Head-neck troubles with modular hip implants

The arthroplasty community currently feels that the advantages gained from modularity in hip implants outweigh the risks, but this Watch raises that risk-benefit question again. The decision to issue the Watch was prompted by a case report by Swann et al. in the August 26, 2015 JBJS Case Connector and a report by Arvinte et al. in the April 22, 2015 JBJS Case Connector. Those two reports described three patients who experienced a complete head-neck dissociation seven to fourteen years after hip replacements that used modular components. The Watch also includes relevant findings from elsewhere in the recent orthopaedic literature to help surgeons better understand and minimize the risks.

In the August 26, 2015 edition of JBJS Case Connector, Swann et al. described two patients who experienced sudden head-neck dissociation seven years after hip-replacement surgery. In the April 22, 2015 JBJS Case Connector, Arvinte et al. reported on a patient who presented with a similar problem fourteen years after receiving a modular hip replacement.

The head-neck failures described in this Watch represent a unique opportunity for orthopaedists and industry to work together to conduct multicenter retrieval studies to better understand, and prevent, these rare but serious outcomes.

"The publication of 'Watches' helps fulfill our mission to serve the orthopaedic community," commented Marc Swiontkowski, MD, Editor-in-Chief of JBJS and co-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."