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Ralles S, Murphy MP, Farooq H, Grayson W, Hopkinson WJ, Brown NM. Short-term outcomes with routine use of size ≥40 femoral heads in THA: A retrospective cohort study. J Orthop 2025; 59:27-29. [PMID: 39351269 PMCID: PMC11439536 DOI: 10.1016/j.jor.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/28/2024] [Accepted: 08/02/2024] [Indexed: 10/04/2024] Open
Abstract
Background Using larger femoral heads during total hip arthroplasty (THA) may result in a more stable hip. Greater volumetric wear and frictional torque, however, may result in increased postoperative complications. The purpose of this study was to compare outcomes of patients with femoral head size ≥40 mm compared to those with femoral head size <40 mm. Materials and methods A retrospective chart review of 504 THAs performed by a single surgeon at a single institution from 2009 to 2016 was conducted. Following exclusions, 131 THAs were identified with femoral heads ≥40 mm and 348 THAs were identified with femoral heads <40 mm. In addition to demographic data, all postoperative complications were recorded. Plain radiographs were used to rule out/in periprosthetic osteolysis and/or acetabular loosening. Chi-square tests and Student's t-tests were used to compare categorical and continuous variables, respectively. Results Mean follow-up period for the entire cohort was 5.5 years. Complications with ≥40 mm femoral heads included 1 superficial infection and 1 deep periprosthetic joint infection (PJI). There were no cases of dislocation, osteolysis, acetabular loosening, or trunnionosis. In contrast, complications with <40 mm femoral heads included 9 dislocations and 7 PJIs. Conclusion The routine use of large femoral heads (≥40-mm) during THA appears to be a safe option for patients at short-term clinical follow-up. Notably, 0 patients had a clinical course complicated by dislocation, osteolysis, acetabular loosening, or trunnionosis. Level of evidence Level III Retrospective Cohort Study.
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Affiliation(s)
- Steven Ralles
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
| | - Michael P. Murphy
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
| | - Hassan Farooq
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
| | - Whisper Grayson
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
| | - William J. Hopkinson
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
| | - Nicholas M. Brown
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
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2
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Ilo KC, Hothi HS, Skinner JA, Hart AJ. Metal-on-metal total hip arthroplasty: does increasing modularity affect clinical outcome? Hip Int 2022; 32:677-684. [PMID: 33322929 DOI: 10.1177/1120700020979275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Modularity of metal-on-metal (MoM) implants has come under scrutiny due to concerns regarding additional sources of metal debris. This study is a retrieval analysis of implants from the same manufacturer with the same MoM bearing surface. The difference between the implants was presence or absence of modular junctions. METHODS This is a retrospective study of 31 retrieved implants from 31 patients who received a Conserve Wright Medical MoM hip prosthesis. The 31 implants consisted of 16 resurfacings and 15 implants with modular junctions; 4 conventional THAs and 11 modular-neck THAs. RESULTS 43% of pre-revision MRI scans performed on resurfacing implants and 91% performed on the modular implants illustrated evidence of an adverse local tissue reaction. There was no difference in pre-revision blood metal ion levels or bearing surface wear between the resurfacings and modular implants. The neck-head tapers of the modular group showed low levels of material loss. However, the neck-stem tapers showed increased severity of corrosion and material loss. CONCLUSIONS The modular implants had an increased incidence of adverse local tissue reaction. This could be related to the presence of modular junctions, particular the neck-stem junction which showed increased susceptibly to corrosion.
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Affiliation(s)
- Kevin C Ilo
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, UK
| | - Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, UK
| | - John A Skinner
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, UK
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, UK
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3
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Taper corrosion in total hip arthroplasty – How to assess and which design features are crucial? J Mech Behav Biomed Mater 2022; 133:105307. [DOI: 10.1016/j.jmbbm.2022.105307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022]
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4
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Dos Santos VO, Cubillos PO, Dos Santos CT, Fernandes WG, de Jesus Monteiro M, Caminha IMV, Moré ADO, de Mello Roesler CR. Pre-clinical evaluation of fretting-corrosion at stem-head and stem-cement interfaces of hip implants using in vitro and in silico models. J Biomed Mater Res B Appl Biomater 2022; 110:2521-2532. [PMID: 35779044 DOI: 10.1002/jbm.b.35110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 10/06/2021] [Accepted: 01/15/2022] [Indexed: 11/07/2022]
Abstract
Prior to clinical use, the corrosion resistance of new prosthesis system must be verified. The fretting-corrosion mechanisms of total hip arthroplasty (THA) implants generate metal debris and ions that can increase the incidence of adverse tissue reactions. For cemented stems, there are at least two interfaces that can be damaged by fretting-corrosion: stem-head and stem-cement. This investigation aimed to evaluate, through in vitro and in silico analyses, fretting-corrosion at the stem-head and stem-cement interfaces, to determine which surface is most affected in pre-clinical testing and identify the causes associated with the observed behavior. Unimodular stems and femoral heads of three different groups were evaluated, defined according to the head/stem material as group I (SS/SS), group II (CoCr/SS), and group III (CoCr/CoCr). Seven pairs of stems and heads per group were tested: three pairs were subjected to material characterization, three pairs to in vitro fretting-corrosion testing, and one pair to geometric modeling in the in silico analysis. The absolute area of the stem body degraded was more than three times higher compared with the trunnion, for all groups. These results were corroborated by the in silico analysis results, which revealed that the average micromotion at the stem-cement interface (9.65-15.66 μm) was higher than that at the stem-head interface (0.55-1.08 μm). In conclusion, the degradation of the stem-cement interface is predominant in the pre-clinical set, indicating the need to consider the fretting-corrosion at the stem-cement interface during pre-clinical implant evaluations.
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Affiliation(s)
- Vinícius Oliveira Dos Santos
- Biomechanical Engineering Laboratory (LEBm), University Hospital, Department of Mechanical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Patricia Ortega Cubillos
- Biomechanical Engineering Laboratory (LEBm), University Hospital, Department of Mechanical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | | | | | | | | | - Ari Digiácomo Ocampo Moré
- Biomechanical Engineering Laboratory (LEBm), University Hospital, Department of Mechanical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil.,Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Carlos Rodrigo de Mello Roesler
- Biomechanical Engineering Laboratory (LEBm), University Hospital, Department of Mechanical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
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5
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Wight CM, Schemitsch EH. In vitro testing for hip head-neck taper tribocorrosion: A review of experimental methods. Proc Inst Mech Eng H 2022; 236:9544119221074582. [PMID: 35139678 PMCID: PMC8915230 DOI: 10.1177/09544119221074582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In vitro test methods are challenged by the multi-factorial nature of head-neck taper connection tribocorrosion due to the consequences of simplification. Incorrect study design and misinterpretation of results has led to contradictory findings regarding important factors affecting head-neck taper tribocorrosion. This review seeks to highlight important considerations when developing in vitro test methods, to help researchers strengthen their study design and analyze the implications of others' design decisions. The advantages, disadvantages, limitations and procedural considerations for finite element analyses, electrochemical studies and in vitro simulations related to head-neck taper connection tribocorrosion are discussed. Finite element analysis offers an efficient method for studying large ranges of mechanical parameters. However, they are limited by neglecting electrochemical, biological and fluid flow factors. Electrochemical studies may be preferred if these factors are considered important. Care must be taken in interpreting data from electrochemical studies, particularly when different materials are compared. Differences in material valence and toxicity affect clinical translation of electrochemical studies' results. At their most complex, electrochemical studies attempt to simulate all aspects of headneck taper connection tribocorrosion in a bench top study. Effective execution requires in-depth knowledge of the tribocorrosion phenomenon, the involved mechanisms, and their measures such that each study design decision is fully informed.
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Affiliation(s)
- Christian M Wight
- Institute of Biomaterial and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Campbell P, Park S, Ebramzadeh E. Semi-quantitative histology confirms that the macrophage is the predominant cell type in metal-on-metal hip tissues. J Orthop Res 2022; 40:387-395. [PMID: 33749015 PMCID: PMC9292819 DOI: 10.1002/jor.25040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/11/2021] [Accepted: 03/10/2021] [Indexed: 02/04/2023]
Abstract
Numerous studies have examined the histology of metal-on-metal hip tissues for evidence of a dose response to metal wear but have often reported inconclusive or contradictory findings. The aim of the present study was to address these discrepancies using multiple histological scoring methods to characterize the tissue features of one large group of revised metal-on-metal total hips. Periprosthetic tissues from 165 metal-on-metal hip revisions were examined for features of aseptic lymphocytic vasculitis associated lesions (ALVAL) as rated using two scoring systems as well as rankings for macrophage and lymphocyte numbers, intracellular wear debris and necrosis. Correlations between histological features and clinical variables including gender and time to revision and implant variables including articular surface wear volume or visual taper corrosion scores were examined. Both ALVAL scores reflected the macrophage dominated histology with average scores of 5.9/10 and 1.5/3. There was a statistically significant correlation between the original ALVAL score and wear rate per year (correlation coefficient = 0.17, p = .05) and a moderate correlation between the number of macrophages and wear particles and wear volume. There was no statistically significant correlation between wear and any other feature including lymphocytic inflammation or necrosis. Strong correlations between combined cup and ball wear volume and histological characteristics were not observed, although the number of macrophages was more closely correlated with wear than lymphocytes or necrosis.
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Affiliation(s)
- Patricia Campbell
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Department of Orthopaedic SurgeryOrthopaedic Institute for Children, UCLALos AngelesCaliforniaUSA
| | - Sang‐Hyun Park
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Department of Orthopaedic SurgeryOrthopaedic Institute for Children, UCLALos AngelesCaliforniaUSA
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Department of Orthopaedic SurgeryOrthopaedic Institute for Children, UCLALos AngelesCaliforniaUSA
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7
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Mai PT, Bormann T, Müller U, Kretzer JP, Gibmeier J. Effect of surface topography and residual stress on the taper connection stability in total hip arthroplasty. J Mech Behav Biomed Mater 2022; 128:105119. [DOI: 10.1016/j.jmbbm.2022.105119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/10/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
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8
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Ilo KC, Aboelmagd K, Hothi HS, Asaad A, Skinner JA, Hart AJ. Does modularity of metal-on-metal hip implants increase cobalt: chromium ratio? Hip Int 2021; 31:109-114. [PMID: 31496282 DOI: 10.1177/1120700019873637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Blood metal ion levels are used in the surveillance of metal-on-metal (MoM) hip implants. Modular implants contain an extra source of metal debris that may affect the ratio of metal ions in the blood. METHODS This was a retrospective study of 503 patients with hip replacements made by a single manufacturer (Smith & Nephew, Warwick, UK) with the same bearing surface. There were 54 total hip arthroplasties, 35 Birmingham Mid-Head Resections and 414 hip resurfacings. Whole blood metal ion levels and their ratios were analysed to investigate the effect of a modular junction. RESULTS The cobalt:chromium ratios were greater in the total hip arthroplasty group (mean 2.3:1) when compared to the resurfacings group (mean 1.3:1, p = <0.05) and Birmingham Mid-Head Resection group (mean 1.1:1, p = 0.11). CONCLUSIONS This study demonstrated a trend for a higher cobalt:chromium ratio in patients with MoM total hip replacement that may be due to metal debris from the modular stem-head junction. Further work is required to correlate clinical data with retrieval analysis to confirm the effect of taper material loss on the cobalt:chromium ratio.
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Affiliation(s)
- Kevin C Ilo
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Karim Aboelmagd
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Asaad Asaad
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - John A Skinner
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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9
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Morlock MM, Hube R, Wassilew G, Prange F, Huber G, Perka C. Taper corrosion: a complication of total hip arthroplasty. EFORT Open Rev 2020; 5:776-784. [PMID: 33312704 PMCID: PMC7722945 DOI: 10.1302/2058-5241.5.200013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The focus on taper corrosion in modular hip arthroplasty increased around 2007 as a result of clinical problems with large-head metal-on-metal (MoM) bearings on standard stems. Corrosion problems with bi-modular primary hip stems focused attention on this issue even more. Factors increasing the risk of taper corrosion were identified in laboratory and retrieval studies: stiffness of the stem neck, taper diameter and design, head diameter, offset, assembly force, head and stem material and loading. The high variability of the occurrence of corrosion in the clinical application highlights its multi-factorial nature, identifying the implantation procedure and patient-related factors as important additional factors for taper corrosion. Discontinuing the use of MoM has reduced the revisions due to metal-related pathologies dramatically from 49.7% (MoM > 32 mm), over 9.2% (MoM ⩽ 32 mm) to 0.8% (excluding all MoM). Further reduction can be achieved by omitting less stiff Ti-alloys and large metal heads (36 mm and above) against polyethylene (PE). Standardized taper assembly of smaller and ceramic heads will reduce the clinical occurrence of taper corrosion even further. If 36 mm heads are clinically indicated, only ceramic heads should be used. Taper-related problems will not comprise a major clinical problem anymore if the mentioned factors are respected.
Cite this article: EFORT Open Rev 2020;5:776-784. DOI: 10.1302/2058-5241.5.200013
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Affiliation(s)
| | | | - Georgi Wassilew
- Department for Orthopaedics and Orthopaedic Surgery, University of Greifswald, Greifswald, Germany
| | - Felix Prange
- TUHH Hamburg University of Technology, Hamburg, Germany
| | - Gerd Huber
- TUHH Hamburg University of Technology, Hamburg, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Orthopedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
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10
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Bergiers S, Hothi H, Henckel J, Eskelinen A, Skinner J, Hart A. Does diametrical clearance influence the wear of Pinnacle hip implants? Bone Joint Res 2020; 9:515-523. [PMID: 32922759 PMCID: PMC7468555 DOI: 10.1302/2046-3758.98.bjr-2019-0195.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The optimum clearance between the bearing surfaces of hip arthroplasties is unknown. Theoretically, to minimize wear, it is understood that clearances must be low enough to maintain optimal contact pressure and fluid film lubrication, while being large enough to allow lubricant recovery and reduce contact patch size. This study aimed to identify the relationship between diametrical clearance and volumetric wear, through the analysis of retrieved components. Methods A total of 81 metal-on-metal Pinnacle hips paired with 12/14 stems were included in this study. Geometrical analysis was performed on each component, using coordinate and roundness measuring machines. The relationship between their as-manufactured diametrical clearance and volumetric wear was investigated. The Mann-Whitney U test and unpaired t-test were used, in addition to calculating the non-parametric Spearman's correlation coefficient, to statistically evaluate the acquired data. Results The hips in this study were found to have had a median unworn diametrical clearance of 90.31 μm (interquartile range (IQR) 77.59 to 97.40); 32% (n = 26) were found to have been below the manufacturing tolerance. There was no correlation found between clearance and bearing (rs = -0.0004, p = 0.997) or taper (rs = 0.0048, p = 0.966) wear rates. The wear performance of hips manufactured within and below these specifications was not significantly different (bearing: p = 0.395; taper: p = 0.653). Pinnacles manufactured from 2007 onwards had a greater prevalence of bearing clearance below tolerance (p = 0.004). Conclusion The diametrical clearance of Pinnacle hips did not influence their wear performance, even when below the manufacturing tolerance. The optimum clearance for minimizing hip implant wear remains unclear.Cite this article: Bone Joint Res 2020;9(8):515-523.
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Affiliation(s)
- Sean Bergiers
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Harry Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - John Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Alister Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
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11
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Crainic AM, Callisti M, van Veelen A, Michalik A, Milton JA, Palmer MR, Cook RB. A comparative study on the physicochemical characteristics of nanoparticles released in vivo from CoCrMo tapers and cement-stem interfaces of total hip replacements. J Biomed Mater Res B Appl Biomater 2020; 108:3311-3322. [PMID: 32596955 DOI: 10.1002/jbm.b.34667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/24/2020] [Accepted: 05/25/2020] [Indexed: 11/09/2022]
Abstract
The good biocompatibility and corrosion resistance of the bulk CoCrMo alloy has resulted in it being used in the manufacture of implants and load bearing medical devices. These devices, however, can release wear and corrosion products which differ from the composition of the bulk CoCrMo alloy. The physicochemical characteristics of the particles and the associated in vivo reactivity are dictated by the wear mechanisms and electrochemical conditions at the sites of material loss. Debris released from CoCrMo hip bearings, taper junctions, or cement-stem interfaces can, therefore, have different chemical and morphological characteristics, which provide them with different in vivo toxicities. Here, we propose to assess and compare the characteristics of the particles released in vivo from CoCrMo tapers and cement-stem interfaces which have received less attention compared to debris originating from the hip bearings. The study uses state-of-art characterization techniques to provide a detailed understanding of the size, morphology, composition, and chemistry of the particles liberated from the wear and corrosion flakes from revised hip replacements, with an enzymatic treatment. The phase analyses identified Cr2 O3 nanoparticles released from tapers and cement-stem interfaces, whose composition did not vary with origin or particle morphology. The size distributions showed significantly smaller particles were released from the stems, compared to the particles originating from the corresponding tapers. The investigation demonstrates that the tribocorrosive processes occurring at the taper and stem interfaces both result in Cr2 O3 nanoparticle formation.
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Affiliation(s)
- Alina M Crainic
- National Centre for Advanced Tribology at Southampton (nCATS), University of Southampton, Southampton, UK
| | - Mauro Callisti
- National Centre for Advanced Tribology at Southampton (nCATS), University of Southampton, Southampton, UK.,Department of Materials Science and Metallurgy, Cambridge University, Cambridge, UK
| | - Arjen van Veelen
- Material Science and Technology Division, Material Science and Technology Division, Los Alamos, NM 87545, UK.,Stanford Synchrotron Radiation Lightsource, SLAC National Accelerator Laboratory, Menlo Park, CA, 94025
| | - Agnes Michalik
- National Oceanography Centre Southampton (NOCS), University of Southampton, School of Ocean and Earth Science, Southampton, UK
| | - James A Milton
- National Oceanography Centre Southampton (NOCS), University of Southampton, School of Ocean and Earth Science, Southampton, UK
| | - Martin R Palmer
- National Oceanography Centre Southampton (NOCS), University of Southampton, School of Ocean and Earth Science, Southampton, UK
| | - Richard B Cook
- National Centre for Advanced Tribology at Southampton (nCATS), University of Southampton, Southampton, UK
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12
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Bansal T, Aggarwal S, Dhillon MS, Patel S. Gross trunnion failure in metal on polyethylene total hip arthroplasty-a systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2020; 44:609-621. [PMID: 31900575 DOI: 10.1007/s00264-019-04474-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/23/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Multiple cases of dissociation of the head from the neck termed as gross trunnion failure (GTF) in total hip replacement have been described. Very little quantitative data is available for patient and implant factors associated and predisposing to this complication. STUDY PURPOSE To systematically review and analyze all studies which have gross trunnion failure in case of metal on polyethylene (MoP) total hip replacement. METHODS PubMed database was searched. We also performed a secondary search by pearling bibliography of all full text articles obtained. Predefined inclusion and exclusion criteria were used for abstract screening by two independent observers. A total 46 cases met our inclusion criteria. These were included in the final analysis and data was pooled. RESULTS Till date, 46 cases of GTF in MoP THR have been reported. The mean age at time of revision was 70.13 years (range 50 to 89 years). The mean time to revision surgery was 8.24 years (range 4.7 to 14 years). 91.4% cases were male. BMI was ≥ 25 in 38/41 cases and ≥ 30 in 21/41 cases. Pain (95.5%) and difficulty or inability to walk (97.7%) were the most common symptoms. A total of 19/44 cases described varying sounds like click, clunk, and pop before dislocation. Accolade TMZF/TMZF plus was the most common stem used in 34/46 cases. The stem neck angle was 127 degrees in 97% cases (32/33 cases). A positive neck offset of 4 mm or more was used in 91.1% cases (40/44 cases). The head size ≥ 36 mm in approximately 90% cases. The head material was cobalt chromium in all 45 cases, where data was available. Among the intra-operative findings, the most common findings were metallosis (41/44), black or brow coloured synovial fluid (21/44), pseudotumour (19/44), synovial hypertrophy (18/44), damage to the abductor musculature (17/44), proximal femoral osteolysis (5/44 cases), and heterotrophic ossification (2/44 cases). Histopathological analysis was available in 11 cases and was suggestive of fibrous tissue with chronic cellular infiltrate in all cases. The serum cobalt and chromium concentrations were raised above normal in 86.4% (19/22) and 21.7% cases (5/23) respectively. CONCLUSIONS Gross trunnion failure may not be as uncommon as was previously thought. A number potential associations and predisposing factors of this complication have been highlighted in this review. But due to small sample size and weak level of evidence, further studies are needed in this field.
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Affiliation(s)
- Tungish Bansal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sameer Aggarwal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Patel
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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13
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Valente G, Lanting B, MacDonald S, Teeter MG, Van Citters D, Howard J. Femoral head material loss at the head-neck junction in total hip arthroplasty: the effect of head size, stem material and stem offset. Hip Int 2019; 29:647-651. [PMID: 30499342 DOI: 10.1177/1120700018814473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Material loss at the head-neck junction in total hip arthroplasty may cause adverse clinical symptoms and implant failure. The purpose of this study was to quantitatively examine the effects of head size, stem material and stem offset on material loss of the head-neck taper interface of a single trunnion design in retrieval implants of metal on polyethylene bearing surfaces. METHODS A retrieval study was performed to identify all 28-mm and 32-mm femoral heads from a single implant/taper design implanted for >2 years. This included n = 56 of the 28-mm heads and n = 23 of the 32-mm heads. The 28-mm femoral heads were matched to 32-mm femoral heads based on time in vivo and head length. A coordinate measuring machine was used to determine maximum linear corrosion depth (MLD). Differences in MLD for head diameter, stem material, and stem offset were determined. RESULTS There were no differences between groups for age, gender, BMI, or implantation time. There was no difference in MLD between 28 mm and 32 mm matched paired head diameters (p = 0.59). There was also no difference in MLD between titanium or cobalt-chromium stems (p = 0.79), and regular or high-offset stems (p = 0.95). CONCLUSION There is no statistical difference in femoral head MLD at the head-neck junction in THA between 28-mm and 32-mm matched paired femoral heads, similar or mixed alloy coupled femoral head stem constructs, and regular or high offset stems.
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Affiliation(s)
- Giuseppe Valente
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
| | - Brent Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
| | - Steven MacDonald
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | | | - James Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
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Is There Material Loss at the Conical Junctions of Modular Components for Total Knee Arthroplasty? J Arthroplasty 2019; 34:2479-2486. [PMID: 31227303 DOI: 10.1016/j.arth.2019.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/01/2019] [Accepted: 05/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Clinical concern exists regarding fretting corrosion and material loss from taper junctions in orthopedic devices, with previous research focusing on the modular components from total hip arthroplasty. Comparatively little has been published regarding the fretting corrosion and material loss in modular knee devices. The purpose of this study is to evaluate fretting corrosion damage and quantify material loss for conical total knee arthroplasty taper interfaces. METHODS Stem tapers of 166 retrieved modular knee devices were evaluated for fretting corrosion using a semiquantitative scoring method. High precision profilometry was then used to determine volumetric material loss and maximum wear depth for a subset of 37 components (implanted for 0.25-18.76 years). Scanning electron microscopy and energy-dispersive X-ray spectroscopy were used to characterize the observed damage. RESULTS Mild to severe fretting corrosion was observed on the majority of tapers, with 23% receiving a maximum visually determined damage score of 4. The median rate of volumetric material loss was 0.11 mm3/y (range 0.00-0.76) for femoral components (both cone and bore taper surfaces combined) and 0.01 mm3 (range 0.00-8.10) for tibial components. Greater rates of material loss were associated with mixed metal pairings. There was a strong correlation between visual fretting corrosion score and calculated material loss (ρ = 0.68, P < .001). Scanning electron microscopy revealed varying degrees of scratching, wear, fretting corrosion, and instances of cracking with morphology not consistent with fretting corrosion, wear, or fatigue. CONCLUSION Although visual evidence of fretting corrosion damage was prevalent and correlated with taper material loss, the measured volumetric material loss was low compared with prior reports from total hip arthroplasty.
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15
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Reito A, Lehtovirta L, Parkkinen J, Eskelinen A. Histopathological patterns seen around failed metal‐on‐metal hip replacements: Cluster and latent class analysis of patterns of failure. J Biomed Mater Res B Appl Biomater 2019; 108:1085-1096. [DOI: 10.1002/jbm.b.34460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/20/2019] [Accepted: 07/13/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Aleksi Reito
- Coxa Hospital for Joint Replacement Tampere Finland
| | - Lari Lehtovirta
- Coxa Hospital for Joint Replacement Tampere Finland
- School of Medicine, Tampere University Tampere Finland
| | - Jyrki Parkkinen
- Coxa Hospital for Joint Replacement Tampere Finland
- Fimlab Laboratories Tampere Finland
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16
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Lanting BA, Wood TJ, Young S, Van Citters DW, MacDonald SJ, Howard JL, Teeter MG. The effect of altering head length on corrosion using a material loss method. Hip Int 2019; 29:368-372. [PMID: 29808723 DOI: 10.1177/1120700018779886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Corrosion at head neck taper junctions in total hip arthroplasty has increasingly been reported in the literature. Debate persists as to the exact causes and clinical significance of corrosion. Increased offset and head length has been correlated with an increased risk of tribocorrosion due to an adverse mechanical environment. The purpose of this study is to assess the effect of head length on corrosion of a metal-on-polyethylene articulation. METHODS Retrievals from a single institution of 28-mm cobalt chromium alloy heads with a 12/14 taper from a single manufacturer were studied. Corrosion of femoral head bores were studied utilising a material loss method. Testing was performed using co-ordinate measuring for maximum linear wear depth. RESULTS 56 heads were examined with lengths of either -3, 0, +4 or +8 mm and all had been in situ for a minimum of 2 years. There were no significant differences in mean maximum linear wear depth (MLWD) (p = 0.6545). There was no correlation found between MLWD and the time implants were in situ (Spearman coefficient -0.1157) and no significant difference seen between high or standard offset stems (p = 0.1336). CONCLUSION In contrast to studies using qualitative methodologies, there was no correlation between head length and material loss when confined to a 28-mm head. Broad application of this outcome should be cautioned against as this study examined 1 taper construct and a metal-on-polyethylene articulation.
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Affiliation(s)
- Brent A Lanting
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Thomas J Wood
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Sam Young
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Douglas W Van Citters
- 2 Department of Surgery, Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Steven J MacDonald
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - James L Howard
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Matthew G Teeter
- 3 Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
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17
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Lehtovirta L, Reito A, Lainiala O, Parkkinen J, Hothi H, Henckel J, Hart A, Eskelinen A. Host-specific factors affect the pathogenesis of adverse reaction to metal debris. BMC Musculoskelet Disord 2019; 20:195. [PMID: 31054584 PMCID: PMC6499989 DOI: 10.1186/s12891-019-2578-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/16/2019] [Indexed: 02/08/2023] Open
Abstract
Background Adverse Reaction to Metal Debris (ARMD) is a major reason for revision surgeries in patients with metal-on-metal (MoM) hip replacements. Most failures are related to excessively wearing implant producing harmful metal debris (extrinsic factor). As ARMD may also occur in patients with low-wearing implants, it has been suggested that there are differences in host-specific intrinsic factors contributing to the development of ARMD. However, there are no studies that have directly assessed whether the development of ARMD is actually affected by these intrinsic factors. Methods We included all 29 patients (out of 33 patients) with sufficient data who had undergone bilateral revision of ASR MoM hips (58 hips) at our institution. Samples of the inflamed synovia and/or pseudotumour were obtained perioperatively and sent to histopathological analysis. Total wear volumes of the implants were assessed. Patients underwent MARS-MRI imaging of the hips preoperatively. Histological findings, imaging findings and total wear volumes between the hips of each patient were compared. Results The difference in wear volume between the hips was clinically and statistically significant (median difference 15.35 mm3, range 1 to 39 mm3, IQR 6 to 23 mm3) (p < 0.001). The median ratio of total wear volume between the hips was 2.0 (range 1.09 to 10.0, IQR 1.67 to 3.72). In majority of the histological features and in presence of pseudotumour, there were no differences between the left and right hip of each patient (p > 0.05 for all comparisons). These features included macrophage sheet thickness, perivascular lymphocyte cuff thickness, presence of plasma cells, presence of diffuse lymphocytic infiltration and presence of germinal centers. Conclusions Despite the significantly differing amounts of wear (extrinsic factor) seen between the sides, majority of the histological findings were similar in both hips and the presence of pseudotumour was symmetrical in most hips. As a direct consequence, it follows that there must be intrinsic factors which contribute to the symmetry of the findings, ie. the pathogenesis of ARMD, on individual level. This has been hypothesized in the literature but no studies have been conducted to confirm the hypothesis. Further, as the threshold of metal debris needed to develop ARMD appears to be largely variable based on the previous literature, it is likely that there are between-patient differences in these intrinsic factors, ie. the host response to metal debris is individual. Electronic supplementary material The online version of this article (10.1186/s12891-019-2578-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lari Lehtovirta
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland.,Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Olli Lainiala
- Coxa Hospital for Joint Replacement, Tampere, Finland
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18
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Bhalekar RM, Smith SL, Joyce TJ. Hip simulator testing of the taper-trunnion junction and bearing surfaces of contemporary metal-on-cross-linked-polyethylene hip prostheses. J Biomed Mater Res B Appl Biomater 2019; 108:156-166. [PMID: 30924612 DOI: 10.1002/jbm.b.34374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/18/2019] [Accepted: 03/11/2019] [Indexed: 12/28/2022]
Abstract
Adverse reaction to metal debris released from the taper-trunnion junction of modular metal-on-polyethylene (MoP) total hip replacements (THRs) is an issue of contemporary concern. Therefore, a hip simulator was used to investigate material loss, if any, at both the articulating and taper-trunnion surfaces of five 32-mm metal-on-cross-linked-polyethylene THRs for 5 million cycles (Mc) with a sixth joint serving as a dynamically loaded soak control. Commercially available cobalt-chromium-molybdenum femoral heads articulating against cross-linked polyethylene (XLPE) acetabular liners were mounted on 12/14 titanium (Ti6Al4V) trunnions. Weight loss (mg) was measured gravimetrically and converted into volume loss (mm3 ) for heads, liners, and trunnions at regular intervals. Additionally, posttest volumetric wear measurements of the femoral tapers were obtained using a coordinate measuring machine (CMM). The surface roughness (Sa) of femoral tapers was measured posttest. After 5 Mc, the mean volumetric wear rate for XLPE liners was 2.74 ± 0.74 mm3 /Mc. The CMM measurements confirmed material loss from the femoral taper with the mean volumetric wear rate of 0.045 ± 0.024 mm3 /Mc. The Sa on the worn area of the femoral taper showed a significant increase (p < 0.001) compared with the unworn area. No other long-term hip simulator tests have investigated wear from the taper-trunnion junction of contemporary MoP THRs. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:156-166, 2020.
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Affiliation(s)
- Rohan M Bhalekar
- School of Engineering, Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
| | - Simon L Smith
- School of Engineering, Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
| | - Thomas J Joyce
- School of Engineering, Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
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19
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Kovochich M, Finley BL, Novick R, Monnot AD, Donovan E, Unice KM, Fung ES, Fung D, Paustenbach DJ. Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review. Crit Rev Toxicol 2019; 48:853-901. [DOI: 10.1080/10408444.2018.1563048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Bergiers S, Hothi HS, Henckel J, Eskelinen A, Skinner J, Hart A. Wear performance of retrieved metal-on-metal Pinnacle hip arthroplasties implanted before and after 2007. Bone Joint Res 2018; 7:595-600. [PMID: 30581557 PMCID: PMC6269595 DOI: 10.1302/2046-3758.711.bjr-2018-0143.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives Previous studies have suggested that metal-on-metal (MoM) Pinnacle (DePuy Synthes, Warsaw, Indiana) hip arthroplasties implanted after 2006 exhibit higher failure rates. This was attributed to the production of implants with reduced diametrical clearances between their bearing surfaces, which, it was speculated, were outside manufacturing tolerances. This study aimed to better understand the performance of Pinnacle Systems manufactured before and after this event. Methods A total of 92 retrieved MoM Pinnacle hips were analyzed, of which 45 were implanted before 2007, and 47 from 2007 onwards. The ‘pre-2007’ group contained 45 implants retrieved from 21 male and 24 female patients, with a median age of 61.3 years (interquartile range (IQR) 57.1 to 65.5); the ‘2007 onwards’ group contained 47 implants retrieved from 19 male and 28 female patients, with a median age of 61.8 years (IQR 58.5 to 67.8). The volume of material lost from their bearing and taper surfaces was measured using coordinate and roundness measuring machines. These outcomes were then compared statistically using linear regression models, adjusting for potentially confounding factors. Results There was no significant difference between the taper and bearing wear rates of the ‘pre-2007’ and ‘2007 onwards’ groups (p = 0.67 and p = 0.39, respectively). Pinnacles implanted from 2007 onwards were revised after a mean time of 50 months, which was significantly earlier than the ‘pre-2007’ hips (96 months) (p < 0.001). A reduction in the time to revision was present year on year from 2003 to 2011. Conclusion We found no difference in the wear rate of these implants based on the year of implantation. The ‘pre-2007’ hips had a two-fold greater time to revision than those implanted after 2007; this may be due to the increased surveillance of MoM hips following UK regulatory advice and several high-profile failures. Interestingly, we observed a decreasing trend in the mean time to revision every year from 2003 onwards. Cite this article: S. Bergiers, H. S. Hothi, J. Henckel, A. Eskelinen, J. Skinner, A. Hart. Wear performance of retrieved metal-on-metal Pinnacle hip arthroplasties implanted before and after 2007. Bone Joint Res 2018;7:595–600. DOI: 10.1302/2046-3758.711.BJR-2018-0143.R1.
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Affiliation(s)
- S Bergiers
- Institute of Orthopaedics and Musculoskeletal Science, University College London, and the Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - H S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London, and the Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - J Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London, and the Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - A Eskelinen
- Orthopaedic Surgeon, The Coxa Hospital for Joint Replacement, Tampere, Finland
| | | | - A Hart
- Limb Reconstruction Unit, Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK; The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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Implant Failure After Motec Wrist Joint Prosthesis Due to Failure of Ball and Socket-Type Articulation-Two Patients With Adverse Reaction to Metal Debris and Polyether Ether Ketone. J Hand Surg Am 2018; 43:1044.e1-1044.e4. [PMID: 29691080 DOI: 10.1016/j.jhsa.2018.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/23/2018] [Accepted: 03/07/2018] [Indexed: 02/02/2023]
Abstract
We describe 2 cases of articulation-related failures resulting in revision surgery after a Motec total wrist arthroplasty: one with an adverse reaction to metal debris and the other with an adverse reaction to polyether ether ketone. In the first patient, blood cobalt and chrome levels were elevated and magnetic resonance imaging showed clear signs of a pseudotumor. The other patient had an extensive release of polyether ether ketone particles into the surrounding synovia due to adverse wear conditions in the cup, leading to the formation of a fluid-filled cyst sac with a black lining and diffuse lymphocyte-dominated inflammation in the synovia. We recommend regular follow-up including x-rays, monitoring of cobalt and chrome ion levels, and a low threshold for cross-sectional imaging in patients who have undergone total wrist arthroplasty with a Motec joint prosthesis. Wear-related problems can also develop in implants in which polyether ether ketone is the bulk material.
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22
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The Distribution and Severity of Corrosion Damage at Eight Distinct Zones of Metallic Femoral Stem Implants. METALS 2018. [DOI: 10.3390/met8100840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Metallic taper junctions of modular total hip replacement implants are analysed for corrosion damage using visual scoring based on different granularity levels that span from analysing the taper holistically to dividing the taper into several distinct zones. This study aims to objectively explore the spatial distribution and the severity of corrosion damage onto the surface of metallic stem tapers. An ordinal logistic regression model was developed to find the odds of receiving a higher score at eight distinct zones of 137 retrieved stem tapers. A method to find the order of damage severity across the eight zones is introduced based on an overall test of statistical significance. The findings show that corrosion at the stem tapers occurred more commonly in the distal region in comparison with the proximal region. Also, the medial distal zone was found to possess the most severe corrosion damage among all the studied eight zones.
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23
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Di Laura A, Hothi HS, Henckel J, Kwon YM, Skinner JA, Hart AJ. Retrieval Findings of Recalled Dual-Taper Hips. J Bone Joint Surg Am 2018; 100:1661-1672. [PMID: 30277996 PMCID: PMC6211785 DOI: 10.2106/jbjs.17.00790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The recent high-profile recalls of several dual-taper hip designs pose questions regarding why those designs perform poorly. We aimed to characterize taper damage in 1 recalled design to understand failure mechanisms to inform surgeons on which patients should be considered at risk of revision and when to revise. METHODS High-precision measurement equipment was used to characterize the metal loss from the neck-stem interface of 116 retrieved Rejuvenate femoral stems (Stryker Howmedica Osteonics) revised because of an adverse reaction to metal debris. Head-neck taper surfaces were also investigated, and clinical and laboratory data were examined. RESULTS The neck-stem junction of each implant was moderately to severely corroded and showed a characteristic wear pattern on both male and female taper surfaces. The severity of taper damage was positively correlated with time to revision (coefficient, 0.040 [95% confidence interval (CI), 0.028 to 0.051]; p < 0.0001) and with serum cobalt concentration (coefficient, 0.02 [95% CI, 0.01 to 0.02]; p < 0.0001) and serum chromium concentration (coefficient, 0.04 [95% CI, 0.009 to 0.070]; p = 0.0142). CONCLUSIONS A forensic examination of the retrieved components that failed secondary to an adverse reaction to metal debris showed, in all cases, visible corrosion. Of the implant and patient factors investigated, we did not identify any predictors of corrosion. The severity of damage was found to increase with time; cobalt was significantly elevated over chromium. CLINICAL RELEVANCE Surgeons should scrupulously follow and consider revision for patients with this implant design to avoid extensive tissue excision. Blood metal ion tests may aid in identifying the mechanisms of taper corrosion.
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Affiliation(s)
- Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom,E-mail address for A. Di Laura:
| | - Harry S. Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Young-Min Kwon
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John A. Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Alister J. Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Herndon CL, Shah RP, Cooper HJ, Geller JA. A case of bilateral hip mechanically assisted crevice corrosion after staged total hip arthroplasty. Arthroplast Today 2018; 4:261-265. [PMID: 30186901 PMCID: PMC6123318 DOI: 10.1016/j.artd.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 12/27/2022] Open
Abstract
Mechanically assisted crevice corrosion (MACC), also known as trunnionosis, and adverse local tissue reaction (ALTR) are entities that can lead to pain and necessitate revision in total hip arthroplasty (THA). We present a case of a 75-year-old female who received a bilateral staged primary THA with metal on cross-linked polyethylene implants and had subsequent bilateral revisions for MACC and ALTR. In both instances, she presented with anterior thigh pain, weakness, and difficulty ambulating, and she was revised to ceramic on cross-linked polyethylene implants. This case may suggest a biologic predisposition or systemic immunogenic reaction to metal debris in some patients with ALTR or represent an implant-specific complication. To our knowledge, this is the first case reported of a patient having bilateral MACC from staged THA performed by 2 different surgeons using the same brand implant.
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Affiliation(s)
- Carl L Herndon
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
| | - Roshan P Shah
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
| | - H John Cooper
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
| | - Jeffrey A Geller
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
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Bhalekar RM, Smith SL, Joyce TJ. Wear at the taper‐trunnion junction of contemporary ceramic‐on‐ceramic hips shown in a multistation hip simulator. J Biomed Mater Res B Appl Biomater 2018; 107:1199-1209. [DOI: 10.1002/jbm.b.34213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/04/2018] [Accepted: 07/21/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Rohan M. Bhalekar
- School of EngineeringNewcastle University Newcastle upon Tyne NE1 7RU England
| | - Simon L. Smith
- School of EngineeringNewcastle University Newcastle upon Tyne NE1 7RU England
| | - Thomas J. Joyce
- School of EngineeringNewcastle University Newcastle upon Tyne NE1 7RU England
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26
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McCarthy EM, Floyd H, Addison O, Zhang ZJ, Oppenheimer PG, Grover LM. Influence of Cobalt Ions on Collagen Gel Formation and Their Interaction with Osteoblasts. ACS OMEGA 2018; 3:10129-10138. [PMID: 30221240 PMCID: PMC6130901 DOI: 10.1021/acsomega.8b01048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/18/2018] [Indexed: 05/03/2023]
Abstract
Metals on metal implants have long been used in arthroplasties because of their robustness and low dislocation rate. Several relatively low-corrosion metals have been used in arthroplasty, including 316L stainless steel, titanium, and cobalt-chromium-molybdenum alloy. Debris from these implants, however, has been found to cause inflammatory responses leading to unexpected failure rates approaching 10% 7 years surgery. Safety assessment of these materials traditionally relies on the use of simple two-dimensional assays, where cells are grown on the surface of the material over a relatively short time frame. It is now well-known that the composition and stiffness of the extracellular matrix (ECM) have a critical effect on cell function. In this work, we have evaluated how cobalt ions influence the assembly of type I collagen, the principle component of the ECM in bone. We found that cobalt had a significant effect on collagen matrix formation, and its presence results in local variations in collagen density. This increase in heterogeneity causes an increase in localized mechanical properties but a decrease in the bulk stiffness of the material. Moreover, when collagen matrices contained cobalt ions, there was a significant change in how the cells interacted with the collagen matrix. Fluorescence images and biological assays showed a decrease in cell proliferation and viability with an increase in cobalt concentration. We present evidence that the cobalt ion complex interacts with the hydroxyl group present in the carboxylic terminal of the collagen fibril, preventing crucial stabilizing bonds within collagen formation. This demonstrates that the currently accepted toxicity assays are poor predictors of the longer-term biological performance of a material.
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Affiliation(s)
- Emma M. McCarthy
- Physical
Sciences for Health, School of Chemistry, Physical Sciences of Imaging in
the Biomedical Sciences, School of Chemistry, Department of BioChemical Engineering,
School of Chemical Engineering, and School of Dentistry, University of Birmingham, Edgbaston, B15 2TT Birmingham, U.K.
- E-mail: (E.M.M.)
| | - Hayley Floyd
- Physical
Sciences for Health, School of Chemistry, Physical Sciences of Imaging in
the Biomedical Sciences, School of Chemistry, Department of BioChemical Engineering,
School of Chemical Engineering, and School of Dentistry, University of Birmingham, Edgbaston, B15 2TT Birmingham, U.K.
| | - Owen Addison
- Physical
Sciences for Health, School of Chemistry, Physical Sciences of Imaging in
the Biomedical Sciences, School of Chemistry, Department of BioChemical Engineering,
School of Chemical Engineering, and School of Dentistry, University of Birmingham, Edgbaston, B15 2TT Birmingham, U.K.
| | - Zhenyu J. Zhang
- Physical
Sciences for Health, School of Chemistry, Physical Sciences of Imaging in
the Biomedical Sciences, School of Chemistry, Department of BioChemical Engineering,
School of Chemical Engineering, and School of Dentistry, University of Birmingham, Edgbaston, B15 2TT Birmingham, U.K.
| | - Pola Goldberg Oppenheimer
- Physical
Sciences for Health, School of Chemistry, Physical Sciences of Imaging in
the Biomedical Sciences, School of Chemistry, Department of BioChemical Engineering,
School of Chemical Engineering, and School of Dentistry, University of Birmingham, Edgbaston, B15 2TT Birmingham, U.K.
| | - Liam M. Grover
- Physical
Sciences for Health, School of Chemistry, Physical Sciences of Imaging in
the Biomedical Sciences, School of Chemistry, Department of BioChemical Engineering,
School of Chemical Engineering, and School of Dentistry, University of Birmingham, Edgbaston, B15 2TT Birmingham, U.K.
- E-mail: (L.M.G.)
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27
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Kubacki GW, Gilbert JL. The effect of the inflammatory species hypochlorous acid on the corrosion and surface damage of Ti-6Al-4V and CoCrMo alloys. J Biomed Mater Res A 2018; 106:3185-3194. [DOI: 10.1002/jbm.a.36513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/12/2018] [Accepted: 07/12/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Gregory W. Kubacki
- Department of Bioengineering; Clemson University; Clemson South Carolina
- Clemson-Medical University of South Carolina Bioengineering Program; Syracuse Biomaterials Institute; Syracuse New York
- Department of Biomedical and Chemical Engineering; Syracuse University; Syracuse New York
| | - Jeremy L. Gilbert
- Department of Bioengineering; Clemson University; Clemson South Carolina
- Clemson-Medical University of South Carolina Bioengineering Program; Syracuse Biomaterials Institute; Syracuse New York
- Department of Biomedical and Chemical Engineering; Syracuse University; Syracuse New York
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Profound Trunnion Wear Resulting in Femoral Head-Neck Dissociation in Total Hip Arthroplasty. Case Rep Orthop 2018; 2018:1534572. [PMID: 30210885 PMCID: PMC6126067 DOI: 10.1155/2018/1534572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/12/2018] [Indexed: 11/17/2022] Open
Abstract
We describe a case of aseptic failure with profound femoral stem trunnion wear and femoral head dissociation nine years after initial primary total hip arthroplasty (THA) with the Stryker Accolade total hip arthroplasty system. Current guidelines for postoperative care and follow-up after THAs as potential intervention points for early detection of prosthetic joint failure are also reviewed.
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Waterson HB, Whitehouse MR, Greidanus NV, Garbuz DS, Masri BA, Duncan CP. Revision for adverse local tissue reaction following metal-on-polyethylene total hip arthroplasty is associated with a high risk of early major complications. Bone Joint J 2018; 100-B:720-724. [PMID: 29855241 DOI: 10.1302/0301-620x.100b6.bjj-2017-1466.r1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims Fretting and corrosion at the modular head/neck junction, known as trunnionosis, in total hip arthroplasty (THA) is a cause of adverse reaction to metal debris (ARMD). We describe the outcome of revision of metal-on-polyethylene (MoP) THA for ARMD due to trunnionosis with emphasis on the risk of major complications. Patients and Methods A total of 36 patients with a MoP THA who underwent revision for ARMD due to trunnionosis were identified. Three were excluded as their revision had been to another metal head. The remaining 33 were revised to a ceramic head with a titanium sleeve. We describe the presentation, revision findings, and risk of complications in these patients. Results The patients presented with pain, swelling, stiffness, or instability and an inflammatory mass was confirmed radiologically. Macroscopic material deposition on the trunnion was seen in all patients, associated with ARMD. Following revision, six (18.2%) dislocated, requiring further revision in four. Three (9.1%) developed a deep infection and six (18.2%) had significant persistent pain without an obvious cause. One developed a femoral artery thrombosis after excision of an iliofemoral pseudotumor, requiring a thrombectomy. Conclusion The risk of serious complications following revision MoP THA for ARMD associated with trunnionosis is high. In the presence of extensive tissue damage, a constrained liner or dual mobility construct is recommended in these patients. Cite this article: Bone Joint J 2018;100-B:720-4.
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Affiliation(s)
- H B Waterson
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | | | - N V Greidanus
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - D S Garbuz
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - B A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - C P Duncan
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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Lehtovirta L, Reito A, Parkkinen J, Peräniemi S, Vepsäläinen J, Eskelinen A. Association between periprosthetic tissue metal content, whole blood and synovial fluid metal ion levels and histopathological findings in patients with failed metal-on-metal hip replacement. PLoS One 2018; 13:e0197614. [PMID: 29768492 PMCID: PMC5955572 DOI: 10.1371/journal.pone.0197614] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/04/2018] [Indexed: 02/08/2023] Open
Abstract
Adverse Reaction to Metal Debris (ARMD) is a major cause of implant failure leading to revision surgery in patients with metal-on-metal (MoM) hip arthroplasties. However, the pathogenesis and its association to implant wear are poorly understood and previous studies have yielded discrepant results. We sought to investigate the associations between histological findings, whole blood and synovial fluid metal ion concentrations and periprosthetic tissue metal concentrations in patients with MoM total hip replacements and hip resurfacings revised for ARMD. 107 hips in total were included in our study. Of these, 87 were total hip replacements and 20 were hip resurfacings, respectively. We found that whole blood, synovial fluid and periprosthetic tissue metal concentrations correlated poorly with histological findings. We suggest that the lack of a clear association between histological findings and wear measures in the present study as well as in previous studies is mostly influenced by variability in patient susceptibility. However, patients presenting with perivascular lymphocytic infiltration had lower chromium concentration in their periprosthetic tissues than patients with no perivascular lymphocytic infiltration. This may reflect the role of metal hypersensitivity in implant failure in these patients. Patients with total hip replacements evinced more necrosis and lymphocytic infiltration in their tissues than patients with hip resurfacings. This suggests that trunnion wear debris is more cytotoxic and/or immunogenic than bearing wear debris leading to higher failure rates seen in patients with total hip replacements.
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Affiliation(s)
- Lari Lehtovirta
- University of Tampere, Tampere, Finland
- Coxa Hospital for Joint Replacement, Tampere, Finland
- * E-mail:
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland
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Hothi HS, Eskelinen AP, Henckel J, Kwon YM, Blunn GW, Skinner JA, Hart AJ. Effect of Bearing Type on Taper Material Loss in Hips From 1 Manufacturer. J Arthroplasty 2018; 33:1588-1593. [PMID: 29370957 DOI: 10.1016/j.arth.2017.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 12/05/2017] [Accepted: 12/19/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Numerous studies have reported on clinical significant volumes of material loss and corrosion at the head-stem junction of metal-on-metal (MOM) hips; less is understood about metal-on-polyethylene (MOP) hips. We compared the effect of bearing type (MOM vs MOP) on taper material loss for a hip system of a single design. METHODS In this cohort study, we recruited retrieved MOM (n = 30) and MOP (n = 22) bearing hips that were consecutively received at our center. We prospectively collected associated clinical and imaging data. We measured the severity of corrosion and volumes of material loss at each head taper surface and used multivariate statistical analysis to investigate differences between the 2 bearing types. RESULTS The median rate of material loss for the MOM and MOP groups was 0.81 mm3/y (0.01-3.45) and 0.03 mm3/y (0-1.07), respectively (P < .001). Twenty-nine of 30 MOM hips were revised for adverse metal reactions, compared with 1 of 22 MOP hips. CONCLUSION MOP hips lost significantly less material from their taper junctions than MOM hips. Our results can reassure patients with MOP Pinnacle hips that they are unlikely to experience clinically significant problems related to material loss from the taper junction.
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Affiliation(s)
- Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | | | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Young-Min Kwon
- Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Gordon W Blunn
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - John A Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Predictive factors for metal ion levels in metal-on-metal total hip arthroplasty. Arch Orthop Trauma Surg 2018; 138:281-286. [PMID: 29260384 DOI: 10.1007/s00402-017-2856-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Although metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacings (HR) have similar bearing surfaces and comparable wear rates, metal ion levels and risk of failure are higher for MoM-THA. The mechanism behind the increased metal ion levels in large head MoM-THA is not completely understood. The current study aims to identify predictive factors for increased metal ion levels in unilateral and bilateral large head MoM-THA. MATERIALS AND METHODS 99 Birmingham modular MoM-THA in 87 patients with metal ion levels at least 36 months after index procedure were analyzed. Mean follow-up time was 61.3 months (range 37-108) and the relationship of the following variables (gender, age, BMI, follow-up time, UCLA Activity Score, cup inclination, femoral head size, bilateral surgery) on metal ion levels were analyzed with multivariate regression models. RESULTS Multivariate regression analysis revealed that bilateral MoM-THA surgery (p < 0.001) had a positive predictive effect on cobalt serum levels, while BMI had a negative (p = 0.018). Female gender (p = 0.012), activity (p = 0.001) and bilateral MoM-THA (p = 0.004) were positively correlated with chromium levels. Positive independent predictors for the cobalt-chromium ratio in the multivariate analysis were overall follow-up time (p = 0.004), bilateral MoM-THA (p < 0.001) and femoral head size (p = 0.007). CONCLUSIONS The data of the current study suggest that bilateral MoM-THA, increased patient activity levels and female gender are associated with increased chromium levels. Patients with larger component size, longer follow-up time and bilateral MoM-THAs have an increased cobalt-chromium ratio. These patients might be at increased risk for adverse local soft tissue reactions secondary to corrosion. Continuous close monitoring is recommended and bearing-surface change should be discussed if local tissue reactions occur.
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Park SH, Lu Z, Hastings RS, Campbell PA, Ebramzadeh E. Five Hundred Fifty-five Retrieved Metal-on-metal Hip Replacements of a Single Design Show a Wide Range of Wear, Surface Features, and Histopathologic Reactions. Clin Orthop Relat Res 2018; 476:261-278. [PMID: 29529655 PMCID: PMC6259711 DOI: 10.1007/s11999.0000000000000044] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In 2010, a widely used metal-on-metal hip implant design was voluntarily recalled by the manufacturer because of higher than anticipated failure rates at 5 years. Although there was a large published range of revision rates, numerous studies had reported a higher risk of revision for excessive wear and associated adverse tissue reactions when compared with other metal-on-metal total hips. The reasons for this were suggested by some to be related to cup design features. QUESTIONS/PURPOSES From retrievals of ASR metal-on-metal implants and tissue samples obtained at revision surgery, we asked the following questions: (1) What were the common and uncommon surface features? (2) What were the common and uncommon linear and volumetric wear characteristics? (3) Were there common taper corrosion characteristics? (4) What aseptic lymphocytic vasculitis-associated lesion (ALVAL) features were present in the tissues? METHODS Five hundred fifty-five ASRs, including 23 resurfacings, were studied at one academic research center. Features of wear (eg, light and moderate scratching), damage (eg, deposits, gouges), and bone attachment on the porous coating were semiquantitatively ranked from 0 (none) to 3 (> 75%) based on the amount of a feature in each region of interest by the same experienced observer throughout the study. Visible features of head taper corrosion were ranked (Goldberg score) from 1 (none) to 4 (severe) by the same observer using a previously published scoring method. An experienced tribologist measured component wear depth using a coordinate measuring machine and quantified wear volume using previously validated methods. All available tissues were sampled and examined for features of ALVAL and scored from 0 to 10 by a single observer using a method they previously developed and published. A score from 0 to 4 is considered low, 5 to 8 is considered moderate, and 9 or 10 is considered high with regard to the risk of metal hypersensitivity features in the tissues. RESULTS The most common bearing surface features were light and moderate scratches and removal or postremoval damage. Discoloration and deposits were commonly observed on femoral heads (55% [305 of 553]) and less commonly on cups (30% [165 of 546]). There was no evidence of impingement or dislocation damage. There was typically a small amount of bone attachment in at least one of eight designated regions of interest (84% [460 of 546]); extensive or no bone attachment was uncommon. Edge wear was highly prevalent. The maximum wear of 469 cups (88%) occurred near the edge, whereas the maximum wear of 508 femoral heads (94%) occurred between the pole and 45° from the pole. The median combined head-cup wear volume was 14 mm (range, 1-636 mm). One hundred sixty-nine pairs (32%) had a combined wear volume of < 10 mm, 42 pairs (8%) had volumetric wear of > 100 mm, and 319 pairs (60%) had wear volume between 10 and 100 mm³. Seventy-four percent of tapers (390 of 530) received a Goldberg score of 4, 22% (116 of 530) a score of 3, < 5% (24 of 530) a score of 2, and none received a score of 1. The most frequent ALVAL score was 5 out of 10 (35 of 144 hips [24%]) and ranged from 2 (one hip) to 10 (nine hips); 92 of 144 (64%) had a moderate score, 17 of 144 (12%) had a high score, and 35 (24%) had a low score. CONCLUSIONS Although edge wear was prevalent, in most cases, this was not associated with high wear. The increased diameter and decreased coverage angle of the ASR design may have resulted in the observed high incidence of edge wear while perhaps decreasing the risk for impingement and dislocation. CLINICAL RELEVANCE The role of bearing wear in the revisions of metal-on-metal implants is controversial, because it is known that there is a large range of in vivo wear rates even within the same implant type and that patient variability affects local tissue responses to wear debris. The observations from our study of 555 retrieved ASR implant sets indicate that there was a wide range of wear including a subset with very high wear. The results suggested that the failure of the ASR and ASR XL was multifactorial, and the failure of different subgroups such as those with low wear may be the result of mechanisms other than reaction to wear debris.
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Affiliation(s)
- Sang-Hyun Park
- S.-H. Park, Z. Lu, P. A. Campbell, E. Ebramzadeh, The J. Vernon Luck, Sr, MD Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA, USA R. S. Hastings, DePuy, Inc, Warsaw, IN, USA
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Berstock JR, Whitehouse MR, Duncan CP. Trunnion corrosion: what surgeons need to know in 2018. Bone Joint J 2018; 100-B:44-49. [PMID: 29292339 PMCID: PMC6424439 DOI: 10.1302/0301-620x.100b1.bjj-2017-0569.r1] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/19/2017] [Indexed: 11/05/2022]
Abstract
AIMS To present a surgically relevant update of trunnionosis. MATERIALS AND METHODS Systematic review performed April 2017. RESULTS Trunnionosis accounts for approximately 2% of the revision total hip arthroplasty (THA) burden. Thinner (reduced flexural rigidity) and shorter trunnions (reduced contact area at the taper junction) may contribute to mechanically assisted corrosion, exacerbated by high offset implants. The contribution of large heads and mixed metallurgy is discussed. CONCLUSION Identifying causative risk factors is challenging due to the multifactorial nature of this problem. Cite this article: Bone Joint J 2018;100-B(1 Supple A):44-9.
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Affiliation(s)
- J R Berstock
- Musculoskeletal Research Unit, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - M R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - C P Duncan
- Vancouver General Hospital, University of British Columbia, JP North 3rd floor, Room 3114, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada
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35
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Del Balso C, Teeter MG, Tan SC, Lanting BA, Howard JL. Does the Additional Articulation in Retrieved Bipolar Hemiarthroplasty Implants Decrease Trunnionosis Compared to Total Hip Arthroplasty? J Arthroplasty 2018; 33:268-272. [PMID: 29033155 DOI: 10.1016/j.arth.2017.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/11/2017] [Accepted: 08/19/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Trunnionosis at the modular head-neck taper interface in metal-on-polyethylene total hip arthroplasty (MoP THA) has been shown to occur, and represents a potential mode of MoP THA failure. The purpose of the present investigation is to elucidate differences in fretting and corrosion at the head-neck taper interface of prostheses retrieved from bipolar hemiarthroplasty (BH) and MoP THA. METHODS A retrieval analysis of BH and MoP THA prostheses featuring a single taper design from a single manufacturer and in vivo for a minimum 2 years was performed. Fifteen femoral heads of 28-mm diameter and corresponding femoral stems retrieved from BH were compared with MoP THA implants matched based on time in vivo and head length (28 mm, -3 mm to 28 mm, +8 mm). Fretting and corrosion damage scoring was completed under stereomicroscopic visualization. RESULTS Femoral head bore tapers retrieved from BH exhibited decreased overall fretting (P = .02), when compared to those retrieved from MoP THA. Total corrosion scores for all retrieved implants were positively correlated with implantation time (ρ = 0.54, P < .02). CONCLUSION Femoral heads retrieved from BH exhibit decreased fretting damage compared to those retrieved from MoP THA. The added articulation in BH implants may decrease torque produced at the head-neck taper junction, thereby decreasing fretting. Increased fretting damage in implants from MoP THA is not associated with increased corrosion in 28-mm heads of this taper design. The longer a BH or MoP THA prosthesis is implanted, the greater the risk of damage due to corrosion.
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Affiliation(s)
- Christopher Del Balso
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Sok C Tan
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
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Langton DJ, Sidaginamale RP, Joyce TJ, Meek RD, Bowsher JG, Deehan D, Nargol AVF, Holland JP. A comparison study of stem taper material loss at similar and mixed metal head-neck taper junctions. Bone Joint J 2017; 99-B:1304-1312. [DOI: 10.1302/0301-620x.99b10.bjj-2016-1005.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 04/24/2017] [Indexed: 11/05/2022]
Abstract
Aims We sought to determine whether cobalt-chromium alloy (CoCr) femoral stem tapers (trunnions) wear more than titanium (Ti) alloy stem tapers (trunnions) when used in a large diameter (LD) metal-on-metal (MoM) hip arthroplasty system. Patients and Methods We performed explant analysis using validated methodology to determine the volumetric material loss at the taper surfaces of explanted LD CoCr MoM hip arthroplasties used with either a Ti alloy (n = 28) or CoCr femoral stem (n = 21). Only 12/14 taper constructs with a rough male taper surface and a nominal included angle close to 5.666° were included. Multiple regression modelling was undertaken using taper angle, taper roughness, bearing diameter (horizontal lever arm) as independent variables. Material loss was mapped using a coordinate measuring machine, profilometry and scanning electron microscopy. Results After adjustment for other factors, CoCr stem tapers were found to have significantly greater volumetric material loss than the equivalent Ti stem tapers. Conclusion When taper junction damage is identified during revision of a LD MoM hip, it should be suspected that a male taper composed of a standard CoCr alloy has sustained significant changes to the taper cone geometry which are likely to be more extensive than those affecting a Ti alloy stem. Cite this article: Bone Joint J 2017;99-B:1304–12.
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Affiliation(s)
- D. J. Langton
- Freeman Hospital, Northern
Retrieval Registry, University Hospital of
North Tees and Freeman Hospital, Newcastle
Upon Tyne, UK
| | - R. P. Sidaginamale
- Newcastle University, Stephenson
Building, Newcastle Upon Tyne, NE1
7RU, UK
| | - T. J. Joyce
- Newcastle University, Stephenson
Building, Newcastle Upon Tyne, NE1
7RU, UK
| | - R. D. Meek
- Southern General Hospital, 1345
Govan Road, Govan, Glasgow, UK
| | - J. G. Bowsher
- Food and Drugs Administration, 10903
New Hampshire Ave., Silver Spring, MD
20993, USA
| | - D. Deehan
- Freeman Hospital, Newcastle
Upon Tyne, UK and Newcastle University, Stephenson
Building, Newcastle Upon Tyne, NE1
7RU, UK
| | - A. V. F. Nargol
- University Hospital of North Tees, Hardwick
Rd, Hardwick, Stockton-on-Tees, UK
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Reito A, Lehtovirta L, Lainiala O, Mäkelä K, Eskelinen A. Lack of evidence-the anti-stepwise introduction of metal-on-metal hip replacements. Acta Orthop 2017; 88:478-483. [PMID: 28715928 PMCID: PMC5560208 DOI: 10.1080/17453674.2017.1353794] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Orthopedics and especially joint replacement surgery have had more than their fair share of unsuccessful innovations that have violated widely endorsed principles for the introduction of new surgical innovations. We aimed to investigate (1) the trends in the use of the Birmingham Hip Resurfacing (BHR), the ASR hip resurfacing (ASR HRA) and the ASR XL total hip replacement (ASR XL THR) system with very different market approval processes and (2) whether their use was corroborated by clinical trials published in the peer-reviewed literature. Methods - The literature was searched for any clinical studies that reported outcomes of the BHR, ASR HRA and ASR XL THRs. Data from 7 national hip arthroplasty registers were collected and the number of annually implanted devices was matched to those reported in the literature. Results - The cumulative number of implanted and published BHRs grew proportionally with a small lag. The growth of implanted BHRs started to decline at the same time as the ASR HR was introduced. With regard to ASR HRAs, the cumulative proportion of implanted hips and those included in the published studies grew disproportionately after the introduction of the ASR in 2003. For ASR XL THRs, the disproportionality is even higher. Interpretation - The adoption of ASR hip replacements did not follow the proposed stepwise introduction of orthopedic implants. The adoption and use of any new implant should follow a strict guideline and algorithm even if the theoretical basis or the results of preclinical studies are excellent.
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Affiliation(s)
- Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere;,Correspondence:
| | - Lari Lehtovirta
- Coxa Hospital for Joint Replacement, Tampere;,Tampere University, Tampere
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Forsthoefel CW, Brown NM, Barba ML. Comparison of metal ion levels in patients with hip resurfacing versus total hip arthroplasty. J Orthop 2017; 14:561-564. [PMID: 28878517 DOI: 10.1016/j.jor.2017.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/21/2017] [Indexed: 12/17/2022] Open
Abstract
Mechanical wear at the articular surface and corrosive processes at modular junctions, such as the trunnion, are responsible for metal ions production. We retrospectively reviewed 64 patients who underwent THA with a metal on metal bearing surface and 34 patients with hip Resurfacing. Metal ion measurements, six-week post-op radiographs, and functional scores were included in the analysis. Cobalt ion levels were significantly elevated in THA patients, 2.95 μg/L as compared to resurfacing patients, (2.95 versus 1.30 μg/L, p < 0.0005). Chromium levels were not significantly different between THA patients and resurfacing patients (1.05 versus 1.00 μg/L, p = 0.529).
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Affiliation(s)
- Craig W Forsthoefel
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nicholas M Brown
- Department of Orthopedic Surgery, Rush University, Chicago, IL, USA
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Lainiala O, Reito A, Jämsä P, Eskelinen A. Mild or moderate renal insufficiency does not increase circulating levels of cobalt and chromium in patients with metal-on-metal hip arthroplasty. Bone Joint J 2017; 99-B:1147-1152. [DOI: 10.1302/0301-620x.99b9.bjj-2016-0773.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 05/16/2017] [Indexed: 11/05/2022]
Abstract
Aims To determine whether there is any association between glomerular filtration rate (GFR) and blood cobalt (Co) and chromium (Cr) levels in patients with metal-on-metal (MoM) hip arthroplasty. Patients and Methods We identified 179 patients with a unilateral 36 mm diameter head as part of a stemmed Summit-Pinnacle MoM hip arthroplasty. GFR was calculated using the Modification of Diet in Renal Disease formula. Results Normal renal function (GFR ≥ 90 ml/min/1.73 m2) was seen in 74 patients. Mild renal insufficiency (GFR 60 to 89 ml/min/1.73 m2) was seen in 90 patients and moderate renal insufficiency (GFR 30 to 59 ml/min/1.73 m2) in 15. There was no statistical difference in Co and Cr levels between patients with normal renal function and those with mild or moderate renal insufficiency. No correlation was seen between creatinine and blood metal ion levels or between GFR and blood metal ion levels. Linear regression analysis did not show any association between Co and Cr levels and GFR. Conclusion We did not find any association between GFR and blood metal ion levels. Consequently, the accumulation of Co and Cr in blood due to renal insufficiency does not seem to be a major risk in patients with mild or moderate renal insufficiency. Cite this article Bone Joint J 2017;99-B:1147–52
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Affiliation(s)
- O. Lainiala
- Coxa Hospital for Joint Replacement, Biokatu
6B, 33520 Tampere, Finland
| | - A. Reito
- Coxa Hospital for Joint Replacement, Biokatu
6B, 33520 Tampere, Finland
| | - P. Jämsä
- Coxa Hospital for Joint Replacement, Biokatu
6B, 33520 Tampere, Finland
| | - A. Eskelinen
- Coxa Hospital for Joint Replacement, Biokatu
6B, 33520 Tampere, Finland
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Whittaker RK, Hothi HS, Eskelinen A, Blunn GW, Skinner JA, Hart AJ. Variation in taper surface roughness for a single design effects the wear rate in total hip arthroplasty. J Orthop Res 2017; 35:1784-1792. [PMID: 27704611 DOI: 10.1002/jor.23456] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/29/2016] [Indexed: 02/04/2023]
Abstract
Material loss from the head-stem taper junction of total hip arthroplasty (THA) is implicated in adverse reactions to metal debris (ARMD); the mechanisms for this are multi-factorial. We investigated the relationship between the roughness of the "as manufactured" taper surface and the wear rate from this junction. Fifty retrieved Pinnacle metal-on-metal (MOM) bearings paired with a Corail stem were included in the study. Multivariable statistical analysis was performed to determine the influence of taper roughness on material loss rate after controlling for other confounding surgical, implant, and patient factors. The surface roughness of the "as manufactured" head taper surface was associated with the rate of material loss from this surface. Four of eighteen roughness variables taken from ISO 4,287 and ISO 13,565-2 were significant: The Reduced Peak Height (Rpk, the protruding peaks above the core) (p = 0.004), Material Ratio 1 (Mr1, the ratio of the protruding peaks above the core) (p = 0.002), Area of the Peak Region (A1, the area of the Abbott-Curve that contains the peaks from the profile) (p = 0.003) and the Skewness (Rsk, the asymmetry of the height distribution corresponding to the height or depth of surface features) (p = 0.03). We found a large variability in the measured values with a median (range) of 0.50 (0.05-2.98), 11.98 (0.46-39.98), 30.89 (0.15-581.00), and 0.04 (-0.73-0.84), respectively. A 1-unit increase in Rpk was associated with a 73% increase in the taper wear rate. The variability of "as manufactured" surface roughness has a significant effect on taper material loss. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1784-1792, 2017.
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Affiliation(s)
- Robert K Whittaker
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, United Kingdom
| | - Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, United Kingdom
| | | | - Gordon W Blunn
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, United Kingdom
| | - John A Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, United Kingdom
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, United Kingdom
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Martin AJ, Seagers KA, Van Citters DW. Assessment of Corrosion, Fretting, and Material Loss of Retrieved Modular Total Knee Arthroplasties. J Arthroplasty 2017; 32:2279-2284. [PMID: 28343824 DOI: 10.1016/j.arth.2017.02.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/10/2017] [Accepted: 02/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Modular junctions in total hip arthroplasties have been associated with fretting, corrosion, and debris release. The purpose of this study is to analyze damage severity in total knee arthroplasties of a single design by qualitative visual assessment and quantitative material loss measurements to evaluate implant performance and patient impact via material loss. METHODS Twenty-two modular knee retrievals of the same manufacturer were identified from an institutional review board-approved database. Junction designs included tapers with an axial screw and tapers with a radial screw. Constructs consisted of 2 metal alloys: CoCr and Ti6Al4V. Components were qualitatively scored and quantitatively measured for corrosion and fretting. Negative values represent adhered material. Statistical differences were analyzed using sign tests. Correlations were tested with a Spearman rank order test (P < .05). RESULTS The median volumetric material loss and the maximum linear depth for the total population were -0.23 mm3 and 5.84 μm, respectively. CoCr components in mixed metal junctions had higher maximum linear depth (P = .007) than corresponding Ti components. Fretting scores of Ti6Al4V alloy components in mixed metal junctions were statistically higher than the remaining groups. Taper angle did not correlate with material loss. CONCLUSION Results suggest that CoCr components in mixed metal junctions are more vulnerable to corrosion than other components, suggesting preferential corrosion when interfacing with Ti6Al4V. Overall, although corrosion was noted in this series, material loss was low, and none were revised for clinical metal-related reaction. This suggests the clinical impact from corrosion in total knee arthroplasty is low.
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Affiliation(s)
- Audrey J Martin
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Kirsten A Seagers
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
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Outcome of revision arthroplasty for failed metal-on-metal total hip replacements; is there a relation with metal ions? Hip Int 2017; 27:235-240. [PMID: 28165602 DOI: 10.5301/hipint.5000460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE We aimed to assess the early outcome following revision arthroplasty for failed metal-on-metal (MoM) total hip replacements (THR) due to adverse reaction to metal debris (ARMD). METHODS We reviewed 106 consecutive revision arthroplasties. Case notes and radiological investigations were reviewed to assess the complications. Oxford Hip Score (OHS) and Euroqol (EQ-5D-3L) scores were used to assess the functional outcome and improvement of quality of life. RESULTS At a mean follow-up of 20 months (12-48 months), the mean OHS was 28.7. Pain improved in 61% patients. A majority of patients were in level 2 for all the EQ-5D-3L dimensions. The overall complication rate was 16%. Survivorship free from further revision for any cause was 94.3% at 48 months. There was no correlation between pre-revision blood metal ions and the final outcome. CONCLUSIONS Revision surgery for failed MoM hip replacement due to ARMD is associated with a relatively higher rate of complications and risk of chronic pain. There is poor correlation between serum metal ions and development of ARMD and outcome following revision surgery.
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Di Laura A, Hothi H, Henckel J, Swiatkowska I, Liow MHL, Kwon YM, Skinner JA, Hart AJ. Retrieval analysis of metal and ceramic femoral heads on a single CoCr stem design. Bone Joint Res 2017; 6:345-350. [PMID: 28566326 PMCID: PMC5457640 DOI: 10.1302/2046-3758.65.bjr-2016-0325.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/01/2017] [Indexed: 11/08/2022] Open
Abstract
Objectives The use of ceramic femoral heads in total hip arthroplasty (THA) has increased due to their proven low bearing wear characteristics. Ceramic femoral heads are also thought to reduce wear and corrosion at the head-stem junction with titanium (Ti) stems when compared with metal heads. We sought to evaluate taper damage of ceramic compared with metal heads when paired with cobalt chromium (CoCr) alloy stems in a single stem design. Methods This retrieval study involved 48 total hip arthroplasties (THAs) with CoCr V40 trunnions paired with either CoCr (n = 21) or ceramic (n = 27) heads. The taper junction of all hips was evaluated for fretting/corrosion damage and volumetric material loss using a roundness-measuring machine. We used linear regression analysis to investigate taper damage differences after adjusting for potential confounding variables. Results We measured median taper material loss rates of 0.210 mm3/year (0.030 to 0.448) for the metal head group and 0.084 mm3/year (0.059 to 0.108) for the ceramic group. The difference was not significant (p = 0.58). Moreover, no significant correlation between material loss and implant or patient factors (p > 0.05) was found. Conclusions Metal heads did not increase taper damage on CoCr trunnions compared with ceramic heads from the same hip design. The amount of material released at the taper junctions was very low when compared with available data regarding CoCr/Ti coupling in metal-on-metal bearings. Cite this article: A. Di Laura, H. Hothi, J. Henckel, I. Swiatkowska, M. H. L. Liow, Y-M. Kwon, J. A. Skinner, A. J. Hart. Retrieval analysis of metal and ceramic femoral heads on a single CoCr stem design. Bone Joint Res 2017;6:–350. DOI: 10.1302/2046-3758.65.BJR-2016-0325.R1.
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Affiliation(s)
- A Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - H Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - J Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - I Swiatkowska
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - M H L Liow
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Y-M Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - J A Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - A J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis. J Mech Behav Biomed Mater 2017; 69:257-266. [DOI: 10.1016/j.jmbbm.2017.01.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/29/2016] [Accepted: 01/11/2017] [Indexed: 11/22/2022]
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McGrory BJ, Payson AM, MacKenzie JA. Elevated Intra-Articular Cobalt and Chromium Levels in Mechanically Assisted Crevice Corrosion in Metal-on-Polyethylene Total Hip Arthroplasty. J Arthroplasty 2017; 32:1654-1658. [PMID: 28041772 DOI: 10.1016/j.arth.2016.11.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/14/2016] [Accepted: 11/29/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Failed total hip arthroplasty (THA) caused by mechanically assisted crevice corrosion (MACC) has serious consequences such as adverse local tissue reaction (ALTR). Serum cobalt (Co) and chromium (Cr) ion levels have been used to diagnose taper corrosion, but have not been shown to be an accurate measure of the severity of MACC or associated ALTRs. Additionally, elevated serum ions are not specific in patients with multiple artificial joints. METHODS We examined the relationship between serum and intra-articular (IA) Co and Cr levels in a cohort of 20 patients undergoing revision THA, 16 who had symptomatic MACC. IA Co and Cr levels in MACC patients were compared with demographic, pre-operative, and operative findings. RESULTS Serum and IA metal levels were found to be relatively low in THA patients undergoing revision surgery for isolated instability, aseptic loosening, or infection (average serum Co 0.03 ppb [parts per billion], IA Co 1.4 ppb, serum Cr 0.32 ppb, IA Cr 3.3 ppb). In patients with MACC, average IA Co (940 ppb) was significantly higher than serum Co (5.1 ppb) (P = .0003) and IA Cr (491 ppb) was significantly higher than serum Cr (1.3 ppb) (P = .0003). IA Co level was associated with shorter time of hip symptoms to revision surgery (P = .0043). CONCLUSION Serum levels of Co and Cr correlated with joint levels in the entire cohort, but IA levels of MACC patients were 100 times greater than serum levels. IA Co and Cr levels may be useful in confirming MACC in a specific joint and the striking elevation may explain symptoms and ALTR with relatively low serum values.
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Affiliation(s)
- Brian J McGrory
- Tufts University School of Medicine, Boston, Massachusetts; Maine Joint Replacement Institute, Portland, Maine; Maine Medical Center Division of Joint Replacements, Falmouth, Maine
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Hothi H, Henckel J, Shearing P, Holme T, Cerquiglini A, Laura AD, Atrey A, Skinner J, Hart A. Assessment of the equivalence of a generic to a branded femoral stem. Bone Joint J 2017; 99-B:310-316. [PMID: 28249969 PMCID: PMC5358204 DOI: 10.1302/0301-620x.99b3.bjj-2016-1208.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/20/2016] [Indexed: 11/15/2022]
Abstract
Aims The aim of this study was to compare the design of the generic
OptiStem XTR femoral stem with the established Exeter femoral stem. Materials and Methods We obtained five boxed, as manufactured, implants of both designs
at random (ten in total). Two examiners were blinded to the implant
design and independently measured the mass, volume, trunnion surface
topography, trunnion roughness, trunnion cone angle, Caput-Collum-Diaphyseal
(CCD) angle, femoral offset, stem length, neck length, and the width
and roughness of the polished stem shaft using peer-reviewed methods.
We then compared the stems using these parameters. Results We found that the OptiStems were lighter (p < 0.001), had
a rougher trunnion surface (p < 0.001) with a greater spacing
and depth of the machined threads (p < 0.001), had greater trunnion
cone angles (p = 0.007), and a smaller radius at the top of the
trunnion (p = 0.007). There was no difference in stem volume (p
= 0.643), CCD angle (p = 0.788), offset (p = 0.993), neck length
(p = 0.344), stem length (p = 0.808), shaft width (p = 0.058 to
0.720) or roughness of the polished surface (p = 0.536). Conclusion This preliminary investigation found that whilst there were similarities
between the two designs, the generic OptiStem is different to the
branded Exeter design. Cite this article: Bone Joint J 2017;99-B:310–16.
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Affiliation(s)
- H Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - J Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - P Shearing
- University College London, Torrington Place, London, UK
| | - T Holme
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - A Cerquiglini
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - A Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - A Atrey
- University of Toronto and St Michael's Hospital, Toronto, Canada
| | - J Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - A Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
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Bills P, Racasan R, Bhattacharya S, Blunt L, Isaac G. Comparative study of material loss at the taper interface in retrieved metal-on-polyethylene and metal-on-metal femoral components from a single manufacturer. Proc Inst Mech Eng H 2017; 231:683-690. [PMID: 28393608 DOI: 10.1177/0954411917701496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There have been a number of reports on the occurrence of taper corrosion and/or fretting and some have speculated on a link to the occurrence of adverse local tissue reaction specifically in relation to total hip replacement which have a metal-on-metal bearing. As such a study was carried out to compare the magnitude of material loss at the taper in a series of retrieved femoral heads used in metal-on-polyethylene bearings with that in a series of retrieved heads used in metal-on-metal bearings. A total of 36 metal-on-polyethylene and 21 metal-on-metal femoral components were included in the study all of which were received from a customer complaint database. Furthermore, a total of nine as-manufactured femoral components were included to provide a baseline for characterisation. All taper surfaces were assessed using an established corrosion scoring method and measurements were taken of the female taper surface using a contact profilometry. In the case of metal-on-metal components, the bearing wear was also assessed using coordinate metrology to determine whether or not there was a relationship between bearing and taper material loss in these cases. The study found that in this cohort the median value of metal-on-polyethylene taper loss was 1.25 mm3 with the consequent median value for metal-on-metal taper loss being 1.75 mm3. This study also suggests that manufacturing form can result in an apparent loss of material from the taper surface determined to have a median value of 0.59 mm3. Therefore, it is clear that form variability is a significant confounding factor in the measurement of material loss from the tapers of femoral heads retrieved following revision surgery.
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Affiliation(s)
- Paul Bills
- 1 Centre for Precision Technologies, University of Huddersfield, Huddersfield, UK
| | - Radu Racasan
- 1 Centre for Precision Technologies, University of Huddersfield, Huddersfield, UK
| | | | - Liam Blunt
- 1 Centre for Precision Technologies, University of Huddersfield, Huddersfield, UK
| | - Graham Isaac
- 2 DePuy Synthes, Leeds, UK.,3 Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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Langton DJ. Response to Letter to the Editor on "Factors Associated With Trunnionosis in the Metal-on-Metal Pinnacle Hip". J Arthroplasty 2017; 32:1045-1046. [PMID: 27894671 DOI: 10.1016/j.arth.2016.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/19/2016] [Indexed: 02/01/2023] Open
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Langton D, Ahmed I, Avery P, Bone M, Cooke N, Deehan D, Duffy P, Foguet P, Green S, Holland J, Jafri A, Longstaff L, Lord J, Loughead J, Meek RMD, Murray H, Nanu A, Nargol AVF, Scholes SC, Sidaginamale RP, Waller S, Joyce T. Investigation of Taper Failure in a Contemporary Metal-on-Metal Hip Arthroplasty System Through Examination of Unused and Explanted Prostheses. J Bone Joint Surg Am 2017; 99:427-436. [PMID: 28244914 DOI: 10.2106/jbjs.15.00917] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Large-diameter (≥36-mm) metal-on-metal (MoM) total hip replacements have been shown to fail at an unacceptably high rate. Globally, the DePuy Pinnacle prosthesis was the most widely used device of this type. There is evidence to suggest that one of the main reasons for the poor clinical performance of large-diameter MoM prostheses is the metal debris released from the head-stem taper junction-i.e., taper junction failure. The aim of this study was to investigate variation in the as-manufactured finish of the female taper surface and to determine its influence on material loss. We hypothesized that rougher surfaces with higher relative material peaks would be significantly associated with greater taper wear rates. METHODS We analyzed 93 Articul/eze femoral head tapers with a 36-mm bearing diameter that had been used in combination with a Corail titanium uncemented stem. The influence of the surface topography of the as-manufactured female taper surface on taper wear was examined by means of a multiple regression model, taking into account other known variables. RESULTS We identified great variation in the as-manufactured surface finish of the female taper surface, with a range of measured Ra values from 0.14 to 4.20 μm. The roughness of the female taper surface appeared to be the most important variable associated with taper wear (p < 0.001). The best-fitting regression model, including duration in vivo, head offset, reduced peak height (Rpk) value, stem shaft angle, and bearing surface wear rate, explained approximately 44% of the variation in taper wear rates. CONCLUSIONS We concluded that the roughness of the female taper surface appears to be a significant factor in metal debris release from head-stem taper junctions. CLINICAL RELEVANCE This study shows evidence that previously unappreciated variations in manufacturing processes may have a major impact on the clinical outcomes of patients.
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Affiliation(s)
- David Langton
- 1Farndale House, University Hospital of North Tees, Middlesbrough, England 2University Hospitals of Coventry and Warwickshire, Coventry, England 3Newcastle University, Newcastle Upon Tyne, England 4University Hospital of North Tees, Stockton-on-Tees, England 5Freeman Hospital, Newcastle Upon Tyne, England 6University Hospital of North Durham, Durham, England 7Sunderland Royal Hospital, Sunderland, England 8Queen Elizabeth Hospital, Gateshead, England 9Southern General Hospital, Glasgow, Scotland 10Nuffield Health Tees Hospital, Stockton-on-Tees, England
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Whittaker RK, Zaghloul AM, Hothi HS, Siddiqui IA, Blunn GW, Skinner JA, Hart AJ. Clinical Cold Welding of the Modular Total Hip Arthroplasty Prosthesis. J Arthroplasty 2017; 32:610-615. [PMID: 27665242 DOI: 10.1016/j.arth.2016.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 06/27/2016] [Accepted: 07/21/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A head that is "clinically cold welded" to a stem is one of the commonest reasons for unplanned removal of the stem. It is not clear which hip designs are at greatest risk of clinical cold welding. METHODS This was a case-control study of consecutively received hip implant retrievals; we chose the design of hip that had the greatest number of truly cold-welded heads (n = 11). For our controls, we chose retrieved hips of the same design but without cold welding of the head (n = 35). We compared the clinical variables between these 2 groups using nonparametric Mann-Whitney tests to investigate the significance of differences between the cold-welded and non-cold-welded groups. RESULTS The design that most commonly caused cold welding was a combination of a Ti stem and Ti taper: 11 out of 48 (23%) were truly cold welded. Comparison of the clinical data showed that no individual factor could be used to predict this preoperatively with none of the 4 predictors tested showing any significance: (1) time to revision (P = .687), (2) head size (P = .067), (3) patient age at primary (P = .380), and (4) gender (P = .054). CONCLUSION We have shown that clinical cold welding is most prevalent in Ti-Ti combinations of the stem and taper; approximately 25% of cases received at our center were cold welded. Analysis of clinical variables showed that it is not possible to predict which will be cold welded preoperatively. Surgeons should be aware of this potential complication when revising a Ti-Ti stem/head junction.
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Affiliation(s)
- Robert K Whittaker
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, London, United Kingdom
| | - Ahmed M Zaghloul
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, London, United Kingdom
| | - Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, London, United Kingdom
| | - Imran A Siddiqui
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, London, United Kingdom
| | - Gordon W Blunn
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, London, United Kingdom
| | - John A Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, London, United Kingdom
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, London, United Kingdom
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