@article{3119809,
    title = "Systematic review of primary total hip arthroplasty using titanium-titanium modular-neck prostheses: the true risk of revision",
    author = "Lex, J.R. and Welch, M.D. and See, A. and Edwards, T.C. and Stavropoulos, N.A. and Babis, G.C.",
    journal = "HIP International",
    year = "2021",
    volume = "31",
    number = "3",
    pages = "295-303",
    publisher = "SAGE Publications Ltd",
    issn = "1120-7000, 1724-6067",
    doi = "10.1177/1120700020916870",
    keywords = "titanium;  titanium, bone necrosis;  hip fracture;  human;  neck;  osteoarthritis;  quality of life;  randomized controlled trial (topic);  Review;  systematic review;  total hip replacement;  adverse event;  hip prosthesis;  hip replacement;  male;  middle aged;  prosthesis complication;  prosthesis design;  reoperation;  retrospective study, Arthroplasty, Replacement, Hip;  Hip Prosthesis;  Humans;  Male;  Middle Aged;  Prosthesis Design;  Prosthesis Failure;  Reoperation;  Retrospective Studies;  Titanium",
    abstract = "Aims: Modular-neck femoral implants are used to enable more variability in femoral neck version, offset and length. It has been reported that these implants carry a higher rate of revision. The aim of this review was to assess the overall and cause-specific revision rate of titanium-titanium alloy modular-neck implants in primary total hip arthroplasty (THA). Methods: A systematic review was conducted following PRISMA guidelines and utilising multiple databases. All results were screened for eligibility. Studies published from 2000 onwards, using a current-generation, titanium-titanium, modular-neck implant were included. Overall and cause-specific revision rates were analysed, comparing to fixed-neck prostheses where applicable. Results: 920 studies were screened. After applying exclusion criteria, 23 were assessed in full and 14 included. These consisted of 12 case series and 2 joint registry analyses. 21,841 patients underwent a modular-neck implant with a weighted mean follow-up of 5.7 years, mean age of 62.4 years, and average body mass index (BMI) of 28.4kg/m2. The overall revision rate was 3.95% and 2.98% for modular and fixed-neck prostheses, respectively. For studies with >5 years follow-up the mean revision rate was 3.08%. There was no difference in cause-specific revision rates by implant design. Mean improvement in Harris Hip Score was 41.9. Conclusions: At medium-term, revision rates for titanium-titanium primary modular-neck THA are acceptable. These prostheses are a sensible management option in patients with considerable anatomical hip deformity not amenable to correction with standard fixed-neck implants. Patients of male gender, high BMI and requiring prostheses with a larger neck, offset or head are at higher risk of implant failure. © The Author(s) 2020."
}