What Is the Difference Between Modular and Nonmodular Tapered Fluted Titanium Stems in Revision Total Hip Arthroplasty

Both modular and nonmodular tapered fluted titanium stems are used in revision total hip arthroplasty (THA), with follow-up showing good results for both stems. We aimed to determine whether there were any differences in clinical outcomes, survivorship, or frequency of complications. A retrospective review of 160 consecutive THAs (153 patients) revised with a tapered fluted modular titanium stem from 2002 to 2014 and 129 consecutive THAs (128 patients) revised with a tapered fluted nonmodular titanium stem between 2008 and 2014 was conducted. The patient's level of satisfaction, clinical assessment, and complications were examined. A Kaplan-Meier survivorship analysis was performed with the endpoint defined as any reoperation due to septic/aseptic complications. Mean duration of follow-up was longer in the modular group (6.3 years) than the nonmodular group (5.0 years; P = .003). No significant group differences were found in the postoperative Harris Hip Score, the level of overall satisfaction, the 8-year cumulative survival, the rate of infection, dislocation, or postoperative periprosthetic fractures. However, intraoperative fractures occurred significantly more frequently in the modular group (16.9%) than in the nonmodular group (7.0%; P = .011), and stem subsidence was significantly less in the modular group (0.95 mm) than in the nonmodular group (1.93 mm; P = .001). Two mechanical failures associated with the modular design occurred in the modular group. Both modular and nonmodular tapered fluted titanium stems provide satisfactory midterm results in revision THA. Although tapered fluted modular stems are gaining in popularity in revision THA, tapered fluted nonmodular stems should not be disregarded as a viable alternative, especially for relatively straightforward cases.