title: Managing femoral bone loss in revision total hip replacement: fluted tapered modular stems.
abstract: If a surgeon is faced with altered lesser trochanter anatomy when revising the femoral component in revision total hip replacement, a peri-prosthetic fracture, or Paprosky type IIIb or type IV femoral bone loss, a modular tapered stem offers the advantages of accurately controlling femoral version and length. The splines of the taper allow rotational control, and improve the fit in femoral canals with diaphyseal bone loss. In general, two centimetres of diaphyseal contact is all that is needed to gain stability with modular tapered stems. By allowing the proximal body trial to rotate on a well-fixed distal segment during trial reduction, appropriate anteversion can be obtained in order to improve intra-operative stability, and decrease the dislocation risk. However, modular stems should not be used for all femoral revisions, as implant fracture and corrosion at modular junctions can still occur.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Cross
authors.forename: W G
authors.initials: WG
authors.lastname: Paprosky
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D005260:Female; D005269:Femur / Q000473:pathology* / Q000601:surgery*; D006617:Hip Dislocation / Q000517:prevention & control; D006622:Hip Prosthesis; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control; D008297:Male; D057068:Periprosthetic Fractures / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D016896:Treatment Outcome
keywords: Modular; femoral; fluted; revision; tapered