Volume 4, Issue 3, Pages (September 2018)

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Volume 4, Issue 3, Pages 306-309 (September 2018) What can the surgeon do to reduce the risk of junction breakage in modular revision stems? Bernd Fink, MD Arthroplasty Today Volume 4, Issue 3, Pages 306-309 (September 2018) DOI: 10.1016/j.artd.2018.03.002 Copyright © 2018 The Author Terms and Conditions

Figure 1 Comparison between the 2 possible combinations of modular components with the same fixation zone in the isthmus of the femur. (a) The combination of a longer distal component and shorter proximal component locates the junction at the level of missing medial bone support. (b) The combination of a shorter distal component with fixation at the tip of the stem (in a 2-degree tapered stem) in the isthmus of the femur and a longer proximal component locates the junction more deep in the femur below the lesser trochanter where the junction gets a medial bone support. Arthroplasty Today 2018 4, 306-309DOI: (10.1016/j.artd.2018.03.002) Copyright © 2018 The Author Terms and Conditions

Figure 2 Revision of the left total hip arthroplasty using a transfemoral approach in a 79-year-old woman 18 years after primary total hip replacement. (a) Preoperative radiograph showing loosening of the left stem and both components on the right side. (b) Postoperative radiograph after transfemoral stem revision with the fixation of the new stem at the tip in the isthmus of the femur, showing the combination of a shorter distal and a longer proximal component which brings the junction more distal. Arthroplasty Today 2018 4, 306-309DOI: (10.1016/j.artd.2018.03.002) Copyright © 2018 The Author Terms and Conditions

Figure 3 Endofemoral revision of a total hip arthroplasty in a 72-year-old woman 12 years after primary total hip replacement. (a) Preoperative radiograph demonstrating loosening of both components on the left side. (b) Postoperative radiograph after endofemoral revision with 3-surface fixation of the new modular revision stem and a cementless cup. Arthroplasty Today 2018 4, 306-309DOI: (10.1016/j.artd.2018.03.002) Copyright © 2018 The Author Terms and Conditions

Figure 4 Revision of a total hip arthroplasty using a transfemoral approach 8 years after primary implantation in a severe bowed femur of a 69-year-old man with height of 198 cm and weight of 130 kg. (a) Preoperative radiograph showing a loosening of the stem in a significant bowed femur. (b) Postoperative radiograph after transfemoral stem revision with the fixation of the new stem at the tip in the isthmus of the femur and a double osteotomy to correct the shape of the femur and to bring the medial femoral bone in contact with the revision stem. A long neck was needed to adapt to the high offset in this tall patient. (c) One-year postoperative radiograph showing the osseous consolidation of the medial osteotomy and an osteointegration of the modular revision stem with unchanged position. Arthroplasty Today 2018 4, 306-309DOI: (10.1016/j.artd.2018.03.002) Copyright © 2018 The Author Terms and Conditions