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Type: Journal article
Title: The use of femoral stems with exchangeable necks in primary total hip arthroplasty increases the rate of revision
Author: Graves, S.
de Steiger, R.
Davidson, D.
Donnelly, W.
Rainbird, S.
Lorimer, M.
Cashman, K.
Vial, R.
Citation: Bone and Joint Journal, 2017; 99B(6):766-773
Publisher: British Editorial Society of Bone and Joint Surgery
Issue Date: 2017
ISSN: 2049-4408
Statement of
S. E. Graves, R. de Steiger, D. Davidson, W. Donnelly, S. Rainbird, M. F. Lorimer, K. S. Cashman, R. J. Vial
Abstract: Aims: Femoral stems with exchangeable (modular) necks were introduced to offer surgeons an increased choice when determining the version, offset and length of the femoral neck during total hip arthroplasty (THA). It was hoped that this would improve outcomes and reduce complications, particularly dislocation. In 2010, the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) first reported an increased rate of revision after primary THA using femoral stems with an exchangeable neck. The aim of this study was to provide a more comprehensive up-to-date analysis of primary THA using femoral stems with exchangeable and fixed necks. Materials and Methods: The data included all primary THA procedures performed for osteoarthritis (OA), reported to the AOANJRR between 01 September 1999 and 31 December 2014. There were 9289 femoral stems with an exchangeable neck and 253 165 femoral stems with a fixed neck. The characteristics of the patients and prostheses including the bearing surface and stem/neck metal combinations were examined using Cox proportional hazard ratios (HRs) and Kaplan-Meier estimates of survivorship. Results: It was found that prostheses with an exchangeable neck had a higher rate of revision and this was evident regardless of the bearing surface or the size of the femoral head. Exchangeable neck prostheses with a titanium stem and a cobalt-chromium neck had a significantly higher rate of revision compared with titanium stem/titanium neck combinations (HR 1.83, 95% confidence interval 1.49 to 2.23, p < 0.001). Revisions were higher for these combinations compared with femoral stems with a fixed neck. Conclusion: There appears to be little evidence to support the continued use of prostheses with an exchangeable neck in primary THA undertaken for OA. Cite this article: Bone Joint J 2017;99-B:766-73.
Keywords: Osteoarthritis, Hip
Rights: © 2017 The British Editorial Society of Bone & Joint Surgery
RMID: 0030080880
DOI: 10.1302/0301-620X.99B6.38020
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