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Giuseppe Solarino Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy

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Giovanni Vicenti Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy

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Massimiliano Carrozzo Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy

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Guglielmo Ottaviani Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy

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Biagio Moretti Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy

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Luigi Zagra IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy

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procedure is not entirely failure-free and new designs are continually developing. 2 , 3 In the late 20th century, a new design has been introduced: the modular neck (MN) femoral stem. It is intended to give the surgeon the possibility to improve

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Michael M. Morlock TUHH Hamburg University of Technology, Hamburg, Germany.

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Robert Hube OCM Clinic Munich, Munich, Germany

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Georgi Wassilew Department for Orthopaedics and Orthopaedic Surgery, University of Greifswald, Greifswald, Germany

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Felix Prange TUHH Hamburg University of Technology, Hamburg, Germany.

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Gerd Huber TUHH Hamburg University of Technology, Hamburg, Germany.

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Carsten Perka Center for Musculoskeletal Surgery, Orthopedic Department, Charité – Universitätsmedizin Berlin, Berlin, Germany

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axis and poorly under bending loading (as in high offset stems, long heads, large heads, and especially for modular necks and revision stems). Fig. 1 Definition of the head-stem taper connection. The male stem taper geometry is defined by the

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Mattia Loppini Department of Biomedical Sciences, Humanitas University, Italy; Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy

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Guido Grappiolo Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy

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and the mean rate of stress shielding was 26.9% (5.2% to 66%) in 556 hips. 16 , 22 , 26 , 28 , 31 Metaphyseal total hip arthroplasty (METHA) The METHA (Aesculap) is an uncemented neck-retaining monoblock or modular stem ( Fig. 2 ). It is

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Hanna Wellauer Department of Orthopaedic Surgery and Traumatology, HFR Fribourg Hospital, University of Fribourg, Fribourg, Switzerland
Division of Orthopaedics and Trauma Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland

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Roman Heuberger RMS Foundation, Bettlach, Switzerland

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Emanuel Gautier Department of Orthopaedic Surgery and Traumatology, HFR Fribourg Hospital, University of Fribourg, Fribourg, Switzerland

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Moritz Tannast Department of Orthopaedic Surgery and Traumatology, HFR Fribourg Hospital, University of Fribourg, Fribourg, Switzerland

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Hubert Steinke Institute for the History of Medicine, University of Bern, Bern, Switzerland

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Peter Wahl Division of Orthopaedics and Trauma Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
Faculty of Medicine, University of Berne, Berne, Switzerland

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). The next major innovation came in 1968 by Weber, another Swiss surgeon, who designed a stem with a cylindrical connection for modular heads ( Fig. 3 ) ( 16 , 17 ). Adaptation of heads with different neck lengths provided more options for

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Mattia Loppini Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, Italy

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Francesco Manlio Gambaro Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy

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Marco di Maio Università degli Studi di Trieste, Piazzale Europa 1, Trieste, Italy

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Guido Grappiolo IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, Italy

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. Therefore, many different surgical strategies have been proposed such as stem with proximal press-fit or extended porous coating ( 6 ), monoblock or modular conical stem ( 7 , 8 ), stem combined with bone grafts ( 9 ), cemented stem, bone impaction grafting

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Catalin Cirstoiu Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Bogdan Cretu Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Sergiu Iordache Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Mihnea Popa Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Bogdan Serban Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Adrian Cursaru Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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secondary to resection and measurements for the final prosthesis. (C) Postoperative image of the resection reconstruction with a modular tapered, fluted stem. Figure 3 (A) Preoperative anterior-posterior image of the pelvis of a 68-year

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Luigi Zagra Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan Italy

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. Modularity became a major issue in the last few years. Metal-backed liners and stem-head modularity are considered a standard for implant and nowadays no one will go back to monoblock implants out of all-poly cemented cups. Exchangeable necks have been

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Ashoklal Ramavath Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK

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Jonathan N. Lamb Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
University of Leeds, Leeds, UK

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Jeya Palan Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK

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Hemant G. Pandit Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
University of Leeds, Leeds, UK

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Sameer Jain Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK

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to bypass the fracture site by a minimum of 2.5 cortical diameters. These are increasingly available as tapered isthmic fitting stems with modular body, neck and head options to allow greater flexibility when balancing leg lengths and stability. These

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Khaled M. Sarraf St Mary’s Hospital, Imperial College Healthcare Trust, London, UK

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Ravi Popat St Mary’s Hospital, Imperial College Healthcare Trust, London, UK

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Kathryn L. Kneale St Mary’s Hospital, Imperial College Healthcare Trust, London, UK

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Rajarshi Bhattacharya St Mary’s Hospital, Imperial College Healthcare Trust, London, UK

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Manoj Ramachandran The Royal London Hospital, Barts Health NHS Trust, London, UK

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Pramod Achan The Royal London Hospital, Barts Health NHS Trust, London, UK

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Sammy A. Hanna The Royal London Hospital, Barts Health NHS Trust, London, UK

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trochanter fracture ( n = 1, 0.4%), modular neck fracture ( n = 1, 0.4%) and unexplained pain ( n = 1, 0.4%). Revision rate There were 32 failures in total necessitating revision surgery in the 268 cases (11.9%). Seven hip resurfacings failed

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Alexis Nogier Service de Chirurgie Orthopédique, Clinique Trenel, Sainte-Colombe, France
Service de Chirurgie Orthopédique, Clinique Maussins-Nollet, Paris, France
Clinique Nollet, Paris, France

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Idriss Tourabaly Service de Chirurgie Orthopédique, Clinique Maussins-Nollet, Paris, France
Clinique Nollet, Paris, France

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Sonia Ramos-Pascual ReSurg SA, Nyon, Switzerland

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Jacobus H. Müller ReSurg SA, Nyon, Switzerland

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Mo Saffarini ReSurg SA, Nyon, Switzerland

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Cyril Courtin Service de Chirurgie Orthopédique, Clinique Trenel, Sainte-Colombe, France

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versatility, as most designs are available in a range of sizes, neck lengths and offsets. Custom femoral stems were introduced for selected THA patients, notably those with major anatomical deformities, 2 , 3 for which off-the-shelf implants would not be

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