JBJS Case Connector, an online case report journal published by The Journal of Bone and Joint Surgery, has issued a "Watch" regarding femoral neck fractures in patients whose implants used modular head-neck and neck-stem designs. While some of these designs are no longer available from manufacturers, thousands of such devices have already been implanted. This Watch encourages surgeons to be wary about one specific aspect of modular hip designs: long femoral necks.
This "Watch" is based on a case presented in the January 22, 2014 issue of JBJS Case Connector and three previously published cases. Modularity and long femoral neck length are the common denominators among all the cited cases. While the "Watch" recognizes the desirable outcome of optimized hip biomechanics--particularly for younger, active patients--these cases indicate a real risk of fracture that should be discussed with patients.
To enhance clinical outcomes and improve patient safety, JBJS Case Connector is committed to alerting the orthopaedic community about potentially problematic devices or therapeutic approaches. When two or more such cases with similar mechanisms appear, our editors will identify the procedure or implant as a "watchable" intervention to sharpen the focus of clinicians on the potential for similar problems, encourage publication of these cases and thereby enhance clinical outcomes and patient safety.
"The publication of 'Watches' helps fulfill our mission to serve the orthopaedic community," commented Marc Swiontkowski, MD, editor of JBJS Case Connector. "The 'Watch' designation may encourage the orthopaedic community to either demonstrate that these are isolated, unrelated cases or sharpen the focus further by rigorously evaluating the intervention and/or reporting related cases."
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