Neck modularity has been proposed to improve THA accuracy, thanks to the close restoration of anatomy, however it has been associated with issues like early breakages or corrosion. Our Hospital has been using neck modularity since the 90s, so we analyzed retrospectively implants performed between January 2000 and December 2014. The minimum follow up was 1Y. The cohort was composed of 1,033 THAs or 951 patients (82 bilateral), of which 643 females and 390 males. Average patient age was 67.7Y. THA indications were primary Osteoarthritis (80.9%), Fracture (9.0%), Congenital Dysplasia or Congenital Luxation (4.2%), Osteonecrosis (3.2%), other causes (2,7%). The stems used were all cementless, 381 anatomically shaped (36.9%), 635 straight (61.5%), 17 short MIS (1.6%). All necks used were made of Titanium alloy. 419 implants (40.5%) were manufactured by Wright Medical, while 614 (59.5%) were produced by Adler Ortho. A total of 37 revisions has been reported, mainly due to periprosthetic fractures (32.4%), luxation (24.3%), implant mobilization (18.9%) and implant breakage (16.2%). We have recorded 3 modular neck breakages. 4 patients required re-revisions, because of luxations (3) and neck breakage (1). The overall survival rate was 96.4%. We did not observe any component corrosion, probably thanks to the exclusive use of Titanium necks. We had a neck breakages rate of 0.29% and a luxation rate of 0.87%, lower than normally reported in the literature. In conclusion, our experience suggests as neck modularity could be a safe and effective way to reconstruct the proximal femur in THA patients.
Reaming intramedullary nailing, possibly associated with autologous bone grafting, is an effective procedure for the treatment of uninfected non-union and limited post-traumatic segmental bony defects. The main purpose of the treatment is to remove the causes responsible for the pathological evolution of fracture healing and to create proper vascular and mechanical conditions in the lesion site. Hypertrophic non-union, which is considered a biologically active pathological condition, can be effectively treated by reaming of the medullary canal and by introducing a new nail of a larger diameter locked in a dynamic configuration; the purpose of this procedure is to help osteogenic compressive forces at the non-union site. In contrast, for the treatment of atrophic non-union it is necessary to avoid all mechanical stresses on the non-union site and give a new proper biological input. Cancellous and cortical-cancellous autologous bone grafting has undoubtedly well-known osteoinduc-tive and osteoconductive properties as well as introducing new osteogenic bone marrow cells to the non-union site. Non-union site exposure, essential to remove pathological tissues and to open medullary canal, must be performed by gently dissecting the soft tissues to lower the infection risk and to save the periosteal vascularisa-tion. The authors report their experience using locked reamed intramedullary nailing combined with cancellous and/or cortical-cancellous autologous bone grafts for the treatment of uninfected non-union, non-biologically active delayed union and limited post-traumatic bony defects in 15 cases. Based on our experience, such a procedure is reliable and with excellent biological and mechanical properties, as all of the lesions healed at the end of the treatment without complications. In these “bone callus” diseases, which always provide clinical and psychological discomfort, this procedure has demonstrated good results and, because of this, in our series, has also been used for the treatment of delayed union.
