This article by Ritesh R. Shah, MD, and colleagues provides important information regarding the durability of one particular modular femoral stem. This implant system allows multiple different distal fixation options, but only the tapered conical implants are depicted, and it is not clear whether there was variability in usage in the study.

Modular implants have a history of specific problems, such as implant fracture and subsidence. The absence of these outcomes in the study speaks to improvements in implant design (modular junction strength, taper angle, surface roughness) and reamer-to-implant relationship. More information on the failures and how they were managed would have been instructive in understanding the features that might have led to fixation failure. One must presume that the patients with loosening were not included in the subsidence data. Periprosthetic fracture distal to a diaphyseal engaging stem is a known complication in osteoporotic revision patient population, and the prevalence reported is in keeping with other reports.

Survivorship is a critical factor in assessing implant systems and their usage in specific clinical circumstances. Further follow-up of these patients will continue to provide data for better understanding how to achieve long survivorship more uniformly.