Evaluation of the Painful Dual Taper Modular Neck Stem Total Hip Arthroplasty: Do They All Require Revision?
Although dual taper modular-neck total hip arthroplasty (THA) design with additional neck-stem modularity has the potential to optimize hip biomechanical parameters by facilitating adjustments of leg length, femoral neck version and offset, there is increasing concern regarding this stem design as a result of the growing numbers of adverse local tissue reactions due to fretting and corrosion at the neck-stem taper junction. Implant factors such as taper cone angle, taper surface roughness, taper contact area, modular neck taper metallurgy, and femoral head size play important roles in influencing extent of taper corrosion. There should be a low threshold to conduct a systematic clinical evaluation of patients with dual-taper modular-neck stem THA using systematic risk stratification algorithms as early recognition and diagnosis will ensure prompt and appropriate treatment. Although specialized tests such as metal ion analysis and cross-sectional imaging modalities such as metal artifact reduction sequence magnetic resonance imaging (MARS MRI) are useful in optimizing clinical decision-making, overreliance on any single investigative tool in the clinical decision-making process for revision surgery should be avoided.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Young-Min
YM
Kwon
D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016477:Artifacts; D015992:Body Mass Index; D003343:Corrosion; D020000:Decision Support Systems, Clinical; D003952:Diagnostic Imaging; D005270:Femur Head; D005272:Femur Neck / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007249:Inflammation; D007477:Ions; D008279:Magnetic Resonance Imaging; D008670:Metals; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation
D007477:Ions; D008670:Metals
MARS MRI; adverse local tissue reaction; metal ion levels; modular femoral neck stem; taper corrosion