La modularità nella chirurgia di revisione

Abstract

The increasing number of joint replacement revision surgeries due to the growth of primary implants has led, regarding the femur, to the development of different kinds of stems, cemented or noncemented, with different indications. Technical considerations and bone defects together with the stability of the implant to be revised—stem, socket or both—, need for ETO or not, general concerns about patient age, low demanding, comorbidities, need to be kept in mind. Modular cemented stems are indicated in selected cases and lead to good results, allowing for less invasive surgery. Considering cementless stems, the modular revision implants, with modular necks, proximal parts and different lengths of distal stems, allow for customisation of the implant that may not be attained with other monoblock revision stems. The aim of modular implants is to minimise the typical complications of revision surgery, which include instability, stem subsidence, periprosthetic intraoperative fracture, allowing for better biomechanics and adaptation to patient anatomy. The possibility of fretting corrosion in combination with a long learning curve concerning their use are the main disadvantages of this modularity.