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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.

Overview

Modular components provide numerous intraoperative options in primary and revision total hip arthroplasty [1]. The long-term effects of additional junctions in these modular components remain unknown [1]. The choice between modular and monoblock stems should be tailored to individual patient needs and specific clinical scenarios [28]. Routine use of a modular femoral stem in the primary setting is recommended against unless absolutely necessary [16].

The variable-axis prosthesis design appears to offer promise in controlling prosthetic loosening [2]. 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]. Combinations of short modular components lead to reproducibly good outcomes in femoral revision with respect to subsidence and loosening [18]. Complications related to the use of dual modular stems of a specific design outweigh the potential benefits [23].

The past decade in total hip arthroplasty has been unsettling and disappointing due to harms from new implants, but expansion of indications, evolving patient demographics, and the necessity of innovation must be considered alongside rigorous registry surveillance and graduated introduction of new devices [24]. It is mandatory to consider both components to determine the accurate impingement-free prosthetic range of motion in total hip arthroplasty [21]. A resurfaced allograft-prosthesis composite could be an alternative surgical option in very young children to preserve bone stock and achieve good functional outcomes, although success may be limited by a high risk of complications [76].

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 [17]. The prosthesis tested exhibits kinematic behavior similar to that in their normal state, with no difference in quadriceps force required for extension [29]. 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 [53]. 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 [60].

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 [95].

Implant Design 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]. 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]. Deformed acetabular shells produced higher frictional torque than spherical shells [90]. It is likely that impaction deformation with consequent friction, wear, and micromotion contributed to the early failure of the Durom acetabular component [91]. The design of the acetabular assembly should be modified to prevent separation of the components [93]. The higher stress in the HX-PE at a steep acetabular cup position did not result in increased wear in the present wear simulator study [94].

Bearing Surfaces and Complications

The squeaking hip is a peculiar phenomenon unique to hard-on-hard bearing surfaces [62]. 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]. Repetitive extreme motion of the involved hip and malposition of the implants can cause impingement after hip resurfacing arthroplasty [92]. Other surgical, implant and patient factors should be considered when determining the mechanisms of failure of large diameter metal-on-metal hip arthroplasties [87].

Long-Term Outcomes and Failure Modes

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]. Increasing symptoms and decreased function related to degenerative hip disease may occur fifteen to twenty years after the procedure [89].

Classification

Purpose and Scope: The primary objective of current classification efforts is to describe the distribution of causes of painful prostheses in daily clinical practice rather than to create a decision tree, which remains based on expert opinion [4]. 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 [59]. Identification of outlier prostheses is one area that may improve overall joint replacement outcomes, although further research is needed to determine the optimum methods for identification [12].

Femoral Stem Classifications: * Cemented Stem Geometry: The proposed classification system categorizes cemented stem implants as taper-slip (Type I) or composite beam (Type II) with further subdivisions based on geometry and surface finish [47]. * Cementless Stem Types: The proposed classification system allows for the easy classification of all currently used cementless femoral stem types [50]. * Stem Length: The authors suggest a classification system for the length of femoral stems to better organize the discussion on stem length [48]. * Revision Reconstruction: 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 [46].

Taper and Modular Connections: The study presents an overview on the characteristics and variations of modular hip taper connections and presents a new classification system regarding the surface finish [45].

Periprosthetic Fractures: 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 [49].

Other Considerations: * 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 be different [17]. * Wear and Activity: The wear of prostheses during various activities of daily living (ADLs) is distinctly different, suggesting that more attention should be paid to the influence of ADLs on wear evaluation and prosthesis design [13]. * Kinematics: The prosthesis tested exhibits kinematic behavior similar to that in the normal state, with no difference in quadriceps force required for extension [29]. * Registry Limitations: 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 [52]. * Debris Composition: The composition of the implant and the size of the modular femoral head were most strongly related to the concentration of debris in tissue [63]. * Modular Head Safety: 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 [65].

Clinical Presentation

The clinical evaluation of painful prostheses requires a systematic approach to identify the underlying etiology. History and Physical Examination: A thorough assessment involving clinical history, focused physical examination, and laboratory tests is essential to identify potential differential diagnoses in patients with painful non-metal-on-metal total hip arthroplasty [39]. For aseptic loosening, diagnosis relies on careful history, focused clinical exam, and serial radiographs as the cornerstone of evaluation [9]. However, different methods may be necessary to diagnose endoprosthetic loosening depending on the specific type of implant examined [10].

Imaging and Diagnostic Modalities: MRI provides real-time assessment of conditions at the prosthesis and can guide intervention [3]. In daily clinical practice, the distribution of causes of painful prostheses is described empirically rather than derived from a decision tree based on expert opinion [4]. Identification of outlier prostheses may improve overall joint replacement outcomes, though further research is needed to determine optimum identification methods [12].

Inspection and Special Tests: Clinicians should heighten suspicion for metallosis secondary to hardware failure when encountering patients with skin discoloration in the setting of a painful and poorly functioning hip arthroplasty [43]. Component malposition is frequently present among patients requiring revision shoulder arthroplasty and occurs in consistent patterns [40].

Stability and Construct Integrity: Critical factors for success in surgical management of periprosthetic fracture between total elbow and shoulder prostheses include proper evaluation of prosthetic stability, restoration of anatomy, minimizing soft tissue insult, and achieving fixation with a sufficiently rigid construct [5]. Modularity of femoral components in total hip arthroplasty offers intraoperative options, but long-term effects of additional junctions remain unknown [1]. Variable-axis knee prosthesis design appears to offer promise in controlling prosthetic loosening [2].

Red-Flag Patterns and Wear: Systemic distribution of metallic and polyethylene wear particles was a common finding in patients with both failed and primary total joint prostheses [42]. 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 [13]. Patients with modular metal-on-metal prostheses should be closely monitored for signs of adverse reaction towards corrosion by-products [8].

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 in the three-year RSA evaluation of vitamin E diffused highly cross-linked polyethylene were stable based on radiographic and clinical examinations with no signs of loosening at 3 years [15]. The Restoration Modular stem had excellent clinical and radiographic performance in patients with significant femoral bone loss [27]. 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 study 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 because 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 periprosthetic joint infection (PJI) in patients with total hip arthroplasty [78]. Metal artifact reduction MRI is advised in all patients with metal-on-metal hip arthroplasties [84]. All patients with recalled modular taper junction implants (e.g., Rejuvenate stems) should undergo baseline MRI surveillance [77]. Revision should be performed promptly in symptomatic patients or those with significant MRI findings to prevent abductor compromise [77].

Other Considerations: 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]. Technologic advances in implant materials, design, amputee care, and imaging continue to drive improvements in patient care and outcomes [14]. 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 [31]. Metal ion levels are not sufficient as a screening measure for adverse reactions in metal-on-metal hip arthroplasties [84]. The revision rate for Rejuvenate stems was 51% [77]. A titanium-encased ceramic liner total hip arthroplasty acetabular component demonstrates favorable and safe clinical and radiological outcomes with over 15 years of follow-up [85].

Treatment

Non-Operative

The provided evidence does not contain specific data supporting conservative management options such as weight loss, physical therapy, or injections.

Operative

Indications: Routine use of a modular femoral stem in the primary setting is not recommended unless absolutely necessary [16]. 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 [102].

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 [5]. 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 [61]. Determining the accurate impingement-free prosthetic range of motion in total hip arthroplasty requires consideration of both components [21].

Implant Selection: Noncemented press-fit femoral stems predominate in total hip arthroplasty with generally excellent long-term survivorship [104]. 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 demonstrates excellent clinical and radiographic performance in patients with significant femoral bone loss [27]. Modular tapered titanium stems offer viable alternatives with high survival rates and bone stock restoration in revision arthroplasty of the hip [66]. Use of an uncemented metaphyseal sleeve with a rotating hinge prosthesis in revision total knee arthroplasty demonstrates good survivorship and improvement in knee pain [7]. Survivorship of modular cemented stems in revision total knee arthroplasty is comparable to early series of nonmodular cemented stems and similar to recent shorter-term follow-up series of modular uncemented stems [32]. Use of combinations of short modular components leads to reproducibly good outcomes in femoral revision with respect to subsidence and loosening [18]. A non-fluted, press-fit stem used with a tumor prosthesis provides a stable bone-prosthesis interface at midterm follow-up [99]. Provided with a well-functioning modular junction, non-metal-on-metal large-head total hip arthroplasty offers an appealing option [103].

Alignment / Balancing Strategy: Accurate placement of components and restoration of knee stability are critical requirements for the success of polycentric total knee prostheses [30]. Suboptimum placement of components (greater than 50°-60° of cup abduction) in Birmingham Hip Resurfacing Arthroplasty leads to high wear and metallosis [96].

Pain Management: The provided evidence does not contain specific data on analgesia regimens.

Adjuncts: The provided evidence does not contain specific data on adjuncts such as tourniquet, tranexamic acid, drains, navigation, or robotics.

Revision: Revision of a stable component is not justifiable based on its long duration in use, non-ideal position, or possible loosening on radiographs [31]. The choice between modular and monoblock stems in revision total hip arthroplasty should be tailored to individual patient needs and specific clinical scenarios [28]. Component revision and reimplantation after failed reverse total shoulder arthroplasty can effectively relieve pain and improve function compared with baseline values, with moderately high patient satisfaction levels [54]. 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 [55]. 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].

Other Considerations: The ten-year survival rate for total hip arthroplasty after operative treatment of an acetabular fracture is 78 percent [25]. Functional outcomes and 10-year implant survival rates are worse in patients undergoing proximal femoral replacement for failed revision arthroplasty compared to those with oncologic indications [26]. Expansion of indications, evolving patient demographics, and the necessity of innovation must be considered alongside the need for rigorous registry surveillance and graduated introduction of new devices to address harms from new implants [24]. Evidence for indications, basic science data on corrosion risk, and ongoing questions and concerns regarding dual mobility implants should be reviewed to provide a balanced critical assessment [64]. 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 [67]. The Mayo femoral stem presents a high aseptic loosening rate when compared to non-conservative stems [97].

Complications

Aseptic loosening: Prosthetic loosening is often 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 [37]. The variable-axis knee prosthesis design appears to offer promise in controlling this complication [2]. Long-term survivorship of highly cross-linked polyethylene liners should be observed to determine whether early wear impacts aseptic loosening [19]. At 15 years, all 143 proximally HA-coated tapered titanium femoral components remained well fixed and clinically asymptomatic [38]. Substantial amounts of bone ingrowth can occur reproducibly in well-functioning, stable cementless femoral prostheses, exceeding what is typically found in implants removed due to pain, loosening, or infection [101].

Instability: In proximal femoral replacement for severe femoral bone loss, dislocation continues to be the most common complication despite good five-year survivorship [51].

Polyethylene wear: Alumina ceramic-on-ceramic bearings in cementless total hip arthroplasty showed excellent implant survival, excellent functional outcomes, and minimal late complications at long-term follow-up [11]. Minimum 10-year follow-up demonstrated durable fixation and reduced wear with contemporary acetabular components and cross-linked polyethylene compared to historical controls in patients aged 50 and under [36]. The long-term effect of elevated-rim acetabular liners on wear and loosening remains unknown, and routine use is not currently advocated [56].

Other Considerations: Modularity of femoral components in total hip arthroplasty introduces additional junctions whose long-term effects remain unknown [1]. Patients with modular metal-on-metal prostheses should be closely monitored for signs of adverse reaction towards corrosion by-products [8]. Monobloc dual mobility components demonstrated excellent implant survivorship, radiographic fixation, and improved functional outcomes at mid-term follow-up in primary total hip arthroplasty [20]. Acetabular revision using a cementless protrusio shell demonstrated excellent survivorship results at midterm follow-up, equal to outcomes for revisions using hemispherical shells [22]. Contemporary revision acetabular components have dramatically improved upon historical results at available follow-up [35]. Revision total knee arthroplasty using an uncemented metaphyseal sleeve rotating hinge prosthesis demonstrated good survivorship and improvement in knee pain [7]. Complications related to the use of dual modular stems of a specific design outweigh the potential benefits [23]. Painful prostheses have a distribution of causes in daily clinical practice that was described rather than defined by a decision tree based on expert opinion [4]. Understanding the history of taper design and geometry, the track record of older implants, and the rationale behind current prostheses helps surgeons assess the pros and cons of new implants [33]. Stepwise or graduated introduction of new prostheses is important, requiring substantial study periods and registry surveillance to identify risks [34]. A small percentage of implants used for primary hip and knee arthroplasty remain unproven regarding long-term survivorship data [57]. Bipolar radial head arthroplasty resulted in major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, despite mainly good clinical results [98]. Future developments in bearing surfaces and robotic assistance may expand indications for hip resurfacing while mitigating historical complications [100].

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: MRI provides real-time assessment of conditions at the prosthesis and can guide intervention [3]. Revision total knee arthroplasty using an uncemented metaphyseal sleeve rotating hinge prosthesis demonstrates good survivorship and improvement in knee pain [7]. Alumina ceramic-on-ceramic bearings in cementless total hip arthroplasty show excellent implant survival, excellent functional outcomes, and minimal late complications at long-term follow-up [11]. Monobloc dual mobility components demonstrate excellent implant survivorship, radiographic fixation, and improved functional outcomes at mid-term follow-up in primary total hip arthroplasty [20]. Acetabular revision using a cementless protrusio shell yields excellent survivorship results at midterm follow-up, comparable to outcomes for revisions using hemispherical shells [22]. The ten-year survival rate for prostheses following operative treatment of an acetabular fracture is 78 percent [25]. Functional outcomes and 10-year implant survival rates are worse in revision arthroplasty patients compared to oncologic patients undergoing proximal femoral replacement [26]. Survivorship of modular cemented stems in revision total knee arthroplasty is comparable to early series of nonmodular cemented stems and similar to recent shorter-term follow-up series of modular uncemented stems [32]. Contemporary revision acetabular components have dramatically improved upon historical results at available follow-up [35]. Contemporary acetabular components and cross-linked polyethylene demonstrate durable fixation and reduced wear compared to historical controls at minimum 10-year follow-up in patients aged 50 and under [36]. Proximally HA-coated tapered titanium femoral components remained well fixed and clinically asymptomatic at 15 years [38]. Extensively porous-coated cylindrical stems used for femoral revision demonstrate excellent survivorship with long-term follow-up [58]. The Wagner cone femoral prosthesis demonstrates excellent clinical, radiographic, and patient-reported functional outcomes at midterm follow-up [69]. Ceramic-on-ceramic bearings for primary total hip arthroplasty exhibit high survivorship and excellent functional outcomes for at least 10 years [74]. Implantation of a short femoral neck hip prosthesis results in no significant changes in bone mineral density in all regions except one at 60 months, which is less change than seen with conventional implants [106].

Other Considerations: Long-term survivorship of highly cross-linked polyethylene liners requires further observation to determine if early wear impacts aseptic loosening [19]. Understanding the history of taper design, geometry, and the track record of older implants helps surgeons choose appropriate implants and assess new prostheses [33]. The stepwise or graduated introduction of new prostheses is important, requiring substantial study periods and registry surveillance to identify risks [34]. Prosthetic loosening is often initiated during or shortly after surgery, with subsequent progression affected by biomechanical factors, fluid pressure fluctuations, and inflammatory responses to necrotic cells and fragments [37]. Aseptic loosening was the major reason for failure of Sikomet metal-on-metal total hip replacements after a mean follow-up of seven years [105].

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)
  • [L5] The purpose of the article was to describe the distribution of causes of painful prostheses in daily clinical practice rather than to create a decision tree, which was based on expert opinion. (10.1016/j.arth.2019.06.001)
  • [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)
  • [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)
  • [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 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)
  • [L5] The authors agree that the past decade has been unsettling and disappointing due to harms from new implants but argue that expansion of indications, evolving patient demographics, and the necessity of innovation must be considered alongside the need for rigorous registry surveillance and graduated introduction of new devices. (10.1016/j.arth.2013.10.012)
  • [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)
  • [L5] The authors agree that stepwise or graduated introduction of new prostheses is important, requiring substantial study periods and registry surveillance to identify risks, but disagree with using Darwinian natural selection as the sole approach to innovation. (10.1016/j.arth.2013.10.013)
  • [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)
  • [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] 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)
  • [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] The authors recommend that all patients with these implants undergo baseline MRI surveillance and emphasize that revision should be performed promptly in symptomatic patients or those with significant MRI findings to prevent abductor compromise, noting a revision rate of 51% for Rejuvenate stems. (10.1016/j.arth.2013.10.028)
  • [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)
  • [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] Future developments in bearing surfaces and robotic assistance may expand the indications while mitigating historical complications. (10.1302/0301-620x.105b5.bjj-2023-0015.r1)
  • [L4] In well-functioning, stable femoral prostheses inserted without cement, a substantial amount of bone ingrowth can occur reproducibly and in excess of what is typically found in implants removed because of pain, loosening, or infection. (10.2106/00004623-199506000-00011)
  • [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] 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)
  • [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)

References

[1] Modularity of the Femoral Component in Total Hip Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2012. DOI: 10.5435/jaaos-20-04-214

[2] The variable-axis knee prosthesis. Two-year follow-up study.. The Journal of Bone & Joint Surgery. 1981. DOI: 10.2106/00004623-198163050-00001

[3] How Useful Is Magnetic Resonance Imaging in Evaluating Adverse Local Tissue Reaction?. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2020.01.009

[4] Response to Letter to the Editor on “Unexplained Painful Hip Arthroplasty: What Should We Find? Diagnostic Approach and Results”. The Journal of Arthroplasty. 2019. DOI: 10.1016/j.arth.2019.06.001

[5] Surgical management of a periprosthetic fracture between a total elbow and total shoulder prostheses: A case report. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.10.003

[6] Custom-designed femoral prostheses in total hip arthroplasty done with cement for severe dysplasia of the hip.. The Journal of Bone & Joint Surgery. 1993. DOI: 10.2106/00004623-199310000-00010

[7] Revision Total Knee Arthroplasty Using an Uncemented Metaphyseal Sleeve, Rotating Hinge Prosthesis: A Case Series of 99 Patients. The Journal of Arthroplasty. 2021. DOI: 10.1016/j.arth.2020.12.047

[8] Corrosion_on_the_Acetabular_Liner_Taper_from_Retrieved_Modular_Metal-on-Metal_To_S0883540314003957. n.d..

[9] Diagnosis and Detection of Subtle Aseptic Loosening in Total Hip Arthroplasty. The Journal of Arthroplasty. 2022. DOI: 10.1016/j.arth.2022.02.060

[10] Use of 18F-FDG-PET in the diagnosis of endoprosthetic loosening of knee and hip implants. Archives of Orthopaedic and Trauma Surgery. 2009. DOI: 10.1007/s00402-009-1000-z

[11] Long-Term Results of Alumina Ceramic-On-Ceramic Bearings in Cementless Total Hip Arthroplasty: A 20-Year Minimum Follow-Up. The Journal of Arthroplasty. 2022. DOI: 10.1016/j.arth.2021.11.028

[12] Identification of implant outliers in joint replacement registries. EFORT Open Reviews. 2023. DOI: 10.1530/eor-22-0058

[13] Which Activity Might Cause the Most Wear of Total Knee Prostheses During Daily Living? A Finite Element Analysis. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.04.028

[14] Chapter 3 Emerging Technologies in Orthopaedic Trauma. 2021.

[15] Three_Year_RSA_Evaluation_of_Vitamin_E_Diffused_Highly_Cross-linked_Polyethylene_S0883540315001291. n.d..

[16] Modular Femoral Neck Fracture After Primary Total Hip Arthroplasty. The Journal of Arthroplasty. 2013. DOI: 10.1016/j.arth.2012.03.050

[17] The Interconnected Ancestral Network of Hip Arthroplasty Device Approval. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-21-00138

[18] Fixation of a modular curved revision stem with a taper of 2° in the femur. Archives of Orthopaedic and Trauma Surgery. 2018. DOI: 10.1007/s00402-018-3067-x

[19] Different wear in two highly cross-linked polyethylene liners in THA: wear analysis with EBRA. Archives of Orthopaedic and Trauma Surgery. 2021. DOI: 10.1007/s00402-021-03832-0

[20] Monobloc Dual Mobility With a Minimum 5-Year Follow-Up: A Safe and Effective Solution in Primary Total Hip Arthroplasty. The Journal of Arthroplasty. 2022. DOI: 10.1016/j.arth.2021.09.002

[21] The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001233

[22] Acetabular Revision Using a Cementless Protrusio Shell: Clinical and Radiographic Analysis at Midterm Follow-Up. The Journal of Arthroplasty. 2007. DOI: 10.1016/j.arth.2006.12.073

[23] Corrosion_and_Adverse_Local_Tissue_Reaction_in_One_Type_of_Modular_Neck_Stem_S0883540315003290. n.d..

[24] Response to William Harris' Editorial: Last Decade in THA: Unsettling and Disappointing. The Journal of Arthroplasty. 2014. DOI: 10.1016/j.arth.2013.10.012

[25] Total Hip Arthroplasty after Operative Treatment of an Acetabular Fracture. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199809000-00008

[26] Different outcomes after proximal femoral replacement in oncologic and failed revision arthroplasty patients - a retrospective cohort study. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04673-z

[27] Revision_Total_Hip_Arthroplasty_With_Modular_Femoral_Stems_S0883540314004239. n.d..

[28] Is There a Difference Between Modular Versus Monoblock Femoral Stems Used During Revision Total Hip Arthroplasty?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2024.10.123

[29] Assessment of a Medial Pivot Total Knee Arthroplasty Design in a Cadaveric Knee Extension Test Model. The Journal of Arthroplasty. 2012. DOI: 10.1016/j.arth.2012.02.008

[30] Failed polycentric total knee prostheses. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658060-00005

[31] One-Component_Revision_in_Total_Hip_Arthroplasty_The_Fate_of_the_Retained_Compon_S088354031400312X. n.d..

[32] Revision Total Knee Arthroplasty With Modular Cemented Stems: Long-Term Follow-Up. The Journal of Arthroplasty. 2007. DOI: 10.1016/j.arth.2006.12.058

[33] Trunnions and Modularity in Total Hip Arthroplasty: A Historical Review With Current Clinical Implications. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-00498

[34] Response to Dr. Mont. The Journal of Arthroplasty. 2014. DOI: 10.1016/j.arth.2013.10.013

[35] Comparative Survival of Contemporary Cementless Acetabular Components Following Revision Total Hip Arthroplasty. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2023.03.093

[36] Fixation_and_Wear_With_Contemporary_Acetabular_Components_and_Cross-Linked_Polye_S0883540315003769. n.d..

[37] Is early migration enough to explain late clinical loosening of hip prostheses?. EFORT Open Reviews. 2020. DOI: 10.1302/2058-5241.5.190014

[38] Late Remodeling Around a Proximally HA-coated Tapered Titanium Femoral Component. Clinical Orthopaedics & Related Research. 2009. DOI: 10.1007/s11999-008-0550-7

[39] Metal Articulations as a Source of Total Hip Arthroplasty Pain. The Journal of Arthroplasty. 2022. DOI: 10.1016/j.arth.2022.01.063

[40] Humeral and glenoid component malposition in patients requiring revision shoulder arthroplasty: a retrospective, cross-sectional study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.11.015

[41] Management of Periprosthetic Joint Infection After Total Hip Arthroplasty Using a Custom Made Articulating Spacer (CUMARS); the Exeter Experience. The Journal of Arthroplasty. 2014. DOI: 10.1016/j.arth.2014.04.013

[42] Dissemination of Wear Particles to the Liver, Spleen, and Abdominal Lymph Nodes of Patients with Hip or Knee Replacement. The Journal of Bone and Joint Surgery-American Volume*. 2000. DOI: 10.2106/00004623-200004000-00002

[43] Cutaneous Manifestation of Metallosis in a Metal-on-Metal Total Hip Arthroplasty After Acetabular Liner Dissociation. The Journal of Arthroplasty. 2012. DOI: 10.1016/j.arth.2012.01.008

[44] The infected hip after total hip arthroplasty.. The Journal of Bone & Joint Surgery. 1984. DOI: 10.2106/00004623-198466090-00012

[45] Same Same but Different? 12/14 Stem and Head Tapers in Total Hip Arthroplasty. The Journal of Arthroplasty. 2017. DOI: 10.1016/j.arth.2017.04.027

[46] CLASSIFICATION AND AN ALGORITHMIC APPROACH TO THE RECONSTRUCTION OF FEMORAL DEFICIENCY IN REVISION TOTAL HIP ARTHROPLASTY. The Journal of Bone and Joint Surgery-American Volume. 2003. DOI: 10.2106/00004623-200300004-00001

[47] Cemented Stem Design in Total Hip Arthroplasty: Fixation Philosophies, Biomechanics, and an Updated Classification System. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-00914

[48] Is the length of the femoral component important in primary total hip replacement?. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b4.33036

[49] Reliability and validity of the Unified Classification System for postoperative periprosthetic femoral fractures around cemented polished taper-slip stems. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b8.bjj-2021-0021.r1

[50] A New Classification System for Cementless Femoral Stems in Total Hip Arthroplasty. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2022.09.014

[51] Proximal femoral replacement in contemporary revision total hip arthroplasty for severe femoral bone loss. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b3.bjj-2016-0822.r1

[52] Modular neck femoral stems. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b8.31525

[53] Head size in primary total hip arthroplasty. EFORT Open Reviews. 2018. DOI: 10.1302/2058-5241.3.170061

[54] Failure after reverse total shoulder arthroplasty: what is the success of component revision?. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.05.029

[55] Hip and Knee Section, Treatment, Prosthesis Factors: Proceedings of International Consensus on Orthopedic Infections. The Journal of Arthroplasty. 2019. DOI: 10.1016/j.arth.2018.09.030

[56] The Elevated-Rim Acetabular Liner in Total Hip Arthroplasty. The Journal of Bone & Joint Surgery. 1996. DOI: 10.2106/00004623-199601000-00011

[57] Implant Use for Primary Hip and Knee Arthroplasty. The Journal of Arthroplasty. 2013. DOI: 10.1016/j.arth.2012.11.012

[58] Extensively Porous-Coated Stems for Femoral Revision. The Journal of Arthroplasty. 2007. DOI: 10.1016/j.arth.2007.01.002

[59] Evaluation and management of chronic total hip instability. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b1.36516

[60] Functional orientation of the acetabular component in ceramic-on-ceramic total hip arthroplasty and its relevance to squeaking. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b7.37062

[61] Total hip arthroplasties: What are the reasons for revision?. International Orthopaedics. 2007. DOI: 10.1007/s00264-007-0364-3

[62] The Squeaking Hip: An Underreported Phenomenon of Ceramic-On-Ceramic Total Hip Arthroplasty. The Journal of Arthroplasty. 2007. DOI: 10.1016/j.arth.2006.12.012

[63] Characterization and Comparison of Wear Debris from Failed Total Hip Implants of Different Types. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199608000-00014

[64] Introduction: Dual-Mobility Total Hip Arthroplasty: A Durable Game Changer or the Next Cause for Concern?. The Journal of Arthroplasty. 2021. DOI: 10.1016/j.arth.2021.01.048

[65] A Modular Head-Neck Adapter System and Ceramic Heads in Revision Hip Arthroplasty: A Registry Study on 354 Implants. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2023.01.055

[66] Modular tapered titanium stems in revision arthroplasty of the hip. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b1.36442

[67] We agree that progressive wear increases the eccentric loads on the liner. However, the mea. 2002.

[68] Range of Motion in a Modular Femoral Stem System with a Variety of Neck Options. The Journal of Arthroplasty. 2013. DOI: 10.1016/j.arth.2012.10.011

[69] Wagner Cone Midterm Survivorship and Outcomes. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2020.03.015

[70] Long-stemmed humeral components in primary shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.01.008

[71] Radiographic and Clinical Outcomes of Porous Titanium-Coated and Plasma-Sprayed Acetabular Shells. Journal of Bone and Joint Surgery. 2018. DOI: 10.2106/jbjs.17.00729

[72] Chapter 12 Hip Microinstability. 2019.

[73] Male gender, Charnley class C, and severity of bone defects predict the risk for aseptic loosening in the cup of ABG I hip arthroplasty. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-243

[74] Primary Total Hip Arthroplasty With Ceramic-On-Ceramic Articulations: Analysis of a Single-Center Series of 1,083 Hips at a Minimum of 10-Year Follow-Up. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2022.12.009

[75] Dislocation After Total Hip Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2004. DOI: 10.5435/00124635-200409000-00006

[76] What Is the Revision-free Survival of Resurfaced Allograft-prosthesis Composites for Proximal Humerus Reconstruction in Children With Bone Tumors?. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000002969

[77] Letter to the Editor: In Response to “Modular Taper Junction Corrosion and Failure: How to Approach a Recalled Total Hip Arthroplasty Implant”. The Journal of Arthroplasty. 2014. DOI: 10.1016/j.arth.2013.10.028

[78] Metal Artefact Reduction Sequences (MARS) in Magnetic Resonance Imaging (MRI) after Total Hip Arthroplasty (THA). BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05560-x

[79] Corrosion at the head-neck interface of current designs of modular femoral components. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b5.35592

[80] Radiographic Accuracy of Malseated Dual-Mobility Liners Varies Based on Implant Design. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2023.05.020

[81] The radiological evaluation of the hip joint after prosthetic arthroplasty of the proximal femur in patients with a tumour using a bipolar femoral head. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b12.36366

[82] The Accuracy and Reproducibility of Radiographic Assessment of Stress-Shielding. The Journal of Bone and Joint Surgery-American Volume. 2000. DOI: 10.2106/00004623-200010000-00007

[83] Agreement Between Proximal Femoral Geometry and Component Design in Total Hip Arthroplasty: Implications for Implant Choice. The Journal of Arthroplasty. 2016. DOI: 10.1016/j.arth.2016.02.015

[84] Metal Ion Levels Not Sufficient as a Screening Measure for Adverse Reactions in Metal-on-Metal Hip Arthroplasties. The Journal of Arthroplasty. 2013. DOI: 10.1016/j.arth.2012.05.029

[85] Long-Term Outcomes of a Titanium-Encased Ceramic Liner Total Hip Arthroplasty (15 to 21Year Results). The Journal of Arthroplasty. 2021. DOI: 10.1016/j.arth.2021.06.016

[86] Does High Hip Center Decrease Range of Motion in Total Hip Arthroplasty? A Computer Simulation Study. The Journal of Arthroplasty. 2016. DOI: 10.1016/j.arth.2016.03.014

[87] The effect of using components from different manufacturers on the rate of wear and corrosion of the head–stem taper junction of metal-on-metal hip arthroplasties. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b7.36554

[89] Colonna Arthroplasty with Concomitant Femoral Shortening and Rotational Osteotomy. Long-Term Results. The Journal of Bone and Joint Surgery-American Volume*. 1997. DOI: 10.2106/00004623-199701000-00009

[90] The Effects of Acetabular Shell Deformation and Liner Thickness on Frictional Torque in Ultrahigh-Molecular-Weight Polyethylene Acetabular Bearings. The Journal of Arthroplasty. 2010. DOI: 10.1016/j.arth.2009.03.020

[91] Does_Deformation_of_Metal-On-Metal_Acetabular_Components_Contribute_to_Early_Fai_S0883540310000367. n.d..

[92] Impingement Between the Acetabular Cup and the Femoral Neck After Hip Resurfacing Arthroplasty. Journal of Bone and Joint Surgery. 2011. DOI: 10.2106/jbjs.j.01771

[93] Postoperative separation of the femoral and acetabular components of a single-assembly total hip (Bateman) replacement.. The Journal of Bone & Joint Surgery. 1979. DOI: 10.2106/00004623-197961050-00024

[94] The_Divergence_of_Wear_Propagation_and_Stress_at_Steep_Acetabular_Cup_Positions_S0883540315001369. n.d..

[95] High Placement of an Acetabular Component Inserted without Cement in a Revision Total Hip Arthroplasty. Results After a Mean of Ten Years. The Journal of Bone & Joint Surgery*. 1999. DOI: 10.2106/00004623-199904000-00004

[96] In Vivo Wear Rate of the Birmingham Hip Resurfacing Arthroplasty. The Journal of Arthroplasty. 2009. DOI: 10.1016/j.arth.2008.06.022

[97] Aseptic_Loosening_Rate_of_the_Mayo_Femoral_Stem_With_Medium-Term_Follow_Up_S0883540314004318. n.d..

[98] Mid- to long-term results after bipolar radial head arthroplasty. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.05.022

[99] Midterm Success of a Custom, Non-Fluted, Diaphyseal, Press-Fit Stem Used With a Tumor Megaprosthesis System. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2019.12.032

[100] Hip resurfacing. The Bone & Joint Journal. 2023. DOI: 10.1302/0301-620x.105b5.bjj-2023-0015.r1

[101] Evaluation of bone ingrowth in proximally and extensively porous-coated anatomic medullary locking prostheses retrieved at autopsy.. The Journal of Bone & Joint Surgery. 1995. DOI: 10.2106/00004623-199506000-00011

[102] On Improving Total Knee Arthroplasties: Sometimes “Progress” Leads Us Nowhere?. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2020.04.031

[103] Despite higher revision rate, MoM large-head THA offers better clinical scores than HR: 14-year results from a randomized controlled trial involving 48 patients. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04286-6

[104] Selecting a Press-fit Stem for Total Hip Arthroplasty: The Rationale and Evolution of the Modern Femoral Prosthesis. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-22-00074

[105] Survivorship and Retrieval Analysis of Sikomet Metal-on-Metal Total Hip Replacements at a Mean of Seven Years. The Journal of Bone & Joint Surgery. 2006. DOI: 10.2106/jbjs.e.00604

[106] Bone mineral density after implantation of a femoral neck hip prosthesis – a prospective 5 year follow-up. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0624-0

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Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

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.