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Mid-term outcomes of revision hip arthroplasty due to titanium modular neck failure

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The current strategy for modular neck failures in total hip arthroplasty (THA) is calibrated on CrCo neck failures. Stem revision is usually required, but the procedure is challenging and achieves modest outcomes (up to 20% of re-revisions at short-term). No study reports revision strategies and outcomes after Ti neck failures. Aims of the study were to evaluate: (1) demographic and implant features of the cohort to be revised, (2) intra-operative findings and surgical revision strategies and (3) clinical and radiological post-revision outcomes.

Materials and methods

Hospital database was enquired about revisions due to Ti neck failures in primary THAs. Sixty-five revisions were enrolled (all with the same modular system). Neck exchange was attempted as the first-line treatment. Patients were clinically and radiographically evaluated after revision.

Results

The revision cohort encompassed fatigue neck fractures occurred 4.4 ± 2.6 years after THA: patients < 65 years and/or > 80 kg (98.5%) were predominant. Fifty-three neck exchanges were performed (81.5%). Eleven failures required stem revisions (16.9%), generally due to demanding neck extraction. Six complications occurred after neck exchange (11.3%), among them 2 acute infections requiring surgery (3.8%). Among stem revisions, one aseptic loosening and one neck re-fracture (18.5%) required re-revisions. At a mean follow-up of 7.1 ± 4 years, the neck exchange cohort achieved a mean HHS of 89.1 ± 6.3 (stem revisions: 84.1 ± 10.9).

Conclusions

Revisions for Ti neck failures were predominantly performed due to fatigue fractures. In case of failures, neck exchange is a feasible procedure in most of the cases, with good outcomes at 7 years.

Level of evidence

Level IV, retrospective case series.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy

    Francesco Castagnini, Stefano Lucchini, Enrico Tassinari & Francesco Traina

  2. Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy

    Barbara Bordini & Monica Cosentino

  3. Orthopaedics and Traumatology, DIBINEM University of Bologna, Bologna, Italy

    Francesco Traina

Authors
  1. Francesco Castagnini
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  2. Barbara Bordini
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  3. Stefano Lucchini
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  4. Monica Cosentino
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  5. Enrico Tassinari
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  6. Francesco Traina
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Contributions

FC and FT concepted the design of the study. BB, SL and MC provided the data, analyzed the data and conducted the statistical analysis. FC, SL and ET wrote the manuscript. ET and FT supervised the article production and corrected the final paper. All the Authors read and approved the final version.

Corresponding author

Correspondence to Francesco Castagnini.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical review committee statement

Institutional board review approved the study (IRB 211/2022/Oss/IOR, 25/3/2022).

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No informed consent was waived due to the nature of the study.

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Castagnini, F., Bordini, B., Lucchini, S. et al. Mid-term outcomes of revision hip arthroplasty due to titanium modular neck failure. Arch Orthop Trauma Surg 143, 5909–5918 (2023). https://doi.org/10.1007/s00402-023-04805-1

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  • DOI: https://doi.org/10.1007/s00402-023-04805-1

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