a 40-year-old woman with Crowe type IV developmental dysplasia of the hip. (B) Total hip arthroplasty with 2-cm shortening and 40° derotation osteotomy combined with a modular stem.

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  Fig. 5 A 41-year old female patient with septic hip sequelae. (A) High-riding hip center and femur with a narrow canal diameter on preoperative anteroposterior radiograph. (B) Severely deformed proximal femur missing its head viewed using three-dimensional computed tomography. (C) Total hip arthroplasty using modular stem with narrow diameter and small medial offset. Cerclage wiring was performed after extended trochanteric osteotomy and subtrochanteric shortening osteotomy.

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  Fig. 6 A patient with severe infection sequelae showing (A) multiple scars of draining sinus and (B) contracted peri-capsular structures and atrophic abductor muscles on axial view of preoperative magnetic resonance imaging.

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  Fig. 7 (A) Preoperative anteroposterior view of a 42-year old man with multiple epiphyseal dysplasia. Both femurs have large and flat femoral heads with decreased horizontal offsets. (B) Five years after simultaneous bilateral total hip arthroplasty with S-ROM modular stems.

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  Fig. 8 (A, B) Preoperative radiographs of a 53-year old male patient who underwent Sugioka osteotomy for osteonecrosis of the femoral head 11 years before. (C) Previous implant removal was followed by bilateral total hip arthroplasty with modular stems.

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