Abstract
The femoral diaphysis presents the best opportunity for fixation during revision THA. Both fully coated cylindrical and modular fluted tapered titanium stems have demonstrated excellent results. Cylindrical stems have demonstrated concerning rates of failure when used in larger, osteopenic canals or in canals with post-isthmal divergent morphologies. Modular stems offer the advantage of separating distal fixation needs from proximal version, leg length, and offset needs via a modular junction. Although early designs demonstrated some breakages at the taper or through thin proximal bodies, newer generation implants have not demonstrated such mechanical concerns. Additionally, the modular junctions do not appear to be having any problems with corrosion. Mid- to long-term data with various designs now support the safety and efficacy of these constructs that can handle a wide variety of challenges during femoral revision. Careful attention to detail is necessary to minimise the risk of subsidence and intra-operative fracture or femoral perforation.
