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Fracture of the neck piece of a bi-modular hip stem. All the above-mentioned products failed despite intensive laboratory testing and the approval of regulatory competent authorities either in the US or in Europe. Failures despite fulfilling all
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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components, modular stem or polyethylene disassociations, or glenoid screw problems. 19 Meanwhile, they defined a ‘problem’ as an intraoperative or postoperative event that was not likely to affect the patient’s final outcome. They considered these to
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, especially in modular hip revisions stems, that elevated mechanical load on the components can lead to fracture of the taper connection. Other causes of mechanical failure (i.e. high offset, short proximal component, lack of adequate medial bone supporting
Department of Surgery, Albany Health Campus, Albany, Australia
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Department of Surgery, Université de Montréal, Montréal, Québec, Canada
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shell. The majority of movement occurs at the small articulation. 4 Movement of the large articulation only happens when the stem’s neck comes into contact with the polyethylene head. Wear can occur at three interfaces: the small and large bearing
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various head/neck junctions and CoCr dual modular neck (DMN), in two types coupled with a TMZF (Ti, Mo, Zr, Fe) stem. 20 , 23 – 29 This body of work for hip implants can also be applied to all other joint replacements with metallic junctions. The
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(2°) and distances (1 mm), 60 has been used to plan THAs with stems featuring modular neck designs. However, these components have been proven to perform poorly in a number of material and design combinations. 61 , 62 Studies so far have
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, as it was initially glued or screwed on the stem. 21 Later, modularity of the acetabulum allowed secure fixation of the Al insert by conical sleeving in a metallic shell ( Fig. 1 ). Finally, in 1995, the introduction of hot isostatic pressing
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months. Aseptic loosening rates for short-stemmed THA are double compared with conventional stems at ten years (2.7% compared with 1.3%). However, revision rates vary according to the type of implant. Femoral stems with modular necks show a double
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NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
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NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
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tapered fluted modular titanium stem (TFMT) 41 , 77 , 78 +/- adjuvant fixation (cables, plates, struts) if advocated. Revision arthroplasty of the acetabular component might take please if required. Cemented stems can also be used, usually for the
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THA initially concerned raised blood cobalt and chromium ions, 27 loosening of components, 28 soft-tissue reactions around the hip 29 and osteolysis. 30 Wear at the ball and socket interface as well as modularity at the head—neck