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Orthopaedic Surgery Hip
Figure 1: Pre-operative X-ray Figure 3: Post-operative X-ray
Total hip arthroplasty with ABGII uncemented modular stem, long neck varus 125 °, alumina head length 0,
diameter 32 and ABG BII cup with alumina insert for primary osteoarthritis.
Figure 2: Pre-operative Templating Modular Femoral Anatomical Stem and Hip
Replacement Optimisation
During the past 20 years, modular designs have replaced the fixed
head–neck femoral components to allow the surgeon increased intra-
operative flexibility to restore leg length, soft-tissue tension and offset,
to decrease the need for large prosthetic inventories and, when
appropriate in revision THA, to facilitate acetabular exposure and
cup replacement.
The new generation of modular stems includes both modular
head–neck and modular neck–stem junctions. In our practice, we have
adopted the ABGII modular range (see Figures 1, 2 and 3), which
comprises eight right and eight left anatomical stems, as well as 10
modular necks, which are available with the various heads used with
the non-modular systems. Short and long necks are available, with
angulations of 125, 130 and 135°, and in three versions: normo-, ante-
and retroversions of 7°. It offers 18 different head centre positions and
allows optimisation of restoration of length, offset and soft-tissue
tension, as well as optimisation of version, neck angulation and the
components, while improper version of the femoral component and/or femoro–acetabular relationship, whose responsibility for stability, wear,
bad placement of the cup can result in instability, impediment to function and succesful arthroplasty has been demonstrated. The ABGII
functional range of motion during daily activities, edge loading, wear also facilitates the insertion of the implant into small incisions and
and squeaking.
8–10
Version of the proximal femur refers to the enables the full potential of the navigation system to be utilised.
relationship of the axis of the femoral neck to the transepicondylar axis
of the distal femur, and varies considerably from one individual to One of the long-standing concerns with implants that possess multiple
another. Developmental hip dysplasia, trauma and acquired hip sites of modularity is the potential for fretting motion and corrosion to
diseases such as Legg-Calvé-Perthes disease and slipped capital generate particulate metallic debris, which itself could cause an
femoral epiphysis may result in an abnormal degree of femoral osteolytic reaction and third-body polyethylene (PE) wear.
11
Even
version. Non-modular femoral components allow for minor or partial though excellent results have been reported over the past 15 years for
adjustments in version at the time of surgery, particularly the the use of morse taper head–neck-junction modular revision implants,
uncemented and anatomical implants whose position and version are longer follow-up is warranted so that the potential for osteolysis can
directed by the shape of the proximal femur. be evaluated fully. ■
1. Tonino AJ, Rahny AI, and the International ABG Study Group, 4. Charnley J, Low friction arthroplasty of the hip: theory and component orientation on recurrent dislocation, pelvis
The HA-ABG Hip System: 5 to 7 year results from an practice, New York: Springer, 1979. osteolysis, Polyethylene wear and component migration,
International Multicentre Study, J Arthroplasty, 2000;15: 5. Sakalkale DP, Sharkey PF, Eng K, et al., Effect of femoral J Arthroplasty, 1998;13:530–34.
274–82. component offset on Polyethylene wear in Total Hip 9. Walter W, Insley G, Walter WK, et al., Edge loading in
2. Herrera A, Canales V, Anderson J, et al., Seven to 10 years Arthroplasty, Clin Orthop, 2001;388:125–34. third generation alumina ceramic on ceramic bearings,
followup of an Anatomic Hip Prosthesis, Clin Orthop, 6. Noble DC, Alexander JW, Lindahl LJ, et al., The anatomic J Arthroplasty, 2004;19:402–13.
2004;423:129–37. basis of femoral component design, Clin Orthop, 1988;235: 10. Walter W, O’Toole GC, Walter WK, et al., Squeaking in
3. Massin P, Geais L, Astoin E, et al., The anatomic basis for the 148–65. ceramic on ceramic hips, J Arthroplasty, 2007;22:496–503.
concept of lateralized femoral stems: a frontal plane 7. Woo RY, Morrey BF, Dislocations after Total Hip Arthroplasty, 11. Jacobs JJ, Gilbert JL, Urban RM, Corrosion of metal
radiographic study of the proximal femur, J Arthroplasty, J Bone J Surg, 1982;64A:1295–1306. orthopaedic implants, J Bone J Surg, 1998;80A:268–79.
2000;15:93–101. 8. Kennedy JG, Rogers WB, Soffe KE, et al., Effect of acetabular
52 EUROPEAN MUSCULOSKELETAL REVIEW 2007
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