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Prosthetic Components

Femoral stem coatings, acetabular cup designs, and bearing surface selection — evaluating fixation methods and wear rates to optimize implant longevity.

105 citationsUpdated Jun 2026

Overview

Modular femoral components provide numerous intraoperative options in primary and revision total hip arthroplasty [1]. However, the long-term effects of additional junctions in modular components remain unknown [1]. Consequently, routine use of a modular femoral stem in the primary setting is not recommended unless absolutely necessary [15]. The choice between modular and monoblock stems should be tailored to individual patient needs and specific clinical scenarios [26]. Complications related to the use of dual modular stems of a specific design outweigh potential benefits [22].

Short stems provide very good clinical results and survivorship, with an overall retrospective evaluation similar to primary hip implants [77]. Combinations of short modular components lead to reproducibly good outcomes in femoral revision with respect to subsidence and loosening [17]. Custom-designed femoral prostheses have a definite role in difficult-to-treat hips, such as severe dysplasia, based on excellent clinical results and low complication rates [6]. A resurfaced allograft-prosthesis composite could be an alternative surgical option to preserve bone stock and achieve good functional outcomes in very young children, although success may be limited by a high risk of complications [76].

In knee arthroplasty, the variable-axis knee prosthesis design appears to offer promise in controlling prosthetic loosening [2]. Accurate placement of components and restoration of knee stability were critical requirements for the success of the polycentric total knee prosthesis [28]. It is mandatory to consider both components to determine the accurate impingement-free prosthetic range of motion in total hip arthroplasty [20]. Critical factors for success in surgical management of periprosthetic fractures include proper evaluation of prosthetic stability, restoration of anatomy, minimizing soft tissue insult, and achieving fixation with a sufficiently rigid construct [4].

Anatomy & Pathophysiology

Kinematics and Biomechanics

The lineage of hip arthroplasty device predicates reflects a complex ancestral web of equivalency across a wide range of implants, although their material and design properties may be different [16]. The prosthesis tested exhibits kinematic behavior similar to that in their normal state, with no difference in quadriceps force required for extension [27]. Hip ROM increased in all positions with increasing head size and neck length [68]; however, there is no benefit in hip range of movement or hip function when head sizes > 36 mm are used [52]. The functional orientation of the acetabular component during activities associated with posterior edge-loading differs from those measured when supine due to patient-specific pelvic kinematics [59].

Hip Center Elevation: The higher hip center gained more bone coverage but decreased the range of hip flexion and internal rotation [86]. Conversely, the use of a high hip center did not adversely affect function of the abductor muscles, and the mean limb-length discrepancy was reduced by the femoral reconstruction [96].

Bearing Surfaces and Interface Mechanics

Corrosion at the head-neck interface is an inherent biomechanical problem with current designs of modular femoral components, occurring in metal-on-polyethylene and ceramic components as well as metal-on-metal [79]. The squeaking hip is a peculiar phenomenon unique to hard-on-hard bearing surfaces [61]. Deformed acetabular shells produced higher frictional torque than spherical shells [91]. It is likely that impaction deformation with consequent friction, wear, and micromotion contributed to the early failure of the Durom acetabular component [92]. The design of the acetabular assembly should be modified to prevent separation of the components [94]. In wear simulator studies, the higher stress in the HX-PE at a steep acetabular cup position did not result in increased wear [95].

Osseous Anatomy and Implant Fit

There is a mismatch between proximal femoral anatomy of a relevant proportion of adult hips and implant geometry of the most common femoral component in total hip arthroplasty [83]. Factors potentially associated with the quality of bone bed and biomechanics of the hip might influence the risk of aseptic loosening in this implant [73]. Hip microinstability is a condition characterized by abnormal femoral head micromotion within the acetabulum, leading to cartilage damage and osteoarthritis, often associated with acetabular dysplasia or femoroacetabular impingement syndrome [72].

Implant Failure and Long-Term Outcomes

Repetitive extreme motion of the involved hip and malposition of the implants can cause impingement after hip resurfacing arthroplasty [93]. Other surgical, implant and patient factors should be considered when determining the mechanisms of failure of large diameter metal-on-metal hip arthroplasties [87]. Increasing symptoms and decreased function related to degenerative hip disease may occur fifteen to twenty years after the procedure [90].

Classification

Activity Influence: Wear of prostheses during various activities of daily living is distinctly different, suggesting attention to the influence of activities of daily living on wear evaluation and prosthesis design [5].

Outlier Identification: Identification of outlier prostheses may improve overall joint replacement outcomes, though further research is needed to determine optimum identification methods [12].

Device Lineage: The lineage of hip arthroplasty device predicates reflects a complex ancestral web of equivalency across a wide range of implants, although their material and design properties may differ [16].

Medial Pivot TKA Kinematics: The tested medial pivot total knee arthroplasty prosthesis exhibits kinematic behavior similar to the normal state with no difference in quadriceps force required for extension [27].

Hip Taper Surface Finish: A new classification system regarding the surface finish of modular hip taper connections has been presented [44].

Femoral Deficiency (Revision THA): A classification system and algorithmic approach guide femoral reconstruction in revision total hip arthroplasty, recommending specific implant strategies based on the type of femoral deficiency to ensure stability and osseointegration [45].

Cemented Stem Geometry: A proposed classification system categorizes cemented stems as taper-slip (Type I) or composite beam (Type II) with further subdivisions based on geometry and surface finish [46].

Femoral Stem Length: A classification system for the length of femoral stems has been suggested to better organize discussion on stem length in primary total hip replacement [47].

Periprosthetic Fracture (Polished Taper-Slip): The Unified Classification System is unsatisfactory for classifying periprosthetic femoral fractures around polished taper-slip stems, demonstrating considerably lower reliability and validity than previously described for other stem types [48].

Cementless Femoral Stems: A new classification system for cementless femoral stems in total hip arthroplasty allows for the easy classification of all currently used stem types [49].

Registry Limitations: Joint replacement registries in the United Kingdom and Australia have provided data on failure rates of modular devices but cannot identify the mechanism of failure [51].

Instability Classification: Correctly classifying the type of instability present based on component position, abductor function, impingement, and polyethylene wear allows the treating surgeon to choose the appropriate revision option for the best potential outcome [58].

Debris Composition: The composition of the implant and the size of the modular femoral head are most strongly related to the concentration of debris in tissue [62].

Modular Head Adapter: A modular head neck adapter system with a ceramic head is a valid option in revisions at 5 and 7 years without additional risk of implant breakage [64].

Tumor-Type Prosthesis: A modular tumor-type prosthesis is a viable option for reconstruction of the severely compromised femur in complex revision hip arthroplasty with massive bone loss [67].

Clinical Presentation

The clinical evaluation of patients with total joint arthroplasty requires a systematic approach to identify complications, assess component integrity, and guide management. Diagnosis of aseptic loosening relies on a careful history, focused clinical exam, and thorough imaging evaluation, with serial radiographs remaining the cornerstone [9]. However, specific methods for diagnosing loosening may vary depending on the implant type [10]. For painful non-metal-on-metal total hip arthroplasty, a systematic evaluation including clinical history, physical examination, laboratory tests, and imaging is required to identify potential differential diagnoses [37].

Inspection and Physical Findings: Clinicians should heighten suspicion for metallosis secondary to hardware failure when encountering skin discoloration in the setting of a painful and poorly functioning hip arthroplasty [41]. Component malposition is frequently present among patients requiring revision arthroplasty and occurs in consistent patterns [38].

Stability and Construct Assessment: Critical factors for success in managing periprosthetic fractures include proper evaluation of prosthetic stability, restoration of anatomy, minimizing soft tissue insult, and achieving fixation with a sufficiently rigid construct [4]. In challenging cases, a construct using a tantalum acetabular shell and a cemented monoblock dual mobility acetabular cup confers stable fixation and prosthetic stability [42].

Diagnostic Imaging and Monitoring: MRI provides real-time assessment of what is occurring at the prosthesis and can guide intervention [3]. Patients with modular metal-on-metal prostheses should be closely monitored for signs of adverse reaction towards corrosion by-products [8]. Identification of outlier prostheses is one area that may improve overall joint replacement outcomes, though further research is needed to determine optimum methods for identification [12].

Wear and Systemic Considerations: Wear of prostheses during various activities of daily living is distinctly different, suggesting attention should be paid to the influence of activities of daily living on wear evaluation and prosthesis design [5]. Systemic distribution of metallic and polyethylene wear particles was a common finding in patients with both failed and primary total joint prostheses [40]. Technologic advances in implant materials, design, amputee care, and imaging continue to drive improvements in patient care and outcomes [13].

Management Implications: Modularity of femoral components in total hip arthroplasty offers intraoperative options, but the long-term effects of additional junctions remain unknown [1]. The variable-axis knee prosthesis design appears to offer promise in controlling prosthetic loosening [2]. Custom-designed femoral prostheses in total hip arthroplasty done with cement for severe dysplasia have a definite role in difficult-to-treat hips based on excellent clinical results and low complication rates [6]. In the evaluation of vitamin E diffused highly cross-linked polyethylene, all cups were stable based on radiographic and clinical examinations with no signs of loosening at 3 years [14]. Good functional results were commonly seen in the management of periprosthetic joint infection after total hip arthroplasty using a custom made articulating spacer, leading to postponing second stage indefinitely with retention of the prosthesis in 34 patients [39]. Prompt removal of prosthetic components and all cement, combined with appropriate antibiotic treatment, will eradicate infection in most patients, and performing a true Girdlestone arthroplasty will improve functional results [43].

Investigations

Plain radiography: Diagnosis of aseptic loosening requires careful history, focused clinical exam, and thorough evaluation of imaging using several diagnostic modalities [9]. Serial radiographs remain the cornerstone of diagnosis for aseptic loosening [9]. Different methods may be necessary to diagnose loosening depending on the type of implant examined [10]. A comprehensive series of plain radiographs can reliably detect a malseated modular dual-mobility liner with a flush rim design in 95% of cases [80]. Radiographic follow-up shows long-stemmed humeral components in primary shoulder arthroplasty are at a low risk for loosening [70]. All cups were stable based on radiographic and clinical examinations with no signs of loosening at 3 years in the evaluation of vitamin E diffused highly cross-linked polyethylene [14]. Less radiological changes were observed around cementless cups when no screws were used in press-fit fixation [89]. Radiological evidence of degenerative change, heterotopic ossification, and protrusion occurs in a few patients who undergo prosthetic arthroplasty of the proximal femur for tumour using a bipolar femoral head [81]. No patient underwent revision surgery due to acetabular component loosening in the evaluation of porous titanium-coated and plasma-sprayed shells, but radiographic findings warrant additional investigation [71]. Assessment of periprosthetic bone loss on plain radiographs is not reliable enough to justify its use in outcomes research, as the loss is not reproducibly recognized until 70 percent of the bone is gone [82].

MRI: MRI provides real-time assessment of conditions at the prosthesis and can guide intervention [3]. MARS-MRI is as suitable as standard diagnostic tools to distinguish between aseptic failure and prosthetic joint infection in patients with total hip arthroplasty [78]. Metal artifact reduction MRI is advised in all patients with metal-on-metal hip arthroplasties because metal ion levels are not sufficient as a screening measure for adverse reactions [84].

Other Considerations: Modularity of femoral components in total hip arthroplasty offers intraoperative options, but long-term effects of additional junctions remain unknown [1]. The variable-axis knee prosthesis design appears to offer promise in controlling prosthetic loosening [2]. The Restoration Modular stem had excellent clinical and radiographic performance in patients with significant femoral bone loss [25]. A titanium-encased ceramic liner total hip arthroplasty acetabular component demonstrates a favorable and safe clinical and radiological outcome with over 15 years of follow-up [85]. Revision of a stable component is not justifiable on the basis of its long duration in use, non-ideal position, or possible loosening on radiographs [29]. Technologic advances in implant materials, design, amputee care, and imaging continue to drive improvements in patient care and outcomes [13].

Treatment

Non-Operative

Treatment options for conditions such as hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures, with selection depending on disease stage and patient factors [88].

Operative

Indications: Routine use of a modular femoral stem in the primary setting is not recommended unless absolutely necessary [15]. Revision of a stable component is not justifiable based on its long duration in use, non-ideal position, or possible loosening on radiographs [29].

Surgical Approach / Technique: Critical factors for success in surgical management of periprosthetic fractures include proper evaluation of prosthetic stability, restoration of anatomy, minimizing soft tissue insult, and achieving fixation with a sufficiently rigid construct [4]. The success of hip arthroplasty is likely to be compromised if technical aspects of surgery for appropriate component positioning and critical protocols to minimize complications such as infection are not given proper attention [60]. For the vast majority of patients, a standard conventional total knee arthroplasty with a familiar surgical approach and standard components leads to satisfactory long-term clinical outcomes, and there is no single 'best' way to perform the procedure [104].

Implant Selection: Noncemented press-fit femoral stems predominate in total hip arthroplasty with generally excellent long-term survivorship [106]. Custom-designed femoral prostheses have a definite role in difficult-to-treat hips, such as severe dysplasia, based on excellent clinical results and low complication rates [6]. The Restoration Modular stem had excellent clinical and radiographic performance in patients with significant femoral bone loss [25]. Use of combinations of short modular components leads to reproducibly good outcomes in femoral revision with respect to subsidence and loosening [17]. Non-modular stems offer a viable alternative with high survival rates and bone stock restoration in revision arthroplasty of the hip [65]. The choice between modular and monoblock stems should be tailored to individual patient needs and specific clinical scenarios [26]. Revision total knee arthroplasty using an uncemented metaphyseal sleeve rotating hinge prosthesis demonstrates good survivorship and improvement in knee pain [7]. Survivorship of modular cemented stems in revision total knee arthroplasty was comparable to early series of nonmodular cemented stems and similar to recent shorter-term follow-up series of modular uncemented stems [30]. A non-fluted, press-fit stem used with a tumor prosthesis provided a stable bone-prosthesis interface at midterm follow-up [100]. Provided with a well-functioning modular junction, non-metal-on-metal large-head total hip arthroplasty would offer an appealing option [105]. Evidence exists for indications, basic science data on corrosion risk, and ongoing questions and concerns regarding dual mobility implants [63]. The Mayo femoral stem presents a high aseptic loosening rate when compared to non-conservative stems [98].

Alignment / Balancing Strategy: Accurate placement of components and restoration of knee stability were critical requirements for the success of polycentric total knee prostheses [28]. It is mandatory to consider both components to determine the accurate impingement-free prosthetic range of motion in total hip arthroplasty [20]. Suboptimum placement of components (greater than 50°-60° of cup abduction) in Birmingham Hip Resurfacing Arthroplasty leads to high wear and metallosis [97].

Adjuncts: Wear of prostheses during various activities of daily living is distinctly different, indicating that attention should be paid to the influence of activities of daily living on wear evaluation and prosthesis design [5].

Revision: Component revision and reimplantation can effectively relieve pain and improve function compared with baseline values, with moderately high patient satisfaction levels [53]. There is no evidence to suggest that the use of cemented or cementless components at the time of reimplantation affects the success rate of infection treatment, though fixation mode may affect implant survivorship [54]. Functional outcomes and 10-year implant survival rates were worse in revision arthroplasty patients compared to tumor patients undergoing proximal femoral replacement [24]. The ten-year survival rate for the prosthesis as a whole in total hip arthroplasty after operative treatment of an acetabular fracture was 78 percent [23]. Management of dislocation after total hip arthroplasty ranges from closed reduction and nonsurgical measures to revision strategies targeting the underlying etiology, such as soft-tissue augmentation, component repositioning, or use of constrained cups [75]. Regular follow-up examinations are advocated for patients with modular acetabular components, with early liner exchange recommended in the setting of accelerated polyethylene wear to reduce the risk of liner dissociation and severe complications [66].

Complications

Aseptic loosening: Prosthetic loosening is initiated during or shortly after surgery, with subsequent progression affected by biomechanical factors, fluid pressure fluctuations, and inflammatory responses to necrotic cells and cell fragments [34]. Aseptic loosening was the major reason for failure of Sikomet metal-on-metal total hip replacements at a mean follow-up of seven years [36]. The variable-axis knee prosthesis design offers promise in controlling prosthetic loosening [2]. Long-term survivorship of highly cross-linked polyethylene liners must be observed to determine if early wear impacts aseptic loosening [18].

Instability: Dislocation is the most common complication in proximal femoral replacement for severe femoral bone loss, despite good five-year implant survivorship [50].

Wear and Corrosion: Corrosion on the acetabular liner taper from retrieved modular metal-on-metal prostheses requires close patient monitoring for adverse reactions to corrosion by-products [8]. Alumina ceramic-on-ceramic bearings in cementless total hip arthroplasty demonstrate minimal late complications at long-term follow-up [11].

Other Considerations: Long-term effects of additional junctions in modular femoral components for total hip arthroplasty remain unknown [1]. The long-term effect of elevated-rim acetabular liners on wear and loosening remains unknown, and their routine use is not advocated [55]. A small percentage of implants used for primary hip and knee arthroplasty remain unproven regarding long-term survivorship [56]. Complications related to the use of dual modular stems of a specific design outweigh potential benefits [22]. Bipolar radial head arthroplasty is associated with major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years [99].

Recovery

Light activity (weeks): Evidence does not specify a week range for light activity, desk work, driving, or light ADLs.

Full activity (months): Evidence does not specify a month range for manual work, sport, or full ROM/strength return.

Complete recovery / outcome plateau (months): Evidence does not specify a month range for the stabilization of pain, strength, and final functional outcomes.

Rehabilitation protocol: Evidence does not provide details on PT phasing, immobilisation duration, weight-bearing/ROM progression, or sling/brace removal timing.

Functional milestones: Uncemented metaphyseal sleeve rotating hinge prostheses demonstrate improvement in knee pain [7]. Alumina ceramic-on-ceramic bearings in cementless total hip arthroplasty show excellent functional outcomes at long-term follow-up [11]. Monobloc dual mobility components demonstrate improved functional outcomes at mid-term follow-up [19]. The Wagner cone femoral prosthesis demonstrates excellent patient-reported functional outcomes at midterm follow-up [69]. Ceramic-on-ceramic bearings for total hip arthroplasty have excellent functional outcomes for at least 10 years [74]. Functional outcomes are worse in revision arthroplasty patients compared to oncologic patients undergoing proximal femoral replacement [24].

Other Considerations: MRI provides real-time assessment of conditions at the prosthesis and can guide intervention [3]. Uncemented metaphyseal sleeve rotating hinge prostheses demonstrate good survivorship [7]. Alumina ceramic-on-ceramic bearings in cementless total hip arthroplasty show excellent implant survival and minimal late complications at long-term follow-up [11]. Long-term survivorship of highly cross-linked polyethylene liners requires observation to determine if early wear impacts aseptic loosening [18]. Monobloc dual mobility components demonstrate excellent implant survivorship and radiographic fixation at mid-term follow-up [19]. Acetabular revision using a cementless protrusio shell yields excellent survivorship results equal to those of revisions using hemispherical shells at midterm follow-up [21]. The ten-year survival rate for prostheses following operative treatment of an acetabular fracture is 78 percent [23]. Modular cemented stems used in revision total knee arthroplasty have survivorship comparable to early series of nonmodular cemented stems and similar to recent shorter-term follow-up series of modular uncemented stems [30]. Understanding the history of taper design, geometry, and the track record of older implants helps surgeons choose appropriate implants and assess new prostheses [31]. Contemporary revision acetabular components have dramatically improved upon historical results at available follow-up [32]. Contemporary acetabular components demonstrate durable fixation and reduced wear compared to historical controls at minimum 10-year follow-up in patients aged 50 and under [33]. Prosthetic loosening is initiated during or shortly after surgery, with subsequent progression affected by biomechanical factors, fluid pressure fluctuations, and inflammatory responses to necrotic cells and cell fragments [34]. All 143 implants of a proximally HA-coated tapered titanium femoral component remained well fixed and clinically asymptomatic at 15 years [35]. Aseptic loosening was the major reason for failure of Sikomet metal-on-metal total hip replacements after a mean follow-up of seven years [36]. Extensively porous-coated cylindrical stems used for femoral revision demonstrate excellent survivorship with long-term follow-up [57]. Ceramic-on-ceramic bearings for total hip arthroplasty have high survivorship for at least 10 years [74]. At 60 months after implantation of a short femoral neck prosthesis, all regions except one showed no significant changes in bone mineral density compared to baseline [107]. Survivorship analysis predicted that total hip replacements in active patients less than fifty-five years old would have 87.6 percent survivorship at ten years of follow-up [108].

Key Evidence

  • [L5] Although modular components offer a plethora of intraoperative options in primary and revision total hip arthroplasty, the long-term effects of these additional junctions remain unknown. (10.5435/jaaos-20-04-214)
  • [L4] The design of the variable-axis prosthesis appears to offer promise in the control of the complication of prosthetic loosening. (10.2106/00004623-198163050-00001)
  • [L5] MRI provides the clinician with a real-time assessment of what is occurring at the prosthesis and can guide intervention. (10.1016/j.arth.2020.01.009)
  • [Case_report] Critical factors for success included proper evaluation of prosthetic stability, restoration of anatomy, minimizing soft tissue insult, and achieving fixation with a sufficiently rigid construct. (10.1016/j.jse.2008.10.003)
  • [L5] The wear of prostheses during various ADLs was distinctly different, suggesting that more attention should be paid to the influence of ADLs on the wear evaluation and prosthesis design. (10.1016/j.arth.2025.04.028)
  • [L4] The authors conclude there is a definite role for these custom components in difficult-to-treat hips based on excellent clinical results and low complication rates. (10.2106/00004623-199310000-00010)
  • [L4] This is the largest study of this prosthesis with longest follow-up, demonstrating good survivorship and improvement in knee pain. (10.1016/j.arth.2020.12.047)
  • [L5] The diagnosis of aseptic loosening involves a careful history, focused clinical exam, and thorough evaluation of imaging using several diagnostic modalities, with careful evaluation of serial radiographs remaining the cornerstone of diagnosis. (10.1016/j.arth.2022.02.060)
  • [L3] Different methods may be necessary to diagnose loosening depending on the type of implant examined. (10.1007/s00402-009-1000-z)
  • [L4] Long-term follow-up showed excellent implant survival, excellent functional outcomes, and minimal late complications. (10.1016/j.arth.2021.11.028)
  • [L4] Identification of outlier prostheses is one area that may improve overall joint replacement outcomes; however, further research is needed to determine the optimum methods for identification. (10.1530/eor-22-0058)
  • [L4] The authors recommend against routine use of a modular femoral stem in the primary setting unless absolutely necessary. (10.1016/j.arth.2012.03.050)
  • [L4] The lineage of hip arthroplasty device predicates reflects a complex ancestral web of equivalency across a wide range of implants, although their material and design properties may be different. (10.5435/jaaos-d-21-00138)
  • [L3] The use of combinations of short modular components leads to reproducibly good outcomes in femoral revision with respect to subsidence and loosening. (10.1007/s00402-018-3067-x)
  • [Paper] Long-term survivorship of these liners should be observed to determine whether early wear has an impact on aseptic loosening. (10.1007/s00402-021-03832-0)
  • [L4] At mid-term follow-up, this DM monobloc component demonstrates excellent implant survivorship, radiographic fixation, and improved functional outcomes. (10.1016/j.arth.2021.09.002)
  • [L5] It is mandatory to consider both components to determine the accurate impingement-free prosthetic ROM in THA. (10.1097/corr.0000000000001233)
  • [L3] At midterm follow-up, the survivorship results are excellent, equal to outcomes for revisions using hemispherical shells. (10.1016/j.arth.2006.12.073)
  • [L3] The ten-year survival rate for the prosthesis as a whole was 78 percent. (10.2106/00004623-199809000-00008)
  • [L3] Functional outcomes and 10-year implant survival rate were worse in the revision group compared to the tumor group. (10.1186/s12891-021-04673-z)
  • [L2] The choice between modular and monoblock stems should be tailored to individual patient needs and specific clinical scenarios. (10.1016/j.arth.2024.10.123)
  • [L5] The prosthesis tested exhibits kinematic behavior similar to that in their normal state, with no difference in quadriceps force required for extension. (10.1016/j.arth.2012.02.008)
  • [L4] Accurate placement of the components and restoration of knee stability were critical requirements for the polycentric total knee prosthesis to be successful. (10.2106/00004623-197658060-00005)
  • [L3] Survivorship was comparable to early series of nonmodular cemented stems and similar to recent shorter-term follow-up series of modular uncemented stems. (10.1016/j.arth.2006.12.058)
  • [L5] Understanding the history of taper design and geometry, the track record of older implants, and the rationale behind the development of current prostheses can help surgeons choose the right implants for their patients and accurately assess the pros and cons of new implants being introduced to the market each year. (10.5435/jaaos-d-22-00498)
  • [L3] Contemporary revision acetabular components have dramatically improved upon historical results at available follow-up. (10.1016/j.arth.2023.03.093)
  • [L4] Much evidence indicates that prosthetic loosening has already been initiated during or shortly after the surgery, and that the subsequent progression of loosening is affected by biomechanical factors, fluid pressure fluctuations and inflammatory responses to necrotic cells and cell fragments, i.e. the concept of late loosening appears to be a misinterpretation of late-detected loosening. (10.1302/2058-5241.5.190014)
  • [L3] At 15 years, all 143 implants remained well fixed and clinically asymptomatic. (10.1007/s11999-008-0550-7)
  • [L4] After a mean duration of follow-up of seven years, aseptic loosening was the major reason for failure of Sikomet metal-on-metal prostheses. (10.2106/jbjs.e.00604)
  • [L5] A systematic evaluation involving clinical history, physical examination, laboratory tests, and imaging is required to identify potential differential diagnoses in patients with painful non-metal-on-metal total hip arthroplasty. (10.1016/j.arth.2022.01.063)
  • [L4] Component malposition is frequently present among patients requiring revision arthroplasty and occurs in consistent patterns. (10.1016/j.jse.2024.11.015)
  • [L4] Good functional results were commonly seen, leading to postponing second stage indefinitely with retention of the CUMARS prosthesis in 34 patients. (10.1016/j.arth.2014.04.013)
  • [L4] Systemic distribution of metallic and polyethylene wear particles was a common finding in patients with both failed and primary total joint prostheses. (10.2106/00004623-200004000-00002)
  • [L4] Clinicians should heighten their suspicion for metallosis secondary to hardware failure when encountering patients with skin discoloration in the setting of a painful and poorly functioning hip arthroplasty. (10.1016/j.arth.2012.01.008)
  • [L4] The construct confers stable fixation and prosthetic stability in challenging cases. (10.5435/jaaos-d-21-00433)
  • [L4] Prompt removal of the prosthetic components and all of the cement, combined with appropriate antibiotic treatment, will eradicate the infection in most patients, and performing a true Girdlestone arthroplasty will improve functional results. (10.2106/00004623-198466090-00012)
  • [L5] This study provides an overview on the characteristics and variations of modular hip taper connections and presents a new classification system regarding the surface finish. (10.1016/j.arth.2017.04.027)
  • [L4] The authors present a classification system and algorithmic approach to guide femoral reconstruction in revision total hip arthroplasty, recommending specific implant strategies based on the type of femoral deficiency to ensure stability and osseointegration. (10.2106/00004623-200300004-00001)
  • [L5] The proposed classification system categorizes implants as taper-slip (Type I) or composite beam (Type II) with further subdivisions based on geometry and surface finish. (10.5435/jaaos-d-23-00914)
  • [L4] The authors suggest a classification system for the length of femoral stems to better organize the discussion on stem length. (10.1302/0301-620x.96b4.33036)
  • [L4] The Unified Classification System (UCS) is unsatisfactory for the classification of periprosthetic femoral fractures around polished taper-slip stems, demonstrating considerably lower reliability and validity than previously described for other stem types. (10.1302/0301-620x.103b8.bjj-2021-0021.r1)
  • [L5] The proposed system allows for the easy classification of all currently used stem types. (10.1016/j.arth.2022.09.014)
  • [L4] While the survivorship of the implant is good at five years, dislocation continues to be the most common complication. (10.1302/0301-620x.99b3.bjj-2016-0822.r1)
  • [L4] Joint replacement registries in the United Kingdom and Australia have provided data on the failure rates of modular devices but cannot identify the mechanism of failure. (10.1302/0301-620x.95b8.31525)
  • [L2] There is no benefit in hip range of movement or hip function when head sizes > 36 mm are used. (10.1302/2058-5241.3.170061)
  • [L4] Component revision and reimplantation can effectively relieve pain and improve function compared with baseline values, and patient satisfaction levels are moderately high. (10.1016/j.jse.2015.05.029)
  • [L5] There is no evidence to suggest that the use of cemented or cementless components at the time of reimplantation affects the success rate of infection treatment, though fixation mode may affect implant survivorship. (10.1016/j.arth.2018.09.030)
  • [L3] However, the long-term effect on wear and loosening remains unknown, and routine use is not currently advocated. (10.2106/00004623-199601000-00011)
  • [L4] The study demonstrates that while the majority of implants used have long-term survivorship data, a small percentage remain unproven. (10.1016/j.arth.2012.11.012)
  • [L3] With long-term follow-up, extensively porous-coated, cylindrical stems used for femoral revision continue to demonstrate excellent survivorship. (10.1016/j.arth.2007.01.002)
  • [L4] Correctly classifying the type of instability present based on component position, abductor function, impingement, and polyethylene wear allows the treating surgeon to choose the appropriate revision option that ultimately will allow for the best potential outcome. (10.1302/0301-620x.98b1.36516)
  • [L3] The functional orientation of the acetabular component during activities associated with posterior edge-loading differs from those measured when supine due to patient-specific pelvic kinematics. (10.1302/0301-620x.98b7.37062)
  • [L4] The success of hip arthroplasty is likely to be compromised if technical aspects of the surgery for appropriate component positioning and critical protocols to minimize complications such as infection are not given the proper attention. (10.1007/s00264-007-0364-3)
  • [L2] The squeaking hip is a peculiar phenomenon unique to hard-on-hard bearing surfaces. (10.1016/j.arth.2006.12.012)
  • [L4] The composition of the implant and the size of the modular femoral head were most strongly related to the concentration of debris in tissue. (10.2106/00004623-199608000-00014)
  • [L5] The purpose of this symposium is to review evidence for indications, present basic science data on corrosion risk, and highlight ongoing questions and concerns regarding dual mobility implants to provide a balanced critical review. (10.1016/j.arth.2021.01.048)
  • [L3] The modular head neck adapter system with a ceramic head seems to be a valid option in revisions at 5 and 7 years, without additional risk of implant breakage in this registry. (10.1016/j.arth.2023.01.055)
  • [L4] Non-modular stems offer a viable alternative with high survival rates and bone stock restoration. (10.1302/0301-620x.98b1.36442)
  • [L3] Our results indicate that a modular tumor-type prosthesis is a viable option for reconstruction of the severely compromised femur. (10.1016/j.arth.2008.11.074)
  • [L5] Hip ROM increased in all positions with increasing head size and neck length. (10.1016/j.arth.2012.10.011)
  • [L3] The Wagner cone femoral prosthesis demonstrated excellent clinical, radiographic, and patient-reported functional outcomes at midterm follow-up. (10.1016/j.arth.2020.03.015)
  • [L4] Radiographic follow-up shows these components are at a low risk for loosening. (10.1016/j.jse.2014.01.008)
  • [L3] No patient underwent revision surgery due to acetabular component loosening, but the radiographic findings warrant additional investigation. (10.2106/jbjs.17.00729)
  • [L3] Factors potentially associated with the quality of bone bed and biomechanics of the hip might influence the risk of aseptic loosening in this implant. (10.1186/1471-2474-11-243)
  • [L3] This CoC bearing for THA had a high survivorship and excellent functional outcomes for at least 10 years. (10.1016/j.arth.2022.12.009)
  • [L4] Management ranges from closed reduction and nonsurgical measures to revision strategies targeting the underlying etiology, such as soft-tissue augmentation, component repositioning, or use of constrained cups. (10.5435/00124635-200409000-00006)
  • [L4] Although its success may be limited owing to a high risk of complications, a resurfaced allograft-prosthesis composite could be an alternative surgical option in order to preserve the bone stock and achieve good functional outcomes in very young children. (10.1097/corr.0000000000002969)
  • [L4] Clinical results and survivorship were very good despite widened indications, giving an overall retrospective evaluation similar to primary hip implants. (10.1530/eor-2025-0056)
  • [L2] MARS-MRI is as suitable as standard diagnostic tools to distinguish between aseptic failure and PJI in patients with THA. (10.1186/s12891-022-05560-x)
  • [L5] Corrosion at the head-neck interface is an inherent biomechanical problem with current designs of modular femoral components, occurring in metal-on-polyethylene and ceramic components as well as metal-on-metal. (10.1302/0301-620x.98b5.35592)
  • [L5] A comprehensive series of plain radiographs can reliably detect a malseated modular dual-mobility liner with a flush rim design in 95% of cases. (10.1016/j.arth.2023.05.020)
  • [L4] Radiological evidence of degenerative change, heterotopic ossification and protrusion occur in a few patients who undergo prosthetic arthroplasty of the proximal femur for tumour. (10.1302/0301-620x.97b12.36366)
  • [L4] Assessment of periprosthetic bone loss on plain radiographs is not reliable enough to justify its use in outcomes research, as the loss is not reproducibly recognized until 70 percent of the bone is gone. (10.2106/00004623-200010000-00007)
  • [L4] The present study revealed a mismatch between proximal femoral anatomy of a relevant proportion of adult hips and implant geometry of the most common femoral component in total hip arthroplasty. (10.1016/j.arth.2016.02.015)
  • [L3] Metal artifact reduction MRI is advised in all patients with metal-on-metal hip arthroplasties. (10.1016/j.arth.2012.05.029)
  • [L3] This acetabular component demonstrates a favorable and safe clinical and radiological outcome with over 15 years of follow-up. (10.1016/j.arth.2021.06.016)
  • [L5] The higher hip center gained more bone coverage but decreased the range of hip flexion and internal rotation. (10.1016/j.arth.2016.03.014)
  • [L3] Other surgical, implant and patient factors should be considered when determining the mechanisms of failure of large diameter metal-on-metal hip arthroplasties. (10.1302/0301-620x.98b7.36554)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [Paper] Less radiological changes were observed around the cup when no screws were used. (10.1007/s00402-005-0001-9)
  • [L4] However, increasing symptoms and decreased function related to degenerative hip disease may occur fifteen to twenty years after the procedure. (10.2106/00004623-199701000-00009)
  • [L5] Deformed acetabular shells produced higher frictional torque than spherical shells. (10.1016/j.arth.2009.03.020)
  • [L4] Although no significant factors were found to explain the impingement, it appears that repetitive extreme motion of the involved hip and malposition of the implants can cause impingement after hip resurfacing arthroplasty. (10.2106/jbjs.j.01771)
  • [L4] The design of the acetabular assembly should be modified to prevent separation of the components. (10.2106/00004623-197961050-00024)
  • [L4] The use of a high hip center did not adversely affect function of the abductor muscles, and the mean limb-length discrepancy was reduced by the femoral reconstruction. (10.2106/00004623-199904000-00004)
  • [L4] Suboptimum placement of components (greater than 50°-60° of cup abduction) leads to high wear and metallosis. (10.1016/j.arth.2008.06.022)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L4] A non-fluted, press-fit stem used with a tumor prosthesis provided a stable bone-prosthesis interface at midterm follow-up. (10.1016/j.arth.2019.12.032)
  • [L5] For the vast majority of patients, a standard conventional total knee arthroplasty with a familiar surgical approach and standard components leads to satisfactory long-term clinical outcomes, and there is no single 'best' way to perform the procedure. (10.1016/j.arth.2020.04.031)
  • [L1] Provided with a well-functioning modular junction, non-MoM LDH THA would offer an appealing option. (10.1186/s12891-021-04286-6)
  • [L5] Noncemented press-fit femoral stems predominate in total hip arthroplasty with generally excellent long-term survivorship. (10.5435/jaaos-d-22-00074)
  • [L4] At 60 months after implantation of a short femoral neck prosthesis, all regions except one showed no significant changes in bone mineral density compared to baseline, which is less than the changes seen in conventional implants. (10.1186/s12891-015-0624-0)
  • [L4] Survivorship analysis predicted that the survivorship of all total hip replacements in this series would be 87.6 per cent at ten years of follow-up. (10.2106/00004623-198668090-00017)

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By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.