Modular hip designs offer potential for customising the implant to the patient. However, the more features a device has to offer, the potential for misuse increases. This paper will review one modular stem and the pearls learned over the years to make this a simple and reproducible surgical technique.

Over a 1,000 primary THA have been performed since the development of the proximal modular stem in 2000. The two senior surgeons developed the stem design and surgical techniques used and described here. Two additional surgeon co-authors have used the device as described confirming the design and techniques to be simple, reliable and reproducible.

Often the tricks of the trade go unpublished and each new surgeon is left to his own learning curve with new devices. As with any surgical instrumentation there are significant little techniques that often make surgery more reproducible and enjoyable.

Surgical technique should be simple and reproducible. We have found that even simple procedures—such as head resection—can, and do, impact the surgical process and can affect surgical outcome. Canal reaming, flute engagement, conical reaming, broaching, trochanter clearance, proper use of modular trials and implant assembly all play critical roles to a successful outcome.

We have found, and previously reported, that the use of this proximal modular stem design has reduced our leg length inequalities +/− 5 mm and has all but eliminated dislocations and aseptic loosening.

There were some mechanical failure problems (previously reported) on the first generation modular junction design that was identified and corrected (never exported outside the U.S.). There have been no reported failures since introduction of the improved modular junction six years ago.

Independent selection of femoral offset and vertical height is possible and we feel that restoration of joint mechanics is more reproducible with proximal modular devices as compared to monoblock stems. It is the responsibility of surgeons to communicate their understanding and experience with newer devices and not rely on industry to fill this function.

There has been considerable activity in the past year as a result of the Justice Department Investigation into the medical device industry. There has been an over reaction by many which may negatively impact future research, development and reporting of clinical outcomes. This paper will review some of these activities. A review of professional standards and guidelines has been conducted looking at health care compliance issues as they related to commercial relationships, professional medical societies, individual surgeons, and health care workers with specific focus on disclosure.

Within any important issue, there are always aspects no one wishes to discuss: conflict of interest. Perception of a conflict of interest is often enough to bring about a review of activity.

Overreaction has occurred as a result of government intervention into the medical device industry. Continuing medical education, professional societies by-laws, clinical/surgical publications, medical/legal exposure, product research, development and industry marketing activities have all been impacted.

When professionals fail to provide a proper review process on standards and guidelines on ethical behavior they set themselves up for government oversight and restrictions on their behavior. Be informed and disclose. Know what, when and how to disclose. Protect yourself, no one else will.