title: Modular femoral stems for revision total hip arthroplasty.
abstract: BACKGROUND
  Modular femoral stems are one option for revision THA surgeons and allow offset restoration, leg length discrepancy correction, and stability independent of distal stem fixation. The complexity of revision THA usually leads surgeons to use multiple revision hip designs to address these issues.
  
  
  OBJECTIVE
  We evaluated functional outcomes with a revision modular system and determined whether such a system achieved initial distal fixation, femoral offset restoration, leg length equalization, and hip stability.
  
  
  METHODS
  We prospectively followed 118 patients in whom a modular stem system was used for reconstruction of their failed index femoral stem. Sixty-nine hips were classified as Type I (classification of Paprosky et al.), 35 as Type II, 17 as Type III, and one as Type IV. Functional assessment was achieved using patient- and physician-administered outcome evaluations (SF-36, WOMAC, Lower Extremity Activity Scale, Harris hip score). Stem fixation, offset restoration, leg length discrepancy, and hip stability were evaluated radiographically. Complications were also recorded. Minimum followup was 2 years (average, 4 years; range, 2-7 years).
  
  
  RESULTS
  Average values on all functional outcome evaluations showed improvement at latest followup. Distal bone ingrowth fixation was obtained in 100% of the patients, offset was corrected in 66%, leg length discrepancy was corrected in 78%, and stability was achieved in 97%. No failures or fractures at the body to stem junction were seen at latest followup.
  
  
  CONCLUSIONS
  Modular femoral components achieved functional outcomes and were useful to address distal fixation, femoral offset restoration, leg length equalization, and hip stability when revising failed femoral components.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: Camilo
authors.initials: C
authors.lastname: Restrepo
authors.forename: Magdalena
authors.initials: M
authors.lastname: Mashadi
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Austin
authors.forename: William J
authors.initials: WJ
authors.lastname: Hozack
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006617:Hip Dislocation / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000473:pathology / Q000601:surgery; D007870:Leg Length Inequality / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000209:etiology; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012720:Severity of Illness Index