Outcomes of neck modularity in total hip arthroplasty: an Italian perspective

  • R. Papalia
  • A. Di MartinoEmail author
  • A. Caldaria
  • B. Zampogna
  • V. Denaro



The aim of this study is to conduct a systematic review of clinical outcomes and complications of modular neck THA among Italian cohorts.


Only reviewed publications focused on Italian cohort patients in English language were considered for inclusion. Studies were included if they involved patients who underwent total hip replacement surgery with modular necks, and reported aetiology or survival rate or bone stability or clinical scores or complications.


The studies included in our search reported data on 3714 patients and 3856 hips. Most of the studies were from high-volume surgery centres. The most frequent diagnosis was osteoarthritis that occurred in 2910 cases (75.9%). The average survival rate and average bone stability were 97.20% and 99.37%, respectively. The average HHS improved from 42.1 prior to surgery to 89.52 after surgery. Studies included in our search reported 40 complications. The most frequently reported complication was dislocation (40%).


This review showed excellent survival rate and bone stability and good clinical outcomes in Italian cohort patients treated with modular neck THA, and these clinical results are comparable with international cohort rates. This review suggests that modular implants represent a very satisfying choice when practised by expert orthopaedic joint surgeons.


Total hip arthroplasty Modular neck Modular stem Modular implants Complications Outcomes Italian cohorts 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Walker JA (2010) Total hip replacement: improving patients’ quality of life. Nurs Stand 24:51–57. (quiz 58) CrossRefGoogle Scholar
  2. 2.
    Ibrahim MS, Raja S, Haddad FS (2013) Acetabular impaction bone grafting in total hip replacement. Bone Joint J 95-B:98–102. CrossRefGoogle Scholar
  3. 3.
    Ceretti M, Falez F (2016) Modular titanium alloy neck failure in total hip replacement: analysis of a relapse case. SICOT J 2:20. CrossRefGoogle Scholar
  4. 4.
    Goyal N, Hozack WJ (2010) Neck-modular femoral stems for total hip arthroplasty. Surg Technol Int 20:309–313Google Scholar
  5. 5.
    Pallini F, Cristofolini L, Traina F, Toni A (2007) Modular hip stems: determination of disassembly force of a neck-stem coupling. Artif Organs 31:166–170. CrossRefGoogle Scholar
  6. 6.
    Traina F, De Clerico M, Biondi F, Pilla F, Tassinari E, Toni A (2009) Sex differences in hip morphology: is stem modularity effective for total hip replacement? J Bone Joint Surg Am 91(Suppl 6):121–128. CrossRefGoogle Scholar
  7. 7.
    De Fine M, Romagnoli M, Toscano A, Bondi A, Nanni M, Zaffagnini S (2017) Is there a role for femoral offset restoration during total hip arthroplasty? A systematic review. Orthop Traumatol Surg Res 103:349–355. CrossRefGoogle Scholar
  8. 8.
    Osman K, Panagiotidou AP, Khan M, Blunn G, Haddad FS (2016) Corrosion at the head-neck interface of current designs of modular femoral components: essential questions and answers relating to corrosion in modular head-neck junctions. Bone Joint J 98-B:579–584. CrossRefGoogle Scholar
  9. 9.
    Ellman MB, Levine BR (2013) Fracture of the modular femoral neck component in total hip arthroplasty. J Arthroplasty 28(196):e191–e195. Google Scholar
  10. 10.
    Toni A, Sudanese A, Paderni S, Guerra E, Bianchi G, Antonietti B, Giunti A (2001) Cementless hip arthroplasty with a modular neck. Chir Organi Mov 86:73–85Google Scholar
  11. 11.
    Capanna R, Biagini R, Ruggieri P, Bettelli G, Campanacci M (1985) The Rizzoli Orthopedic Institute modular-type prosthesis for the proximal femur; preliminary results. Chir Organi Mov 70:45–51Google Scholar
  12. 12.
    Toni A, Giardina F, Guerra G, Sudanese A, Montalti M, Stea S, Bordini B (2017) 3rd generation alumina-on-alumina in modular hip prosthesis: 13 to 18 years follow-up results. Hip Int 27:8–13. CrossRefGoogle Scholar
  13. 13.
    Cristante L, Herrmann HD (1994) Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery 35:69–74 (discussion 74–66) CrossRefGoogle Scholar
  14. 14.
    Chillemi M, Placella G, Caraffa A, Cerulli G, Antinolfi P (2017) Serologic and radiographic outcome of total hip arthroplasty with CoCr modular neck at mid-term follow-up. Musculoskelet Surg 101:51–58. CrossRefGoogle Scholar
  15. 15.
    Bellomo F, Bertignone L, Morino L, Milano P, Schiavone E, Barale M (2002) MP-Link cementless distal fixation modular prosthesis for revision total hip arthroplasty. J Orthop Traumatol 2:121–124. CrossRefGoogle Scholar
  16. 16.
    Antonietti B, Paderni S, Sama D, Comitini V, Sudanese A (2003) Anatomic cementless total hip arthroplasty with ceramic bearings and modular necks: 3 to 5 years follow-up. Chir Organi Mov 88:259–265Google Scholar
  17. 17.
    Benazzo F, Cuzzocrea F, Stroppa S, Ravasi F, Dalla Pria P (2007) Modular stems in DDH. Hip Int 17(Suppl 5):S138–S141CrossRefGoogle Scholar
  18. 18.
    Benazzo F, Rossi SM, Cecconi D, Piovani L, Ravasi F (2010) Mid-term results of an uncemented femoral stem with modular neck options. Hip Int 20:427–433CrossRefGoogle Scholar
  19. 19.
    Traina F, De Fine M, Tassinari E, Sudanese A, Calderoni PP, Toni A (2011) Modular neck prostheses in DDH patients: 11-year results. J Orthop Sci 16:14–20. CrossRefGoogle Scholar
  20. 20.
    Bistolfi A, Massazza G, Rosso F, Ventura S, Lagalla F, Crova M (2012) Modular cementless cup for total hip arthroplasty: results at 4-year follow-up. Musculoskelet Surg 96:89–94. CrossRefGoogle Scholar
  21. 21.
    Dagnino A, Grappiolo G, Benazzo FM, Learmonth ID, Spotorno L, Portinaro N (2012) Medium-term outcome in patients treated with total hip arthroplasty using a modular femoral stem. Hip Int 22:274–279. CrossRefGoogle Scholar
  22. 22.
    Traina F, De Fine M, Abati CN, Bordini B, Toni A (2012) Outcomes of total hip replacement in patients with slipped capital femoral epiphysis. Arch Orthop Trauma Surg 132:1133–1139. CrossRefGoogle Scholar
  23. 23.
    Benazzo FM, Piovani L, Combi A, Perticarini L (2015) MODULUS stem for developmental hip dysplasia: long-term follow-up. J Arthroplasty 30:1747–1751. CrossRefGoogle Scholar
  24. 24.
    Wirtz DC, Gravius S, Ascherl R, Thorweihe M, Forst R, Noeth U, Maus UM, Wimmer MD, Zeiler G, Deml MC (2014) Uncemented femoral revision arthroplasty using a modular tapered, fluted titanium stem: 5- to 16-year results of 163 cases. Acta Orthop 85:562–569. CrossRefGoogle Scholar
  25. 25.
    Holt G, McCaul J, Jones B, Ingram R, Stark A (2011) Outcome after femoral revision using the restoration cone/conical femoral revision stem. Orthopedics 34:11. Google Scholar
  26. 26.
    Collet T, Atanasiu JP, de Cussac JB, Oufroukhi K, Bothorel H, Saffarini M, Badatcheff F (2017) Midterm outcomes of titanium modular femoral necks in total hip arthroplasty. Ann Transl Med 5:395. CrossRefGoogle Scholar
  27. 27.
    Silverton CD, Jacobs JJ, Devitt JW, Cooper HJ (2014) Midterm results of a femoral stem with a modular neck design: clinical outcomes and metal ion analysis. J Arthroplasty 29:1768–1773. CrossRefGoogle Scholar
  28. 28.
    Cossetto DJ, Goudar A (2012) Mid-term outcome of a modular, cementless, proximally hydroxyapatite-coated, anatomic femoral stem. J Orthop Surg (Hong Kong) 20:322–326. CrossRefGoogle Scholar
  29. 29.
    Blakey CM, Eswaramoorthy VK, Hamilton LC, Biant LC, Field RE (2009) Mid-term results of the modular ANCA-Fit femoral component in total hip replacement. J Bone Joint Surg Br 91:1561–1565. CrossRefGoogle Scholar
  30. 30.
    Vanbiervliet J, Somers JFA (2017) Excellent mid-term results of a new polished tapered modular cemented stem: a study of 113 hip replacements with minimum 5-year follow-up. Hip Int 27:455–459. CrossRefGoogle Scholar
  31. 31.
    Hashem A, Al-Azzawi A, Riyadh H, Mukka S, Sayed-Noor A (2018) Cementless, modular, distally fixed stem in hip revision arthroplasty: a single-center study of 132 consecutive hips. Eur J Orthop Surg Traumatol 28:45–50. CrossRefGoogle Scholar
  32. 32.
    Kouzelis A, Georgiou CS, Megas P (2012) Dissociation of modular total hip arthroplasty at the neck-stem interface without dislocation. J Orthop Traumatol 13:221–224. CrossRefGoogle Scholar
  33. 33.
    Barlow BT, Boles JW, Lee YY, Ortiz PA, Westrich GH (2016) Short-term outcomes and complications after rejuvenate modular total hip arthroplasty revision. J Arthroplasty 31:857–862. CrossRefGoogle Scholar
  34. 34.
    Konan S, Garbuz DS, Masri BA, Duncan CP (2016) Modular tapered titanium stems in revision arthroplasty of the hip: the risk and causes of stem fracture. Bone Joint J 98-B:50–53. CrossRefGoogle Scholar
  35. 35.
    Takemoto S, Vail TP, Houman J, Barnes CL (2015) What defines a high-volume hip or knee surgeon in the United States? J Surg Orthop Adv 24:87–90CrossRefGoogle Scholar

Copyright information

© Istituto Ortopedico Rizzoli 2019

Authors and Affiliations

  • R. Papalia
    • 1
  • A. Di Martino
    • 1
    • 2
    Email author
  • A. Caldaria
    • 1
  • B. Zampogna
    • 1
  • V. Denaro
    • 1
  1. 1.Department of Orthopaedic and Trauma SurgeryUniversity Campus Bio-Medico of RomeRomeItaly
  2. 2.Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA

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