Modular stems in DDH.

The Modulus (Lima-Lto) system has been created on the association of a conical stem and a modular neck in order to address the so called "difficult hip". Modularity can maximize the options for a correct reconstruction in a total hip replacement of the coxofemoral anatomy as well as biomechanics. Modulus should be used in CDH, primary hip arthritis, the sequelae of osteotomies and in each case in which we face a congenital or acquired hip deformity. The Modulus stem has been commonly utilised in association with the Delta cup (Lima-Lto) with the chance to use big diameter heads (32-36 mm) and ceramic on ceramic coupling. Modulus has been used in association with Delta cup since November 2002. 51 patients affected by CDH have been treated. Clinical and radiographic results can be considered very good. The average evaluation based on Merle D'Aubigné schedule is equal to 17.5 with a significant increase in the results with respect to the preoperatory score (with an average score equal to 10). In the light of the above, Modulus should be considered a valuable system to optimize the results of total hip replacement also in those more complex situations with a modified femoral morphology, allowing the restoration of a normal biomechanics in terms of off-set and anteversion with benefit in terms of stability and length of the implant as well as in terms of satisfaction of the patient as far as limb length and ROM are concerned. The association of Modulus with big diameter heads gives a higher guarantee in terms of duration of the implant and restoration of the functionality in young patients with a serious deformity and increased functional demands.