title: Modular femoral sleeve and stem implant provides long-term total hip survivorship.
abstract: BACKGROUND
  A femoral implant with a modular sleeve and stem has been designed to allow independent and complete metaphyseal-diaphyseal fit and fill as well as independent rotation to accommodate anteversion at the time of THA.
  
  
  OBJECTIVE
  In a prospective study we asked whether such a modular femoral sleeve and stem implant used during THA could provide (1) high long-term survivorship; (2) radiographically stable implants without radiolucencies, stress shielding, or osteolysis; and (3) high clinical scores in patients 15 to 20 years after a primary THA.
  
  
  METHODS
  We prospectively evaluated 31 hips that underwent a primary THA using a modular femoral component for clinical outcome (Harris hip score) and radiographic outcome (implant stability, femoral loosening, osteolysis and stress shielding) at a minimum followup of 15 years (mean, 17 years; range, 15-20.2 years).
  
  
  RESULTS
  There were no femoral revisions for aseptic loosening; all hips had radiographic evidence of bone ingrowth. Two well-ingrown components were revised for late hematogenous infection. Some degree of proximal femoral disuse atrophy from stress shielding occurred in 23 hips (74%) but was nonprogressive and did not result in any failures or complications. Femoral osteolysis occurred in 18 hips (58%), but we cannot definitively determine whether or not the modular junction contributed to this.
  
  
  CONCLUSIONS
  These data suggest this modular femoral stem can provide long-term survivorship with no cases of aseptic loosening at 15 to 20 years after primary THA. However, it may be prudent when using this femoral stem to consider an articulation with an alternative bearing or, if the modularity is not needed to address femoral anteversion and metaphyseal-diaphyseal mismatch, to consider a nonmodular femoral stem.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Orthopaedic Surgery, McGill University, 1650 Cedar Avenue #B5159, Montreal, QC H3G 1A4, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Le
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.forename: Dylan
authors.initials: D
authors.lastname: Tanzer
authors.forename: Michael
authors.initials: M
authors.lastname: Tanzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000209:etiology; D011859:Radiography; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D013314:Stress, Mechanical; D055815:Young Adult
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