Orthopaedic Surgeon Modularity Utilization and Surgical Technique Considerations in the Face of Implant Corrosion

摘要

The use of modular femoral components for total hip arthroplasty (THA) allows surgeons to adjust leg lengths, restore anatomy, and improve stability through alterations in femoral offset, neck length, and version; however, corrosion, fretting, and fatigue failure have raised concerns about these implants. To determine surgeons' opinions and trends regarding the use of modularity in THA, during 2013 and 2014 surveys were sent to American Academy of Orthopaedic Surgeons fellows to investigate the use of modularity in THA. The survey included questions regarding technique and basic science knowledge of modular components. Results from 2013 and 2014 were compared to evaluate trends in modular component use. Ninetynine surgeons (2013) and 106 surgeons (2014) responded, more than 93 % of whom routinely perform THA. More than 50 % of respondents were fellowship trained. Most respondents (>87 %) in both years reported that they had used a modular implant, either when absolutely necessary (<5 % of time) or routinely (>50 % of time). From 2013 to 2014, the routine use of modular metal-metal junction implants decreased (head-neck, neck-stem, stem-body). In 2014, a higher percentage of surgeons reported concerns over debris and stem breakage and more chose ceramic heads over metal heads. Most respondents reported locking the femoral head with one or more forceful hits. When corrosion was noted on the taper during revision cases, most surgeons retained the femur while cleaning the taper with either a sponge or bovie scratch pad. Some respondents applied a ceramic head with a titanium sleeve between the damaged taper and the new femoral head; 94 % of respondents reported cleaning and drying the taper before head insertion. These results demonstrate that modular implants are widely used in THA. The number of surgeons routinely using modular implants remains high, making education regarding debris production and breakage with modular stems a necessity.