Nahhas CR, et al. - Authors examined mid-term survivorship of total hip arthroplasty (THA) among 221 subjects who underwent a primary THA using the ALFA II modular stem by a single surgeon between 2002 and 2004. At a mean 6.5-year follow-up, all-cause survivorship of the modular stem system was 81%. They noted that 52.0% of 25 cases requiring revision surgery were for dissociation of the modular components, 32.0% for fracture of the prosthesis, 12.0% for instability/multiple dislocations, and 4.0% for chronic septic THA. They observed body mass index (odds ratio = 1.080) and offset (odds ratio = 1.254) as independent risk factors for mechanical failures of the modular stem system. The interesting modular stem hip system in this study showed a high mid-term follow-up failure rate, and the authors warned against using similar designs in primary THAs.