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Dislocation After Total Hip Arthroplasty

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Complications after Primary Total Hip Arthroplasty

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Abstract

Modularity in total hip arthroplasty (THA) allows surgeons to optimize implant reconstruction to patient anatomy intraoperatively. Dual-modular femoral neck stem or “dual-taper” THA implants possess interchangeable necks, providing additional modularity at the neck stem interface. Modular taper designs have the potential to allow precise reconstruction of center of rotation of the hip by facilitating adjustments in limb length, femoral neck version, and hip offset in order to optimize hip biomechanical parameters. Recently, there is increasing concern regarding this stem design as a result of the growing numbers of clinical failures due to fretting and corrosion at neck-stem taper junction, in a process that has been described as mechanically assisted crevice corrosion (MACC). Implant, surgical, and patient factors have been identified as likely contributing factors responsible for taper corrosion in dual-modular neck stem THA. There should be a low threshold to conduct a systematic clinical evaluation of patients with dual-modular neck stem THAs as early recognition and diagnosis will ensure prompt and appropriate treatment. As painful dual-modular neck stem total hip arthroplasties have various intrinsic and extrinsic causes, patients should be evaluated utilizing systematic risk stratification algorithms. Although specialized test such as metal ion analysis and cross -sectional imaging modalities such as MARS MRI and ultrasound should be used to optimize clinical decision- making, over-reliance on any single investigative tool in the clinical decision-making process should be avoided. Further research is required to gain understanding of implant, surgical, and patient risk factors associated with taper corrosion in dual- modular neck stem THA.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr, Cleveland, OH, 44109, USA

    Glenn D. Wera MD

  2. Department of Orthopaedic Surgery, Northwestern Medicine Central DuPage Hospital, Rush University Medical Center, 25 North Winfield Road, Suite #505, Winfield, IL, 60190, USA

    Nicholas T. Ting MD

  3. Division of Adult Reconstruction, Rush University Medical Center, 1611 West Harrison, Suite 300, Chicago, IL, 60614, USA

    Nicholas T. Ting MD & Craig J. Della Valle MD

Authors
  1. Glenn D. Wera MD
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  2. Nicholas T. Ting MD
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  3. Craig J. Della Valle MD
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Correspondence to Glenn D. Wera MD .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA

    Matthew P. Abdel

  2. Division of Adult Reconstruction, Rush University Medical Center, Chicago, Illinois, USA

    Craig J. Della Valle

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Wera, G.D., Ting, N.T., Della Valle, C.J. (2017). Dislocation After Total Hip Arthroplasty. In: Abdel, M., Della Valle, C. (eds) Complications after Primary Total Hip Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-54913-2_8

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  • DOI: https://doi.org/10.1007/978-3-319-54913-2_8

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