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Modular versus Nonmodular Neck Femoral Implants in Primary Total Hip Arthroplasty: Which is Better?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Restoration of the hip center is considered important for a successful THA and requires achieving the right combination of offset, anteversion, and limb length. Modular femoral neck designs were introduced to make achieving this combination easier. No previous studies have compared these designs in primary THA, and there is increasing concern that modular designs may have a higher complication rate than their nonmodular counterparts.

Questions/purposes

We therefore asked (1) whether use of a stem with a modular neck would restore limb length and offset more accurately than a stem with a nonmodular neck, and (2) whether patients who received modular neck systems had better hip scores or a lower frequency of complications and reoperations than those receiving a comparable nonmodular stem.

Methods

Two cohorts of patients undergoing primary THAs, 284 patients with a nonmodular neck and 594 patients with a modular neck, were treated by one surgeon through a posterior approach. These were two nearly sequential series with little overlap. Harris hip scores and SF-12 outcomes surveys were administered at followup with a mean of 2.4 years (maximum, 5.9 years).

Results

In the modular neck cohort, a greater proportion of patients had equal (within 5 mm) radiographic limb lengths (89%, compared with 77% in nonmodular cohort p = 0.036), and a smaller offset difference (6.1 versus 7.5 mm, p = 0.047) was observed. Whether these statistical differences are clinically important is unclear. A smaller proportion of patients in the modular neck cohort achieved equal apparent or clinical limb length at 1 year (85% versus 95%, p < 0.001) and at 2 years (81% versus 94%, p < 0.001). In addition, these differences did not appear to result in better Harris hip or SF-12 scores, fewer complications, or reduced likelihood of revision surgery.

Conclusions

Use of modular neck stems did not improve hip scores nor reduce the likelihood of complications or reoperations. Because of their reported higher risks, there is no clear indication for modularity with a primary THA, unless the hip center cannot be achieved with a nonmodular stem, which is rare.

Level of Evidence

Level III, therapeutic study. See the Instructions to Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Orthopedic + Fracture Specialists, 11782 SW Barnes Road #300, Portland, OR, 97225, USA

    Paul J. Duwelius MD, Bob Burkhart PA, Clay Carnahan PA & Laura Matsen Ko MD

  2. Orthopedic Institute, Providence Health & Services, Portland, OR, USA

    Grant Branam BSc & Cecily Froemke MS

  3. Medical Data Research Center, Providence Health & Services, Portland, OR, USA

    YingXing Wu MD, Lian Wang MS & Gary Grunkemeier PhD

Authors
  1. Paul J. Duwelius MD
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  2. Bob Burkhart PA
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  3. Clay Carnahan PA
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  4. Grant Branam BSc
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  5. Laura Matsen Ko MD
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  6. YingXing Wu MD
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  7. Cecily Froemke MS
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  8. Lian Wang MS
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  9. Gary Grunkemeier PhD
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Corresponding author

Correspondence to Paul J. Duwelius MD.

Additional information

One of the authors (PJD) is a consultant for Zimmer (Warsaw, IN, USA), receives royalties from Zimmer for fracture and joint implants, is chairman of the adult hip reconstruction committee, medical legal defense expert, and a board member of an orthopedic surgical center.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Providence St Vincent Medical Center, Portland, OR, USA.

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Duwelius, P.J., Burkhart, B., Carnahan, C. et al. Modular versus Nonmodular Neck Femoral Implants in Primary Total Hip Arthroplasty: Which is Better?. Clin Orthop Relat Res 472, 1240–1245 (2014). https://doi.org/10.1007/s11999-013-3361-4

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  • DOI: https://doi.org/10.1007/s11999-013-3361-4

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