Indications, complications and outcomes of modular stems in total hip revision arthroplasty: a systematic review of the literature

INTRODUCTION: As number of total hip arthroplasty performed yearly is increasing revision hip arthroplasty will increase consequently. Femoral bone loss and fixation managing are the most challenging features of this procedures. This review discusses about the usage of modular stem and their potential aim for surgeons facing these surgeries. EVIDENCE ACQUISITION: A comprehensive search of the PubMed, Cochrane Library and Google scholar databases was performed since the onset of database to March 2023. Adequate statistical analysis and a minimum 2.9 years of follow-up were considered as inclusion criteria. Quality assessment was stated following the modified Coleman Score. The following data were extracted: Demographics, stem design, indications, intraoperative complications, osteotomies performed, postoperative complications, clinical and radiological outcomes. EVIDENCE SYNTHESIS: Finally, 24 articles were included in this systematic review. The 24 articles selected for the final analysis were published from 2001 to 2023. Finally, our review included 2063 patients, with a total of 2115 hips revised. Mean follow-up calculated was 6.2 years with a range between 2.9 and 16. The overall number of revision surgeries performed for periprosthetic fractures was 325 (22.34%). PJI was reported as an indication to revision in 198 hips with a percentage among all indications of 13,6%. fractures occurred in a total of 154 cases (10,6%). The most described postoperative complication is dislocation and has been reported in a total of 77 cases resulting to be the 26.7% of all complications. Periprosthetic joint infection (PJI) percentage among all complications was 25.7%, with an absolute infection rate of 3.5% overall. Surprisingly modular stem implant failures occurred in 6 stems among 2115 hip revised. CONCLUSIONS: Dislocation, PJI and revision rates obtained do not differ significantly from monobloc complication rates described in literature. The clinical outcomes, collected throughout the articles that were examined, suggest a general acceptable revisions and infections rate after these surgeries. Despite the many surgical difficulties that may present to surgeons during Revision Hip Arthroplasty, the knowledge of modular stems and their correct intraoperative handling, (Cite this article as: Cottino U, Pirato F, Battaglia DL, Dettoni F, Bruzzone M, Rossi R. Indications, complications and outcomes of modular stems in total hip revision arthroplasty: a systematic review of the literature. Minerva Orthop 2024;75:243