Femoral fixation in the face of considerable bone loss: the use of modular stems.

Considerable femoral bone loss can be encountered in the multiply revised total hip arthroplasty patient. Deficient proximal bone requires either a bulk allograft or a femoral component that allows stable distal fixation. Extensively coated stems have shown excellent results for many revisions but have shown higher rates of failure among patients with femoral remodeling in retroversion, an enlarged endosteal diameter, or an ectatic canal. A modular tapered stem is an alternative in this subset of patients. A modular tapered implant provides axial and rotational stability through the use of distal splines, and the proximal body segments can allow independent adjustment of leg length, offset, and anteversion.