- Michael J Archibeck: The New Mexico Center for Joint Replacement Surgery, New Mexico Orthopaedics, 201 Cedar SE, Suite 6600, Albuquerque, NM 87106, USA. archibeckmj@nmortho.net
BACKGROUND: Restoration of hip offset and leg length during THA is often limited by available implant geometries. The recent introduction of femoral components with a modular junction at the base of the neck (two modular junction components) has expanded the options to restore femoral offset and leg length.
QUESTIONS/PURPOSES: We asked (1) whether a femoral component with two modular junctions would predict by templating more frequent restoration of preoperative offset and leg length abnormalities than one with single modular junctions; and (2) how our use of these options compared with national sales data.
PATIENTS AND METHODS: We retrospectively reviewed the preoperative templating data in 100 primary THAs using single modular junction implants with only a neutral version stem and 100 THAs using two modular junction implants. We compared the frequency with which the desired leg length and offset were completely restored by preoperative templating in the two groups.
RESULTS: Offset and leg lengths were restored to within 1 mm in 85% of cases with two modular junction implants and 60% of cases with single modular junction implants. An anteverted or a retroverted neck was used in 25% of cases with the two modular junction stems. The national sales data revealed femoral neck components with version were used in 28% of cases.
CONCLUSIONS: The use of a femoral component with two modular junctions resulted in more frequent ability to restore femoral offset and leg length than a single modular junction. The advantage of clinical flexibility should be tempered by the potential concerns of prosthetic mechanical failure (which has been reported in another implant system with two modular junctions), increased third-body wear and corrosive debris, and increased prosthetic cost.
LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.