We have a few questions about our C2 stem to Dr. Christian Jager, an orthopedic surgeon with 20 years’ experience in prosthetic surgery and currently Head of Orthopedics and

Traumatology Department at the San Rocco Clinical Institute in Ome,

northern Italy.

Dr. Jager, how long have you used the C2 stem and what type of cases do

you select it for?

We started using the C2 stem in 2000 and have now implanted about 700 implants, mostly joint replacement cases, carried out by me and my team, made of Dr Giuseppe

Saviori and Dr Antonio Scotto.

What in your opinion are the advantages of the C2 stem philosophy?

We chose the C2 stem mainly for its primary and long-term stability thanks to the fixation given by its wedge shape, for the substantial and well-documented osteo-integration generated and the high implant survival rates, as reported by numerous national and

international studies.

What surgical indications would you recommend it for?
The C2 stem is an extremely versatile implant and so we use it in our daily practice not only for primary hip replacement cases like osteoarthrosis, osteonecrosis, fractures etc., but also for simple dysplasias when there is no alteration of the ante- or retroversion of the femoral neck, as well as for GRADE 1 and sometimes even Grade 2 GIR-classified revision

cases.

Do you think the introduction of the tapered neck has helped to increase the ROM?

Yes, absolutely. There’s no doubt that the tapered neck profile has further reduced the risk of joint impingement, with a ROM gain of

around 20%.

Does the blunt rounded distal tip also help to reduce thigh pain?
My answer is without doubt yes!

Do its double conical shape and the proximal geometry of the stem eliminate the risk of subsidence reported in the literature for stems with the same underlying philosophy?
We have never encountered the phenomenon of subsidence not even in cases of fracture of the proximal femur in elderly patients with severe osteoporosis.

Has the introduction of the lateralized version been useful? If so, in what cases?
The introduction of the lateralized version with the neck at 124° was, I would say, a logical and necessary development to allow management of special cases like coxa vara and coxa protusa, and joint instability due to inadequate muscle tone etc.

What sort of tribologic bearing do you prefer with the C2 stem?
In our daily practice, the lion’s share, some 60%, undoubtedly goes to the polyethylene-metal bearing while polyethylene-ceramic accounts for 25% and ceramic-ceramic bearing accounts for15%; this latter option is reserved for biologically “younger” patients.

Do you think our instrument set with modular broaches is of help when choosing the stem intraoperatively?
The wide modular variability of the broaches means you can be very precise in selecting the correct implant size, furthermore reducing operative time considerably.

Given your vast experience, what advice would you give to your colleagues approaching this philosophy? What do you mean by vast experience?
No one is ever through with learning. What I would advise, especially young colleagues using this stem for the first time, is to give a lot of time to the learning curve. It’s apparently easy to use but really requires great precision and manual dexterity. Once you’ve become comfortable using the stem, you realize how versatile it is and how it can be used universally. Last but by no means least, there is the excellent cost-benefit aspect.