Modular Fluted Titanium Stems in Revision Hip Arthroplasty.

Abstract

➤ Modular fluted titanium stems have become the implant of choice for most femoral component revisions as they have a lower risk of subsidence, thigh pain, femoral fracture, and stress shielding compared with previously used extensively coated cobalt-chromium stems.➤ Modularity of the femoral component allows for optimal and independent fit and fill of the proximal and distal femoral segments, permitting immediate axial and rotational stability in shorter diaphyseal segments (<4 cm of scratch fit), thus reducing the risk of subsidence. Modularity also allows for independent adjustment of version of the proximal body relative to the distal stem, thus improving joint stability. The ability to make small adjustments in vertical and lateral offset further reduces the potential for instability and leg-length discrepancy, and the use of a titanium implant minimizes the risk of stress shielding compared with cobalt-chromium stems.➤ In several retrospective case series, excellent mid-term to long-term outcomes and low complication rates have been observed with the use of modular fluted titanium stems in femoral revisions.➤ The major disadvantages to the routine use of modular fluted titanium stems are the potential for taper junction failure (corrosion or fracture) and the increased cost of these stems compared with nonmodular stems.