Adverse Clinical Outcomes in a Primary Modular Neck/Stem System

Restrepo, Camilo; Ross, David B.; Restrepo, Santiago; Heller, Snir; Goyal, Nitin; Moore, R. W.; Hozack, William J.

doi:10.1016/j.arth.2014.01.040

Cited by 41 publications

(23 citation statements)

References 28 publications

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“…Subsequently, a type II voluntary recall was initiated by the manufacturer, Stryker Orthopedics in July 2012 [2]. A similar modular dual taper stem, the ABG II was also recalled at the same time for similar increased risk of revision [11].…”

Section: Discussionmentioning

confidence: 99%

Short-Term Metal Ion Trends Following Removal of Recalled Modular Neck Femoral Stems

Barlow

Assini

Boles

et al. 2015

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

Short-Term Metal Ion Trends Following Removal of Recalled Modular Neck Femoral Stems

Barlow

Assini

Boles

et al. 2015

The Journal of Arthroplasty

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“…However, reports of complications at the neck-stem junction are generating increasing concern [1][2][3][4][5][6]. In addition, registry data indicate higher revision rates compared to standard implants without neck-stem modularity [7].…”

Section: Introductionmentioning

confidence: 99%

Adverse tissue reaction to corrosion at the neck-stem junction after modular primary total hip arthroplasty

Gkagkalis¹,

Mettraux²,

Omoumi³

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

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Complications related to the neck-stem junction of modular stems used for total hip arthroplasty (THA) are generating increasing concern. A 74-year-old male had increasing pain and a cutaneous reaction around the scar 1 year after THA with a modular neck-stem. Imaging revealed osteolysis of the calcar and a pseudo-tumour adjacent to the neck-stem junction. Serum cobalt levels were elevated. Revision surgery to exchange the stem and liner and to resect the pseudo-tumour was performed. Analysis of the stem by scanning electron microscopy and by energy dispersive X-ray and white light interferometry showed fretting corrosion at the neck-stem junction contrasting with minimal changes at the head-neck junction. Thus, despite dry assembly of the neck and stem on the back table at primary THA, full neck-stem contact was not achieved, and the resulting micromotion at the interface led to fretting corrosion. This case highlights the mechanism of fretting corrosion at the neck-stem interface responsible for adverse local tissue reactions. Clinical and radiological follow-up is mandatory in patients with dual-modular stems.

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“…However, they also have been reported to result in adverse effects, including fretting, corrosion, implant failure, metallic wear debris generation [10, 19, 27, 30, 46], and local tissue reaction [10, 24, 29, 51]. Whether they result in a net improvement to or impairment of reconstructive survivorship remains controversial [8, 13, 14, 34, 50, 52].…”

Section: Introductionmentioning

confidence: 99%

Exchangeable Femoral Neck (Dual-Modular) THA Prostheses Have Poorer Survivorship Than Other Designs: A Nationwide Cohort of 324,108 Patients

Colas

Allalou

Poichotte

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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BackgroundExchangeable neck stems, defined as those with a dual taper (that is, a modular junction between the femoral head and the femoral neck and an additional junction between the neck and the stem body), were introduced in THA to improve restoration of joint biomechanics (restoring anteversion, offset, and limb length) and reduce the risk of dislocation. However exchangeable necks have been reported to result in adverse effects such as stem fractures and acute local tissue reaction. Whether they result in a net improvement to or impairment of reconstructive survivorship remains controversial.Questions/Purposes(1) To compare the prosthetic survivorship and all-cause revision risk of exchangeable femoral neck THAs versus fixed neck THAs, taking known prosthetic revision risk factors into account; and (2) to compare the cause-specific revision risk of exchangeable femoral neck THAs versus fixed neck THAs, adjusting for known prosthetic risk factors.MethodsUsing French national health-insurance databases, we identified all French patients older than 40 years who underwent primary THA from 2009 through 2012. To ensure accuracy of the data, we considered only beneficiaries of the general insurance scheme (approximately 77% of the population). Characteristics of the prosthesis and the patients receiving an exchangeable femoral neck THA were compared with those receiving a fixed femoral neck THA (defined as femoral stem with only the head being exchangeable). Revision was the event of interest. Followup started on the date the THA was performed, until the patient experienced revision, died, was lost to followup, or until the followup period ended (December 31, 2014), whichever came first. Competing risk THA survivorship was calculated and compared (purpose 1), as were cause-specific Cox regression models (purpose 2). The study cohort included 324,108 individuals with a mean age of 77 years. A total of 24% underwent THA for acute trauma, and 3% of the group received an exchangeable neck THA. During the median 45-month followup (mean, 42 months; minimum, 1 day; maximum, 6 years), 11,968 individuals underwent prosthetic revision.ResultsThe cumulative revision incidence was 6.5% (95% CI, 5.8%–7.3%) for exchangeable neck THAs versus 4.7% (95% CI, 4.6%–4.8%) for fixed neck THAs (p < 0.001). After controlling for potential confounding variables including age, sex, comorbidities, indication for THA, cementation, bearing surface, and the characteristics of the center where the implantation was performed, we found that the exchangeable femoral neck THA was associated with an increased hazard ratio (HR) of revision of 1.26 (95% CI, 1.14–1.38; p < 0.001) compared with the fixed neck THA. When dealing with cause-specific revision, exchangeable neck THAs had a higher incidence of revision for implant failure or periprosthetic fracture, and for mechanical complications; adjusted HRs were, respectively, 1.68 (95% CI, 1.24–2.27; p < 0.001) and 1.27 (95% CI, 1.13–1.43; p < 0.001), for exchangeable neck THAs compared with fixed ones.C...

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Adverse Clinical Outcomes in a Primary Modular Neck/Stem System

Cited by 41 publications

References 28 publications

Short-Term Metal Ion Trends Following Removal of Recalled Modular Neck Femoral Stems

Short-Term Metal Ion Trends Following Removal of Recalled Modular Neck Femoral Stems

Adverse tissue reaction to corrosion at the neck-stem junction after modular primary total hip arthroplasty

Exchangeable Femoral Neck (Dual-Modular) THA Prostheses Have Poorer Survivorship Than Other Designs: A Nationwide Cohort of 324,108 Patients

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