301
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Arnholt C, MacDonald DW, Tohfafarosh M, Gilbert JL, Rimnac CM, Kurtz SM, Klein G, Mont MA, Parvizi J, Cates HE, Lee GC, Malkani A, Kraay M. Mechanically assisted taper corrosion in modular TKA. J Arthroplasty 2014; 29:205-8. [PMID: 24996586 PMCID: PMC4156900 DOI: 10.1016/j.arth.2013.12.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/07/2013] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to characterize the prevalence of taper damage in modular TKA components. One hundred ninety-eight modular components were revised after 3.9±4.2 years of implantation. Modular components were evaluated for fretting corrosion using a semi-quantitative 4-point scoring system. Design features and patient information were assessed as predictors of fretting corrosion damage. Mild-to-severe fretting corrosion (score ≥2) was observed in 94/101 tapers on the modular femoral components and 90/97 tapers on the modular tibial components. Mixed alloy pairs (p=0.03), taper design (p<0.001), and component type (p=0.02) were associated with taper corrosion. The results from this study supported the hypothesis that there is taper corrosion in TKA. However the clinical implications remain unclear.
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Affiliation(s)
- Christina Arnholt
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104
| | - Daniel W. MacDonald
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104
| | - Mariya Tohfafarosh
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104
| | - Jeremy L. Gilbert
- Biomedical and Chemical Engineering, Syracuse University, 303C Bowne Hall, Syracuse, NY 13244
| | - Clare M. Rimnac
- Orthopaedic Implant Retrieval Analysis Laboratory, Case Western Reserve University, 10900 Euclid Ave., Cleveland, Ohio 44106
| | - Steven M. Kurtz
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104
- Exponent, Inc., 3440 Market Street, Suite 600, Philadelphia, PA 19104
| | | | - Gregg Klein
- Hartzband Center for Hip and Knee Replacement, 10 Forest Avenue, Paramus, NJ 07652
| | - Michael A. Mont
- Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Ave, Baltimore, MD 21215
| | - Javad Parvizi
- Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107
| | - Harold E. Cates
- Tennessee Orthopaedic Clinics, 9430 Park West Blvd Suite 130 Knoxville, TN 37923
| | - Gwo-Chin Lee
- Penn Orthopaedics, Penn Presbyterian Medical Center 51 N 39th Street Philadelphia, PA 19104
| | - Arthur Malkani
- Jewish Hospital, 200 Abraham Flexner Way, Louisville, KY 40202
| | - Matthew Kraay
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106
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302
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Goyal N, Ho H, Fricka KB, Engh CA. Do you have to remove a corroded femoral stem? J Arthroplasty 2014; 29:139-42. [PMID: 24973927 DOI: 10.1016/j.arth.2014.03.055] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 02/20/2014] [Accepted: 03/24/2014] [Indexed: 02/01/2023] Open
Abstract
Corrosion at the head-neck taper has been recently identified as a cause of adverse local tissue reaction. There are no guidelines concerning removal of fixed femoral components when corrosion is present. The objective of this study is to report the survivorship when a new metal ball is placed on a corroded stem. We examined 86 retrieved femoral heads from metal-on-polyethylene THAs that underwent head and liner exchanges after a minimum 10 years in-vivo and evaluated the subsequent survivorship. There were 7 re-revisions (8.1%) but none were for corrosion-related diagnoses and there was no difference in the survivorship between the 32 THAs with high-grade head taper corrosion and the 54 THAs with low-grade corrosion. We do not currently recommend removing well-fixed femoral stems with corrosion.
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Affiliation(s)
- Nitin Goyal
- Anderson Orthopaedic Research Institute, Alexandria, Virginia; Inova Center for Joint Replacement at Mount Vernon Hospital, Alexandria, Virginia
| | - Henry Ho
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | - Kevin B Fricka
- Anderson Orthopaedic Research Institute, Alexandria, Virginia; Inova Center for Joint Replacement at Mount Vernon Hospital, Alexandria, Virginia
| | - Charles A Engh
- Anderson Orthopaedic Research Institute, Alexandria, Virginia; Inova Center for Joint Replacement at Mount Vernon Hospital, Alexandria, Virginia
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303
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Whittaker RK, Hexter A, Hothi HS, Panagiotidou A, Bills PJ, Skinner JA, Hart AJ. Component size mismatch of metal on metal hip arthroplasty: an avoidable never event. J Arthroplasty 2014; 29:1629-34. [PMID: 24726175 DOI: 10.1016/j.arth.2014.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/28/2014] [Accepted: 03/08/2014] [Indexed: 02/01/2023] Open
Abstract
Size mismatch of components used in total hip arthroplasty is a serious, preventable patient safety incident of unknown prevalence as many cases are not detected. Component size mismatch was found in 11 cases (0.9%) at our retrieval centre. All cases of mismatch were not detected on plain radiograph during routine clinical follow up and blood metal ion levels were elevated above the MHRA action level of 7 ppb. Root cause analysis identified manufacturer, hospital and surgeon factors that need to be addressed to reduce the incidence of this avoidable clinical problem. Retrieval analysis is the only method of confirming size mismatch and is likely to be under-represented in National Joint Registries that record the indication for revision at the time of revision.
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Affiliation(s)
- Robert K Whittaker
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Adam Hexter
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Anna Panagiotidou
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Paul J Bills
- The Centre for Precision Technologies, University of Huddersfield, 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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304
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Talmo CT, Sharp KG, Malinowska M, Bono JV, Ward DM, LaReau J. Spontaneous modular femoral head dissociation complicating total hip arthroplasty. Orthopedics 2014; 37:e592-5. [PMID: 24972443 DOI: 10.3928/01477447-20140528-62] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/11/2013] [Indexed: 02/03/2023]
Abstract
Modular femoral heads have been used successfully for many years in total hip arthroplasty. Few complications have been reported for the modular Morse taper connection between the femoral head and trunnion of the stem in metal-on-polyethylene bearings. Although there has always been some concern over the potential for fretting, corrosion, and generation of particulate debris at the modular junction, this was not considered a significant clinical problem. More recently, concern has increased because fretting and corrosive debris have resulted in rare cases of pain, adverse local tissue reaction, pseudotumor, and osteolysis. Larger femoral heads, which have gained popularity in total hip arthroplasty, are suspected to increase the potential for local and systemic complications of fretting, corrosion, and generation of metal ions because of greater torque at the modular junction. A less common complication is dissociation of the modular femoral heads. Morse taper dissociation has been reported in the literature, mainly in association with a traumatic event, such as closed reduction of a dislocation or fatigue fracture of the femoral neck of a prosthesis. This report describes 3 cases of spontaneous dissociation of the modular prosthetic femoral head from the trunnion of the same tapered titanium stem because of fretting and wear of the Morse taper in a metal-on-polyethylene bearing. Continued clinical and scientific research on Morse taper junctions is warranted to identify and prioritize implant and surgical factors that lead to this and other types of trunnion failure to minimize complications associated with Morse taper junctions as hip implants and surgical techniques continue to evolve.
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305
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The reliability of a scoring system for corrosion and fretting, and its relationship to material loss of tapered, modular junctions of retrieved hip implants. J Arthroplasty 2014; 29:1313-7. [PMID: 24411082 DOI: 10.1016/j.arth.2013.12.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 02/01/2023] Open
Abstract
It has been suggested that corrosion and fretting at the tapered, modular junctions of hip arthroplasties may contribute to implant failure. In this study the reliability of a commonly used peer-reviewed scoring system for visual assessment of corrosion and fretting at these junctions was evaluated. Volumetric material loss at the tapered head surface was measured and associations with the visual scores were investigated. We found that the inter-observer reproducibility and single-observer repeatability of the corrosion scores were substantial using Cohen's weighted Kappa statistic (k = 0.64-0.71). The reproducibility and repeatability of the fretting scores however were slight to fair (k = 0.18-0.31). Taper corrosion scores were significantly and moderately correlated with the volume of material loss measured (Spearman's r = 0.59; P < 0.001). We recommend the continued use of this scoring system but it should not be a substitute for measurement of material loss.
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306
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Woelfle JV, Fraitzl CR, Reichel H, Wernerus D. Significantly reduced leg length discrepancy and increased femoral offset by application of a head-neck adapter in revision total hip arthroplasty. J Arthroplasty 2014; 29:1301-7. [PMID: 24405617 DOI: 10.1016/j.arth.2013.11.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 02/01/2023] Open
Abstract
Head-neck adapters in total hip arthroplasty (THA) promise the reconstruction of optimal femoral offset and leg length in revision THA while retaining stable implants. Radiological parameters after adapter implantation in THA revision were determined in 37 cases. Significant reduction of leg length discrepancy and improvement of femoral offset (P < 0.001) were found. Clinical endpoints were determined in 20 cases (mean follow-up 4.0 years). Clinical scores were rather poor (median Harris hip score 54, WOMAC score 41) due to age and comorbidities, postoperative dislocation occurred in 3 cases. Only one stable femoral stem had to be revised due to recurrent postoperative dislocation. In conclusion, a head-neck adapter can be a valuable tool in certain cases of revision THA with acceptable dislocation rates while allowing the retention of stable implants.
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Affiliation(s)
- Julia V Woelfle
- Department of Orthopaedic Surgery, Ulm University, Ulm, Germany
| | | | - Heiko Reichel
- Department of Orthopaedic Surgery, Ulm University, Ulm, Germany
| | - Dirk Wernerus
- Department of Orthopaedic Surgery, Ulm University, Ulm, Germany
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307
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Palmisano AC, Nathani A, Weber AE, Blaha JD. Femoral neck modularity: A bridge too far—Affirms. ACTA ACUST UNITED AC 2014. [DOI: 10.1053/j.sart.2014.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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308
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Dorn U, Neumann D, Frank M. Corrosion behavior of tantalum-coated cobalt-chromium modular necks compared to titanium modular necks in a simulator test. J Arthroplasty 2014; 29:831-5. [PMID: 24099841 DOI: 10.1016/j.arth.2013.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 07/30/2013] [Accepted: 08/25/2013] [Indexed: 02/08/2023] Open
Abstract
This study compared the corrosion behavior of tantalum-coated cobalt-chromium modular necks with that of titanium alloy modular necks at their junction to titanium-alloy femoral stem. Tests were performed in a dry assembly and two wet assemblies, one contaminated with calf serum and the other contaminated with calf serum and bone particles. Whereas the titanium modular neck tested in the dry assembly showed no signs of corrosion, the titanium modular necks tested in both wet assemblies showed marked depositions and corrosive attacks. By contrast, the tantalum-coated cobalt-chromium modular necks showed no traces of corrosion or chemical attack in any of the three assemblies. This study confirms the protective effect of tantalum coating the taper region of cobalt-chromium modular neck components, suggesting that the use of tantalum may reduce the risk of implant failure due to corrosion.
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Affiliation(s)
- Ulrich Dorn
- Orthopaedic University Clinic Salzburg, Muellner Hauptstr. 48, Salzburg, Austria
| | - Daniel Neumann
- Orthopaedic University Clinic Salzburg, Muellner Hauptstr. 48, Salzburg, Austria
| | - Mario Frank
- Intraplant Company, Grenzg. 38a, Mödling, Austria
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309
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Ghoz A, Broadhead ML, Morley J, Tavares S, McDonald D. Outcomes of dual modular cementless femoral stems in revision hip arthroplasty. Orthop Rev (Pavia) 2014; 6:5247. [PMID: 24822088 PMCID: PMC4017333 DOI: 10.4081/or.2014.5247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/10/2014] [Indexed: 11/23/2022] Open
Abstract
With an increasing number of primary hip replacements being performed every year, the burden of revision hip arthroplasty, for septic and aseptic loosening, recurrent dislocation or periprosthetic fracture, is also increasing. In recent years, different approaches to revising the femoral prosthesis have emerged; including both cemented and cementless techniques. With a stable cement mantle and good bone quality, or through the use of impaction bone grafting when bone stock is lacking, it is possible to re-cement a femoral prosthesis. Alternatively, a cementless modular femoral prosthesis may be used, providing the surgeon with further options for restoring leg length, hip offset, anteversion and stability. Studies evaluating the use of modular cementless prostheses have so far been limited to midterm studies, with results comparable to primary hip arthroplasty. There are some concerns, however, regarding tribological complications such as stem fracture, corrosion, and failure, and long-term studies are required to further evaluate these concerns. This review outlines the current evidence for the use of both cemented and cementless modular femoral prostheses in the setting of revision hip arthroplasty. Results of prospective and retrospective studies will be outlined, along with results obtained from national joint registries.
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Affiliation(s)
- Ali Ghoz
- Royal Berkshire NHS Trust , Reading, UK
| | - Matthew L Broadhead
- University of New South Wales , Kensington NSW, Australia ; Australian Orthopaedic Research Group , Melbourne, Australia
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310
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Brooks E, Tobias M, Krautsak K, Ehrensberger M. The influence of cathodic polarization and simulated inflammation on titanium electrochemistry. J Biomed Mater Res B Appl Biomater 2014; 102:1445-53. [DOI: 10.1002/jbm.b.33123] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/07/2014] [Accepted: 01/22/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Emily Brooks
- Department of Biomedical Engineering; State University of New York at Buffalo; Buffalo New York
| | - Menachem Tobias
- Department of Orthopaedic Surgery; State University of New York at Buffalo; Buffalo New York
| | - Kevin Krautsak
- Department of Orthopaedic Surgery; State University of New York at Buffalo; Buffalo New York
| | - Mark Ehrensberger
- Department of Biomedical Engineering; State University of New York at Buffalo; Buffalo New York
- Department of Orthopaedic Surgery; State University of New York at Buffalo; Buffalo New York
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311
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Donaldson FE, Coburn JC, Siegel KL. Total hip arthroplasty head-neck contact mechanics: a stochastic investigation of key parameters. J Biomech 2014; 47:1634-41. [PMID: 24657104 DOI: 10.1016/j.jbiomech.2014.02.035] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/25/2014] [Accepted: 02/27/2014] [Indexed: 11/15/2022]
Abstract
A variety of design and patient parameters have been implicated in recent reports of fretting corrosion at modular connections in total hip arthroplasty. We sought to identify the relative sensitivity of mechanical fretting to a comprehensive set of parameters such that attention may be focused on key variables. Stochastic finite element simulation of the head-neck taper-trunnion junction was performed. Four-hundred parameter sets were simulated using realistic variations of design variables, material properties and loading parameters to predict contact pressures (P), micromotions (M) and fretting work (coefficient of friction×P×M) over cycles of gait. Results indicated that fretting work was correlated with only three parameters: angular mismatch, center offset and body weight (r=0.47, 0.53 and 0.43, p<0.001). Maximum contact pressure increased by 85MPa for every 0.1° of angular mismatch. Maximum micromotion increased by 5µm per 10mm additional head offset and 1µm per 10kg increased body weight. Uncorrelated parameters included trunnion diameter, trunnion length and impaction forces. It was concluded that appropriate limiting of angular mismatch and center offset could minimize fretting, and hence its contribution to corrosion, at modular connections.
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Affiliation(s)
- Finn E Donaldson
- Division of Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Office of Medical Products and Tobacco, U.S. Food and Drug Administration, Silver Spring, MD, USA.
| | - James C Coburn
- Division of Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Office of Medical Products and Tobacco, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Karen Lohmann Siegel
- Division of Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Office of Medical Products and Tobacco, U.S. Food and Drug Administration, Silver Spring, MD, USA
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312
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Design parameters and the material coupling are decisive for the micromotion magnitude at the stem–neck interface of bi-modular hip implants. Med Eng Phys 2014; 36:300-7. [DOI: 10.1016/j.medengphy.2013.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 11/04/2013] [Accepted: 11/17/2013] [Indexed: 11/20/2022]
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313
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Durig N, Pace T, Broome B, Osuji O, Harman MK. Clinical Outcomes of Tibial Components with Modular Stems Used in Primary TKA. Adv Orthop 2014; 2014:651279. [PMID: 24669319 PMCID: PMC3941588 DOI: 10.1155/2014/651279] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 12/14/2013] [Accepted: 12/16/2013] [Indexed: 11/17/2022] Open
Abstract
Due to the known potential for fretting and corrosion at modular junctions in orthopaedic implants, this retrospective study evaluated radiographic and clinical outcomes of 85 primary TKA patients implanted with modular stemmed tibial components and followed up for an average of 82 months. There was low incidence of tibial radiolucent lines, excellent functional outcomes, and no complications associated with stem modularity. The findings were comparable to the historical control study involving 107 TKA with a nonmodular tibial stem design. When using surface cemented tibial components combined with a constrained polyethylene bearing, modular stems appear to be a viable option for primary TKA when adequate fixation and rotational stability are maintained.
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Affiliation(s)
- Nicole Durig
- Department of Bioengineering, 301 Rhodes Engineering Research Center, Clemson University, Clemson, SC 29634, USA
| | - Thomas Pace
- University of South Carolina, School of Medicine Greenville, 607 Grove Road, Greenville, SC 29605, USA
| | - Brandon Broome
- Steadman Hawkins Clinic of the Carolinas, 200 Patewood Drive, Suite C100, Greenville, SC 29615, USA
| | - Obi Osuji
- Steadman Hawkins Clinic of the Carolinas, 200 Patewood Drive, Suite C100, Greenville, SC 29615, USA
| | - Melinda K. Harman
- Department of Bioengineering, 301 Rhodes Engineering Research Center, Clemson University, Clemson, SC 29634, USA
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314
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Abstract
BACKGROUND Large-head metal-on-metal (MoM) hip arthroplasties have demonstrated poor survival. Damage at the taper-trunnion junction is a contributing factor; however, the influence of junction design is not well understood. QUESTIONS/PURPOSES (1) Does taper type affect fretting, corrosion, and volumetric wear at the junction? (2) Do taper types have different wear patterns? (3) Does larger offset or head diameter increase fretting, corrosion, and wear? (4) Is the extent of fretting and corrosion associated with earlier failure? METHODS Taper damage in 40 retrieved heads was subjectively graded for fretting and corrosion, and wear was determined with high-resolution confocal measurement. Taper types (11/13, 12/14, and Type 1) differed by angle, distal diameter, and contact length; Type 1 were thinnest and 11/13 had longer contact lengths. RESULTS Fretting scores were higher in 11/13 than in Type 1 tapers. Volumetric wear and wear rates did not differ among types. Uniform, circumferential, and longitudinal wear patterns were observed in all types, but fretting, corrosion, and wear did not differ among the patterns. Head diameter and lateral offset did not correlate with fretting, corrosion, or wear. No correlation was found between fretting, corrosion, or wear and length of implantation. CONCLUSIONS In general, thicker tapers with longer contact lengths were associated with greater fretting scores, whereas no relationship was found among the three designs for corrosion scores or volumetric wear. This finding suggests that trunnion diameter and engagement length are important factors to consider when improving taper-trunnion junction design.
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315
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Elkins JM, Callaghan JJ, Brown TD. Stability and trunnion wear potential in large-diameter metal-on-metal total hips: a finite element analysis. Clin Orthop Relat Res 2014; 472:529-42. [PMID: 24218160 PMCID: PMC3890205 DOI: 10.1007/s11999-013-3244-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large-diameter femoral heads for metal-on-metal THA hold theoretical advantages of joint stability and low bearing surface wear. However, recent reports have indicated an unacceptably high rate of wear-associated failure with large-diameter bearings, possibly due in part to increased wear at the trunnion interface. Thus, the deleterious consequences of using large heads may outweigh their theoretical advantages. QUESTIONS/PURPOSES We investigated (1) to what extent femoral head size influenced stability in THA for several dislocation-prone motions; and the biomechanics of wear at the trunnion interface by considering the relationship between (2) wear potential and head size and (3) wear potential and other factors, including cup orientation, type of hip motion, and assembly/impaction load. METHODS Computational simulations were executed using a previously validated nonlinear contact finite element model. Stability was determined at 36 cup orientations for five distinct dislocation challenges. Wear at the trunnion interface was calculated for three separate cup orientations subjected to gait, stooping, and sit-to-stand motions. Seven head diameters were investigated: 32 to 56 mm, in 4-mm increments. RESULTS Stability improved with increased diameter, although diminishing benefit was seen for sizes of greater than 40 mm. By contrast, contact stress and computed wear at the trunnion interface all increased unabatedly with increasing head size. Increased impaction forces resulted in only small decreases in trunnion wear generation. CONCLUSIONS These data suggest that the theoretical advantages of large-diameter femoral heads have a limit. Diameters of greater than 40 mm demonstrated only modest improvement in terms of joint stability yet incurred substantial increase in wear potential at the trunnion. CLINICAL RELEVANCE Our model has potential to help investigators and designers of hip implants to better understand the optimization of trunnion design for long-term durability.
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Affiliation(s)
- Jacob M. Elkins
- />Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA USA , />Department of Biomedical Engineering, University of Iowa, Iowa City, IA USA
| | - John J. Callaghan
- />Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA USA , />Department of Biomedical Engineering, University of Iowa, Iowa City, IA USA , />Iowa City Veterans Administration Medical Center, Iowa City, IA USA
| | - Thomas D. Brown
- />Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA USA , />Department of Biomedical Engineering, University of Iowa, Iowa City, IA USA , />Orthopaedic Biomechanics Laboratory, University of Iowa, 2181 Westlawn, Iowa City, IA 52242 USA
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316
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Nawabi DH, Nassif NA, Do HT, Stoner K, Elpers M, Su EP, Wright T, Potter HG, Padgett DE. What causes unexplained pain in patients with metal-on metal hip devices? A retrieval, histologic, and imaging analysis. Clin Orthop Relat Res 2014; 472:543-54. [PMID: 23897506 PMCID: PMC3890159 DOI: 10.1007/s11999-013-3199-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Adverse tissue reactions associated with metal-on-metal (MOM) hips are common in resurfacing and total hip arthroplasty (THA) designs. The etiology of these reactions in painful, well-positioned arthroplasties is inconsistently described. QUESTIONS/PURPOSES The purposes of this study were to compare the (1) articular wear rates; (2) histologic findings; (3) synovial response on MRI; and (4) graded intraoperative tissue damage between well-positioned, MOM hips revised for unexplained pain and MOM hips revised for other reasons and to (5) determine whether the presence of a taper junction on a MOM articulation affects these four parameters in unexplained pain. METHODS We retrospectively studied 88 patients (94 hips) who had undergone revision of either a hip resurfacing or a large-head (> 36 mm) THA. Thirty-five hips revised for unexplained pain were compared with a control group of 59 hips revised for other causes. Articular wear was measured using three-dimensional contactless metrology and histologic analysis was performed using the aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) score. Preoperative MRI was performed on 57 patients to determine synovial volumes and thicknesses. Tissue damage was graded from intraoperative reports. RESULTS Articular wear rates in the unexplained pain group were lower than in the control group (median 2.6 μm/year versus 12.8 μm/year, p < 0.001). Sixty-six percent of patients in the unexplained pain group had histologic confirmation of ALVAL compared with 19% in the control group (p < 0.001). The synovial thickness on MRI was higher in the unexplained pain group (p = 0.04) and was highly predictive of ALVAL. Severe intraoperative tissue damage was noted in more cases in the unexplained pain group (p = 0.01). There were no differences in articular wear, histology, MRI, and tissue damage between resurfacings and THAs revised for unexplained pain. CONCLUSIONS Unexplained pain in patients with well-positioned MOM hips warrants further investigation with MRI to look for features predictive of ALVAL. Tissue destruction in these cases does not appear to be related to high bearing wear or the presence of a taper.
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Affiliation(s)
- Danyal H. Nawabi
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Nader A. Nassif
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Huong T. Do
- Epidemiology and Biostatistics Core, Hospital for Special Surgery, New York, NY USA
| | - Kirsten Stoner
- Department of Biomechanics, Hospital for Special Surgery, New York, NY USA
| | - Marcella Elpers
- Department of Biomechanics, Hospital for Special Surgery, New York, NY USA
| | - Edwin P. Su
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Timothy Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY USA
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY USA
| | - Douglas E. Padgett
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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317
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Abstract
Large ceramic femoral heads offer several advantages that are potentially advantageous to patients undergoing both primary and revision total hip replacement. Many high-quality studies have demonstrated the benefit of large femoral heads in reducing post-operative instability. Ceramic femoral heads may also offer an advantage in reducing polyethylene wear that has been reported in vitro and is starting to become clinically apparent in mid-term clinical outcome studies. Additionally, the risk of taper corrosion at a ceramic femoral head-neck junction is clearly lower than when using a metal femoral head. With improvements in the material properties of both modern ceramic femoral heads and polyethylene acetabular liners that have reduced the risk of mechanical complications, large ceramic heads have gained popularity in recent years.
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Affiliation(s)
- J A Rodriguez
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, New York 10075, USA
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318
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Abstract
Corrosion has long been recognized to occur in total hip arthroplasty, but the local effects of this process have only recently become better understood. This article provides an overview of corrosion at modular junctions, and discusses the various etiologic factors for corrosion and the biologic response to metal debris released from this junction. Algorithms are provided for diagnosis and treatment, in accordance with the best available data.
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319
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Panagiotidou A, Meswania J, Hua J, Muirhead-Allwood S, Hart A, Blunn G. Enhanced wear and corrosion in modular tapers in total hip replacement is associated with the contact area and surface topography. J Orthop Res 2013; 31:2032-9. [PMID: 23966288 DOI: 10.1002/jor.22461] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 07/15/2013] [Indexed: 02/04/2023]
Abstract
Widespread concern exists about adverse tissue reactions after metal-on-metal (MoM) total hip replacement (THR). Concerns have also been expressed with wear and corrosion of taper junctions in THR. We report the effect of surface finish and contact area associated with a single combination of materials of modular tapers. In an in vitro test, we investigated the head/neck (CoCrMo/Ti) interface of modular THRs using commercially available heads. Wear and corrosion of taper surfaces was compared following a 10 million loading cycle. Surface parameters and profiles were measured before and after testing. Electrochemical static and dynamic corrosion tests were performed under loaded and non-loaded conditions. After the load test, the surface roughness parameters on the head taper were significantly increased where the head/neck contact area was reduced. Similarly, the surface roughness parameters on the head taper were significantly increased where rough neck tapers were used. Corrosion testing showed breaching of the passive film on the rough but not the smooth neck tapers. Thus, surface area and surface finish are important factors in wear and corrosion at modular interfaces.
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Affiliation(s)
- Anna Panagiotidou
- Institute of Orthopaedics and Musculo-Skeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, United Kingdom
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320
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Adverse local tissue reaction associated with a modular hip hemiarthroplasty. Clin Orthop Relat Res 2013; 471:4082-6. [PMID: 23813241 PMCID: PMC3825897 DOI: 10.1007/s11999-013-3133-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 06/19/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The local and systemic effects of wear debris and corrosion products remain a concern in arthroplasty and reaction to corrosion or wear products from modular junctions has been reported in primary and revision total joint arthroplasties. These effects have not been reported previously for unipolar hemiarthroplasties where there is no prosthetic bearing surface to contribute to the phenomenon. This may have implications for clinical surveillance and implant design. CASE DESCRIPTION We report the case of a 72-year-old man who had symptomatic pseudotumor formation, confirmed by pathologic examination of the excised pseudotumor, with a large-head modular hip hemiarthroplasty. Metallosis and corrosion of the modular head/neck taper junction were noted at the time of revision surgery. LITERATURE REVIEW To our knowledge, this is the first report of pseudotumor formation where the corrosion or wear products arose from the modular junction of the implant with no bearing couple present to contribute wear debris that may influence the formation of the pseudotumor. PURPOSES AND CLINICAL RELEVANCE Adverse tissue reactions to wear debris generated at prosthetic articulating surfaces and corrosion and wear products from nonarticulating prosthetic junctions have been reported. The problem has been reported to be higher in metal-on-metal bearing couples and in large-diameter hip arthroplasties. Mixed-alloy junctions appear to be more susceptible to corrosion. We believe that corrosion should be considered a possible diagnostic entity when investigating persistent symptoms after hemiarthroplasty and may be avoided with the use of monoblock components.
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321
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Kocagöz SB, Underwood RJ, Sivan S, Gilbert JL, Macdonald DW, Day JS, Kurtz SM. Does Taper Angle Clearance Influence Fretting and Corrosion Damage at the Head-Stem Interface? A Matched Cohort Retrieval Study. ACTA ACUST UNITED AC 2013; 24:246-254. [PMID: 24610994 DOI: 10.1053/j.sart.2014.01.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Previous studies have speculated that modular taper design may have an effect on the corrosion and material loss at the taper surfaces. We present a novel method to measure taper angle for retrieved head taper and stem trunnions using a roundness machine (Talyrond 585, Taylor Hobson, UK). We also investigated the relationship between taper angle clearance and visual fretting-corrosion score at the taper-trunnion junction using a matched cohort study of 50 ceramic and 50 metal head-stem pairs. In this study, no correlation was observed between the taper angle clearance and the visual fretting-corrosion scores in either the ceramic or the metal cohorts.
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Affiliation(s)
- Sevi B Kocagöz
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia PA
| | - Richard J Underwood
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia PA ; Exponent Inc., Philadelphia PA
| | - Shiril Sivan
- Syracuse Biomaterials Institute, Syracuse University, Syracuse, NY ; Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse NY
| | - Jeremy L Gilbert
- Syracuse Biomaterials Institute, Syracuse University, Syracuse, NY ; Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse NY
| | - Daniel W Macdonald
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia PA
| | - Judd S Day
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia PA ; Exponent Inc., Philadelphia PA
| | - Steven M Kurtz
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia PA ; Exponent Inc., Philadelphia PA
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322
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Abstract
A modular femoral head–neck junction has practical advantages in total hip replacement. Taper fretting and corrosion have so far been an infrequent cause of revision. The role of design and manufacturing variables continues to be debated. Over the past decade several changes in technology and clinical practice might result in an increase in clinically significant taper fretting and corrosion. Those factors include an increased usage of large diameter (36 mm) heads, reduced femoral neck and taper dimensions, greater variability in taper assembly with smaller incision surgery, and higher taper stresses due to increased patient weight and/or physical activity. Additional studies are needed to determine the role of taper assembly compared with design, manufacturing and other implant variables. Cite this article: Bone Joint J 2013;95-B, Supple A:3–6.
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Affiliation(s)
- A. J. Wassef
- Joint Replacement Institute at St. Vincent
Medical Center, 2200 West Third Street, Suite 400, Los
Angeles, California 90057, USA
| | - T. P. Schmalzried
- Joint Replacement Institute at St. Vincent
Medical Center, 2200 West Third Street, Suite 400, Los
Angeles, California 90057, USA
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323
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Matthies AK, Racasan R, Bills P, Blunt L, Cro S, Panagiotidou A, Blunn G, Skinner J, Hart AJ. Material loss at the taper junction of retrieved large head metal-on-metal total hip replacements. J Orthop Res 2013; 31:1677-85. [PMID: 23918742 DOI: 10.1002/jor.22431] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 06/13/2013] [Indexed: 02/04/2023]
Abstract
It has been speculated that material loss, either as corrosion or wear, at the head-stem taper junction is implicated in the high revision rates reported for metal-on-metal total hip replacements. We measured the volume of material loss from the taper and bearing surfaces of retrieved devices, and investigated the associations with blood metal ion levels and the diagnosis of a cystic or solid pseudotumor. The median volumes of material lost from the female and male taper surfaces were 2.0 and 0.29 mm(3) , respectively, while the median volumes of wear from the cup and head bearing surfaces were 1.94 and 3.44 mm(3) , respectively. Material loss from the female taper was similar to that from the acetabular bearing surface (p = 0.55), but significantly less than that from the femoral bearing surface (p < 0.001). Material loss from the male taper was less than that from both bearing surfaces (p < 0.001). Multivariable analysis demonstrated no significant correlations between the volume of material lost from the taper surfaces and either blood cobalt or chromium ions, or the presence of pseudotumor. While a substantial volume of material is lost at the taper junction, the clinical significance of this debris remains unclear.
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Affiliation(s)
- Ashley K Matthies
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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324
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Abstract
Following the recall of modular neck hip stems in July 2012, research into femoral modularity will intensify over the next few years. This review aims to provide surgeons with an up-to-date summary of the clinically relevant evidence. The development of femoral modularity, and a classification system, is described. The theoretical rationale for modularity is summarised and the clinical outcomes are explored. The review also examines the clinically relevant problems reported following the use of femoral stems with a modular neck. Joint replacement registries in the United Kingdom and Australia have provided data on the failure rates of modular devices but cannot identify the mechanism of failure. This information is needed to determine whether modular neck femoral stems will be used in the future, and how we should monitor patients who already have them implanted.
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Affiliation(s)
- H Krishnan
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK.
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325
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Hariri S, Chun S, Cowan JB, Bragdon C, Malchau H, Rubash HE. Range of motion in a modular femoral stem system with a variety of neck options. J Arthroplasty 2013; 28:1625-33. [PMID: 23886407 DOI: 10.1016/j.arth.2012.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/10/2012] [Accepted: 10/12/2012] [Indexed: 02/01/2023] Open
Abstract
Modular femoral stem systems decouple leg length, offset, and version. The hip ROM and type of impingement for 162 femoral head/neck combinations were measured at four extreme hip positions in a Sawbones pelvis and femur to identify constructs that lead to early impingement. Hip ROM increased in all positions with increasing head size and neck length. We identified a new type of impingement created by the build-up of the proximal femoral stem: femoral stem on acetabular liner impingement. Seventy percent of neutral neck options achieved our definition of acceptable ROM. In general, when utilizing a modular femoral stem, surgeons can minimize impingement by choosing the longest femoral neck that does not over-lengthen the limb, using the largest femoral head accommodated by the cup, and avoiding neck version unless the cup or stem is malaligned.
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Affiliation(s)
- Sanaz Hariri
- Arthroplasty, Orthopaedic Surgery, Massachusetts General Hospital, Los Gatos, California
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326
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Kurtz SM, Kocagöz SB, Hanzlik JA, Underwood RJ, Gilbert JL, MacDonald DW, Lee GC, Mont MA, Kraay MJ, Klein GR, Parvizi J, Rimnac CM. Do ceramic femoral heads reduce taper fretting corrosion in hip arthroplasty? A retrieval study. Clin Orthop Relat Res 2013; 471:3270-82. [PMID: 23761174 PMCID: PMC3773155 DOI: 10.1007/s11999-013-3096-2] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 05/29/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies regarding modular head-neck taper corrosion were largely based on cobalt chrome (CoCr) alloy femoral heads. Less is known about head-neck taper corrosion with ceramic femoral heads. QUESTIONS/PURPOSES We asked (1) whether ceramic heads resulted in less taper corrosion than CoCr heads; (2) what device and patient factors influence taper fretting corrosion; and (3) whether the mechanism of taper fretting corrosion in ceramic heads differs from that in CoCr heads. METHODS One hundred femoral head-stem pairs were analyzed for evidence of fretting and corrosion using a visual scoring technique based on the severity and extent of fretting and corrosion damage observed at the taper. A matched cohort design was used in which 50 ceramic head-stem pairs were matched with 50 CoCr head-stem pairs based on implantation time, lateral offset, stem design, and flexural rigidity. RESULTS Fretting and corrosion scores were lower for the stems in the ceramic head cohort (p=0.03). Stem alloy (p=0.004) and lower stem flexural rigidity (Spearman's rho=-0.32, p=0.02) predicted stem fretting and corrosion damage in the ceramic head cohort but not in the metal head cohort. The mechanism of mechanically assisted crevice corrosion was similar in both cohorts although in the case of ceramic femoral heads, only one of the two surfaces (the male metal taper) engaged in the oxide abrasion and repassivation process. CONCLUSIONS The results suggest that by using a ceramic femoral head, CoCr fretting and corrosion from the modular head-neck taper may be mitigated but not eliminated. CLINICAL RELEVANCE The findings of this study support further study of the role of ceramic heads in potentially reducing femoral taper corrosion.
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Affiliation(s)
- Steven M Kurtz
- Implant Research Center, School of Biomedical Engineering, Science, and Heath Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA,
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327
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Higgs GB, Hanzlik JA, MacDonald DW, Gilbert JL, Rimnac CM, Kurtz SM. Is increased modularity associated with increased fretting and corrosion damage in metal-on-metal total hip arthroplasty devices?: a retrieval study. J Arthroplasty 2013; 28:2-6. [PMID: 23910820 PMCID: PMC3971476 DOI: 10.1016/j.arth.2013.05.040] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 05/16/2013] [Accepted: 05/30/2013] [Indexed: 02/01/2023] Open
Abstract
This retrieval study documents taper damage at modular interfaces in retrieved MOM THA systems and investigates if increased modularity is associated with increased fretting and corrosion. One hundred thirty-four (134) heads and 60 stems (41 modular necks) of 8 different bearing designs (5 manufacturers) were analyzed. Damage at the shell-liner interface of 18 modular CoCr acetabular liners and the corresponding 11 acetabular shells was also evaluated. The results of this study support the hypothesis that fretting and corrosion damage occurs at a variety of modular component interfaces in contemporary MOM THAs. We also found that modularity of the femoral stem was associated with increased damage at the head. An analysis of component and patient variables revealed that dissimilar alloy pairing, larger head sizes, increased medio-lateral offsets and longer neck moment arms were all associated with increased taper damage at the modular interfaces.
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Affiliation(s)
| | - Josa A. Hanzlik
- Implant Research Center, Drexel University, Philadelphia, Pennsylvania
| | | | - Jeremy L. Gilbert
- Biomedical and Chemical Engineering, Syracuse University, Syracuse, New York
| | - Clare M. Rimnac
- Orthopaedic Implant Retrieval Analysis Laboratory, Case Western Reserve University, Cleveland, Ohio
| | - Steven M. Kurtz
- Implant Research Center, Drexel University, Philadelphia, Pennsylvania,Exponent, Inc., Philadelphia, Pennsylvania
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328
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Cook RB, Bolland BJRF, Wharton JA, Tilley S, Latham JM, Wood RJK. Pseudotumour formation due to tribocorrosion at the taper interface of large diameter metal on polymer modular total hip replacements. J Arthroplasty 2013; 28:1430-6. [PMID: 23528556 DOI: 10.1016/j.arth.2013.02.009] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/08/2013] [Accepted: 02/05/2013] [Indexed: 02/01/2023] Open
Abstract
We present an in-depth failure analysis of two large diameter bearing metal-on-polymer (MoP) modular total hip replacements, which have required revision surgery due to pseudotumour formation. The failure analysis showed a discrete pattern of material loss from the distal end of the head taper/stem trunnion interface. We postulate that the use of a proximal contacting taper design had provided insufficient mechanical locking between the head and the stem, enabling the head to toggle on the trunnion. In addition, the difference in angle between the taper and the trunnion formed a crevice between the two components. Through a combination of crevice environment, mechanically assisted corrosion, mechanical wear and erosion; debris and metal-ions have been released resulting in the adverse local tissue reactions (ALTR).
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Affiliation(s)
- Richard B Cook
- National Centre for Advanced Tribology at Southampton (nCATS), University of Southampton, Highfield, Southampton, SO17 1BJ, UK
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329
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Bisseling P, Tan T, Lu Z, Campbell PA, van Susante JLC. The absence of a metal-on-metal bearing does not preclude the formation of a destructive pseudotumor in the hip--a case report. Acta Orthop 2013; 84:437-41. [PMID: 23848217 PMCID: PMC3768048 DOI: 10.3109/17453674.2013.823590] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Pepijn Bisseling
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, the Netherlands
| | - Timothy Tan
- Los Angeles Orthopaedic Hospital, Los Angeles, CA, USA
| | - Zhen Lu
- Los Angeles Orthopaedic Hospital, Los Angeles, CA, USA
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330
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Jauch SY, Huber G, Sellenschloh K, Haschke H, Baxmann M, Grupp TM, Morlock MM. Micromotions at the taper interface between stem and neck adapter of a bimodular hip prosthesis during activities of daily living. J Orthop Res 2013; 31:1165-71. [PMID: 23553890 DOI: 10.1002/jor.22354] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/05/2013] [Indexed: 02/04/2023]
Abstract
The stem-neck taper interface of bimodular hip endoprostheses bears the risk of micromotions that can result in ongoing corrosion due to removal of the passive layer and ultimately cause implant fracture. We investigated the extent of micromotions at the stem-neck interface and the seating behavior of necks of one design made from different alloys during daily activities. Modular hip prostheses (n = 36, Metha®, Aesculap AG, Germany) with neck adapters (CoCr29Mo6 or Ti6Al4V) were embedded in PMMA (ISO 7206-4) and exposed to cyclic loading with peak loads ranging from walking (Fmax = 2.3 kN) to stumbling (Fmax = 5.3 kN). Translational and rotational micromotions at the taper interface and seating characteristics during assembly and loading were determined using four eddy-current sensors. Seating during loading after implant assembly was dependent on load magnitude but not on material coupling. Micromotions in the stem-neck interface correlated positively with load levels (CoCr: 2.6-6.3 µm, Ti: 4.6-13.8 µm; p < 0.001) with Ti neck adapters exhibiting significantly larger micromotions than CoCr (p < 0.001). These findings explain why high body weights and activities related to higher loads could increase the risk of fretting-induced implant failures in clinical application, especially for Ti-Ti combinations. Still, the role of taper seating is not clearly understood.
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Affiliation(s)
- Sabrina Yvonne Jauch
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestr. 15, 21073, Hamburg, Germany.
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331
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Severe metal-induced osteolysis many years after unipolar hip endoprosthesis. Clin Orthop Relat Res 2013; 471:2078-82. [PMID: 23292889 PMCID: PMC3676628 DOI: 10.1007/s11999-012-2780-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 12/21/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Modularity of the femoral head-neck junction provides increased intraoperative flexibility to the surgeon. Complications of this modularity include damage to the trunnion, with subsequent bone and/or soft tissue loss from adverse reactions to metal debris. CASE DESCRIPTION We describe two cases of severe metal-induced osteolysis and soft tissue damage requiring revision 10 and 13 years following implantation of a unipolar endoprosthesis. Damage to the trunnion resulted in severe acetabular and trochanteric osteolysis and soft tissue loss requiring complex revision surgery. LITERATURE REVIEW Several reports have shown the trunnion, the head-neck interface, and the neck-stem couple as the causes of this early failure secondary to metal ion release from mechanical fretting corrosion or from crevice corrosion at these modular interfaces. These reports have been in association with a total hip prosthesis rather than a unipolar endoprosthesis. Revision of a unipolar endoprosthesis is most commonly attributable to stem loosening or acetabular erosion from the large femoral head articulating on the host acetabular cartilage and not owing to failure of the trunnion. PURPOSES AND CLINICAL RELEVANCE Trunnion damage resulting in a severe reaction to metal debris with acetabular osteolysis, erosion of the greater trochanter, and loss of the abductor mechanism can occur years after implantation of a cementless unipolar endoprosthesis. This raises questions regarding long-term safety of the modular interface of a contemporary cementless stem and a large-diameter unipolar head. We recommend long-term followup of patients with a unipolar endoprosthesis as early recognition and treatment are required to avoid a potentially complex revision.
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332
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Dyrkacz RMR, Brandt JM, Ojo OA, Turgeon TR, Wyss UP. The influence of head size on corrosion and fretting behaviour at the head-neck interface of artificial hip joints. J Arthroplasty 2013; 28:1036-40. [PMID: 23528551 DOI: 10.1016/j.arth.2012.10.017] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 09/14/2012] [Accepted: 10/12/2012] [Indexed: 02/01/2023] Open
Abstract
The primary goal of this study was to determine if head size affects corrosion and fretting behaviour at the head-neck taper interface of modular hip prostheses. Seventy-four implants were retrieved that featured either a 28 mm or a 36 mm head with a metal-on-polyethylene articulation. The bore of the heads and the neck of the stems were divided into eight regions each and graded by three observers for corrosion and fretting damage separately using modified criteria as reported in the literature. The 36 mm head size featured a significant difference in the corrosion head scores (p=0.022) in comparison to the 28 mm heads. This may be attributed to a greater torque acting along the taper interface due to activities of daily living.
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Affiliation(s)
- Richard M R Dyrkacz
- University of Manitoba, Department of Mechanical and Manufacturing Engineering, E2-327 Engineering and Information Technology Complex, 75A Chancellors Circle, Winnipeg, Manitoba, Canada R3T 2N2
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333
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334
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Zhao ZS, Sun JY. Total hip arthroplasty using S-ROM prosthesis in elder patients with type C and B bone. J Orthop 2013; 10:65-9. [PMID: 24403752 DOI: 10.1016/j.jor.2013.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 04/01/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical and radiological results using S-ROM prosthesis in patients with type C and B femoral bone requiring primary total hip arthroplasty (THA) for multiple reasons. METHODS Sixteen hips were followed up for a mean of 38 months (range, 26-48), with a mean age at surgery of 72 years (range, 65-75). RESULTS The average Harris hip score improved from 52.2 points to 88.5 points. All femoral stems showed stable fixation. Neither osteolysis around the femoral stem nor subsidence of the femoral stem were found at the final follow-up. CONCLUSION For the patients with poor bone quality, total hip arthroplasty with the use of the proximal modular femoral stem yielded good short-to-mid-term results with respect to the clinical and radiological criteria.
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Affiliation(s)
- Zhong-Shou Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, PR China
| | - Jun-Ying Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, PR China
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335
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Cooper HJ, Urban RM, Wixson RL, Meneghini RM, Jacobs JJ. Adverse local tissue reaction arising from corrosion at the femoral neck-body junction in a dual-taper stem with a cobalt-chromium modular neck. J Bone Joint Surg Am 2013; 95:865-72. [PMID: 23677352 PMCID: PMC3748981 DOI: 10.2106/jbjs.l.01042] [Citation(s) in RCA: 264] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Femoral stems with dual-taper modularity were introduced to allow additional options for hip-center restoration independent of femoral fixation in total hip arthroplasty. Despite the increasing availability and use of these femoral stems, concerns exist about potential complications arising from the modular neck-body junction. METHODS This was a multicenter retrospective case series of twelve hips (eleven patients) with adverse local tissue reactions secondary to corrosion at the modular neck-body junction. The cohort included eight women and three men who together had an average age of 60.1 years (range, forty-three to seventy-seven years); all hips were implanted with a titanium-alloy stem and cobalt-chromium-alloy neck. Patients presented with new-onset and increasing pain at a mean of 7.9 months (range, five to thirteen months) following total hip arthroplasty. After serum metal-ion studies and metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) revealed abnormal results, the patients underwent hip revision at a mean of 15.2 months (range, ten to twenty-three months). Tissue specimens were examined by a single histopathologist, and the retrieved implants were studied with use of light and scanning electron microscopy. RESULTS Serum metal levels demonstrated greater elevation of cobalt (mean, 6.0 ng/mL) than chromium (mean, 0.6 ng/mL) or titanium (mean, 3.4 ng/mL). MRI with use of MARS demonstrated adverse tissue reactions in eight of nine patients in which it was performed. All hips showed large soft-tissue masses and surrounding tissue damage with visible corrosion at the modular femoral neck-body junction. Available histology demonstrated large areas of tissue necrosis in seven of ten cases, while remaining viable capsular tissue showed a dense lymphocytic infiltrate. Microscopic analysis was consistent with fretting and crevice corrosion at the modular neck-body interface. CONCLUSIONS Corrosion at the modular neck-body junction in dual-tapered stems with a modular cobalt-chromium-alloy femoral neck can lead to release of metal ions and debris resulting in local soft-tissue destruction. Adverse local tissue reaction should be considered as a potential cause for new-onset pain in patients with these components, and early revision should be considered given the potentially destructive nature of these reactions. A workup including serologic studies (erythrocyte sedimentation rate and C-reactive protein), serum metal levels, and MARS MRI can be helpful in establishing this diagnosis.
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Affiliation(s)
- H. John Cooper
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612. E-mail address for J.J. Jacobs:
| | - Robert M. Urban
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612. E-mail address for J.J. Jacobs:
| | - Richard L. Wixson
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, #924, Chicago, IL 60611
| | - R. Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, 541 Clinical Drive, Suite 600, Indianapolis, IN 46202
| | - Joshua J. Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612. E-mail address for J.J. Jacobs:
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336
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Abstract
This case report details the presentation, imaging results, and operative findings of a pseudotumor associated with a press-fit metal-on-polyethylene total hip arthroplasty (THA). An 80-year-old man presented approximately 7 years after undergoing THA with worsening right groin and lateral hip pain with an associated proximal thigh mass. Physical examination demonstrated a tender, large anterolateral thigh mass that was also evident on metal artifact reduction sequence magnetic resonance imaging.An exploratory operative procedure revealed extensive tissue necrosis involving nearly the entire hip capsule, short external rotators, and tendinous portion of the gluteus medius muscle. In addition, marked surface corrosion was discovered about the taper at the head-neck junction of the prosthetic femoral component and the trunnion within the femoral head. The press-fit THA components were solidly fixed. The metallic head was replaced with a ceramic component, and the polyethylene liner was exchanged. The patient had complete resolution of his preoperative symptoms but had persistent problems with dislocations.Although reports of pseudotumor and local soft tissue reactions associated with metal-on-metal THAs have become increasingly ubiquitous in the literature, similar reports involving metal-on-polyethylene THA implants are less common.
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Affiliation(s)
- William F Scully
- Orthopedics Service, Madigan Healthcare System, Tacoma, WA 98431, USA.
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337
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Levine BR, Hsu AR, Skipor AK, Hallab NJ, Paprosky WG, Galante JO, Jacobs JJ. Ten-year outcome of serum metal ion levels after primary total hip arthroplasty: a concise follow-up of a previous report*. J Bone Joint Surg Am 2013; 95:512-8. [PMID: 23515985 PMCID: PMC3748974 DOI: 10.2106/jbjs.l.00471] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We previously reported on the metal ion concentrations of cobalt, chromium, and titanium that were found in the serum of patients three years after they had undergone primary total hip arthroplasty as compared with the concentrations found in the serum of control patients who did not have an implant. This study is a concise update on the serum metal levels found in a cohort of these patients ten years after the time of hip implantation. Of the original seventy-five subjects, metal ion levels were available for forty patients (53%). Ten patients (hybrid group) had received a hybrid total hip replacement that consisted of a modular cobalt-alloy femoral stem with a cobalt-alloy femoral head that had been inserted with cement and a titanium acetabular socket that had been inserted without cement. Nine patients (cobalt-chromium [CoCr] group) had received an implant with an extensively porous-coated modular cobalt-alloy femoral stem and femoral head along with a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Eight patients (titanium group) had undergone insertion of a proximally porous-coated modular titanium-alloy femoral stem with a cobalt-alloy femoral head and a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Thirteen patients (control group) from the original control group of patients who had not received an implant served as control subjects. Serum metal levels were measured with use of high-resolution sector field inductively coupled plasma mass spectrometry. The hybrid total hip arthroplasty group had mean cobalt levels that were 3.2 times higher at 120 months than they were at baseline, and the cobalt levels in that group were significantly higher than those in the titanium total hip arthroplasty group at thirty-six, sixty, eighty-four, ninety-six, and 120 months (p < 0.01). The hybrid group had mean chromium levels that were 3.9 times higher at 120 months than they were at baseline, and the CoCr total hip arthroplasty group had chromium levels that were 3.6 times higher at 120 months than they were at baseline. The serum titanium levels were higher in the titanium group at all follow-up time intervals as compared with the levels in all other groups, and the level in the titanium group at 120 months was eighteen times higher than it was at baseline (p < 0.01). Patients with well-functioning primary metal-on-polyethylene total hip replacements had elevated serum metal levels for as many as ten years postoperatively. Furthermore, metal release at the modular femoral head-neck junctions, rather than passive dissolution from porous ingrowth surfaces, was likely the dominant source of serum cobalt and chromium.
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Affiliation(s)
- Brett R. Levine
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite #300, Chicago, IL 60612. E-mail address for J.J. Jacobs:
| | - Andrew R. Hsu
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite #300, Chicago, IL 60612. E-mail address for J.J. Jacobs:
| | - Anastasia K. Skipor
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite #300, Chicago, IL 60612. E-mail address for J.J. Jacobs:
| | - Nadim J. Hallab
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite #300, Chicago, IL 60612. E-mail address for J.J. Jacobs:
| | - Wayne G. Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite #300, Chicago, IL 60612. E-mail address for J.J. Jacobs:
| | - Jorge O. Galante
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite #300, Chicago, IL 60612. E-mail address for J.J. Jacobs:
| | - Joshua J. Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite #300, Chicago, IL 60612. E-mail address for J.J. Jacobs:
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338
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Adverse tissue reactions in modular exchangeable neck implants: a report of two cases. J Arthroplasty 2013; 28:543.e13-5. [PMID: 23141863 DOI: 10.1016/j.arth.2012.07.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 06/11/2012] [Accepted: 07/02/2012] [Indexed: 02/08/2023] Open
Abstract
Dual-modular femoral stems with exchangeable necks theoretically allow optimization of hip joint biomechanics via selective restoration of femoral anteversion, offset, and limb length. A potential disadvantage is the possible generation of metal ions and debris by fretting and crevice corrosion at the additional stem-neck interface. We present 2 cases of early-onset adverse inflammatory tissue reactions as a result of accelerated corrosion at the stem-neck interface of a dual-modular implant, requiring subsequent revision of well-fixed components.
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339
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Cooper HJ, Della Valle CJ, Jacobs JJ. Biologic Implications of Taper Corrosion in Total Hip Arthroplasty. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.sart.2013.01.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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340
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Preuss R, Lars Haeussler K, Flohr M, Streicher RM. Fretting Corrosion and Trunnion Wear—Is it Also a Problem for Sleeved Ceramic Heads? ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.sart.2013.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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341
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Abstract
Hip implant retrieval analysis is the most important source of insight into the performance of new materials and designs of hip arthroplasties. Even the most rigorous in vitro testing will not accurately simulate the behavior of implant materials and new designs of prosthetic arthroplasties. Retrieval analysis has revealed such factors as the effects of gamma-in-air sterilisation of polyethylene, fatigue failure mechanisms of polymethylmethacrylate bone cement, fretting corrosion of Morse taper junctions, third body wear effects of both hard-on-hard and hard-on-soft bearing couples, and the effects of impingement of components on the full spectrum of bearing surfaces, none of which was predicted by pre-implantation in vitro testing of these materials and combinations. The temporal sequence of the retrieval process is approximately six years from first implantation through retrieval analysis, laboratory investigation, and publication of results, and thus, in addition to rigorous clinical evaluation, represents the true development and insight cycle for new designs and materials.
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Affiliation(s)
- J. M. Cuckler
- Alabama Medical Consultants, 100
Club Drive, Suite 164, Burnsville, North
Carolina 28714, USA
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342
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John Cooper H, Della Valle CJ, Berger RA, Tetreault M, Paprosky WG, Sporer SM, Jacobs JJ. Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am 2012; 94:1655-61. [PMID: 23289127 PMCID: PMC3444948 DOI: 10.2106/jbjs.k.01352] [Citation(s) in RCA: 440] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Corrosion at the modular head-neck junction of the femoral component in total hip arthroplasty has been identified as a potential concern, although symptomatic adverse local tissue reactions secondary to corrosion have rarely been described. METHODS We retrospectively reviewed the records of ten patients with a metal-on-polyethylene total hip prosthesis, from three different manufacturers, who underwent revision surgery for corrosion at the modular head-neck junction. RESULTS All patients presented with pain or swelling around the hip, and two patients presented with recurrent instability. Serum cobalt levels were elevated prior to the revision arthroplasty and were typically more elevated than were serum chromium levels. Surgical findings included large soft-tissue masses and surrounding tissue damage with visible corrosion at the femoral head-neck junction; the two patients who presented with instability had severe damage to the hip abductor musculature. Pathology specimens consistently demonstrated areas of tissue necrosis. The patients were treated with debridement and a femoral head and liner exchange, with use of a ceramic femoral head with a titanium sleeve in eight cases. The mean Harris hip score improved from 58.1 points preoperatively to 89.7 points at a mean of 13.0 months after the revision surgery (p=0.01). Repeat serum cobalt levels, measured in six patients at a mean of 8.0 months following revision, decreased to a mean of 1.61 ng/mL, and chromium levels were similar to prerevision levels. One patient with moderate hip abductor muscle necrosis developed recurrent instability after revision and required a second revision arthroplasty. CONCLUSIONS Adverse local tissue reactions can occur in patients with a metal-on-polyethylene bearing secondary to corrosion at the modular femoral head-neck taper, and their presentation is similar to the adverse local tissue reactions seen in patients with a metal-on-metal bearing. Elevated serum metal levels, particularly a differential elevation of serum cobalt levels with respect to chromium levels, can be helpful in establishing this diagnosis.
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Affiliation(s)
- H. John Cooper
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612. E-mail address for H.J. Cooper:
| | - Craig J. Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612. E-mail address for H.J. Cooper:
| | - Richard A. Berger
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612. E-mail address for H.J. Cooper:
| | - Matthew Tetreault
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612. E-mail address for H.J. Cooper:
| | - Wayne G. Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612. E-mail address for H.J. Cooper:
| | - Scott M. Sporer
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612. E-mail address for H.J. Cooper:
| | - Joshua J. Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612. E-mail address for H.J. Cooper:
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343
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Ryu JJ, Letchuman S, Shrotriya P. Roughness evolution of metallic implant surfaces under contact loading and nanometer-scale chemical etching. J Mech Behav Biomed Mater 2012; 14:55-66. [PMID: 22963747 DOI: 10.1016/j.jmbbm.2012.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 04/29/2012] [Accepted: 04/30/2012] [Indexed: 11/17/2022]
Abstract
Surface damage of metallic implant surface at taper lock and clamped interfaces may take place through synergistic interactions between repeated contact loading and corrosion. In the present research, we investigated the influence of surface roughness and contact loading on the mechanical and chemical damage phenomena. Cobalt-chromium (CoCrMo) specimens with two different roughness configurations created by milling and grinding process were subjected to normal and inclined contact loading. During repeated contact loading, amplitude of surface roughness reached a steady value after decreasing during the first few cycles. During the second phase, the alternating experiment of rough surface contact and micro-etching was conducted to characterize surface evolution behavior. As a result, surface roughness amplitude continuously evolved-decreasing during contact loading due to plastic deformation of contacting asperities and increasing on exposure to corrosive environment by the preferential corrosion attack on stressed area. Two different instabilities could be identified in the surface roughness evolution during etching of contact loaded surfaces: increase in the amplitude of dominant wavenumber and increase in amplitude of a small group of roughness modes. A damage mechanism that incorporates contact-induced residual stress development and stress-assisted dissolution is proposed to elucidate the measured instabilities in surface roughness evolution.
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Affiliation(s)
- J J Ryu
- Mechanical and Industrial Engineering Department, Texas A&M University - Kingsville, Kingsville, Texas, USA
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344
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Fricka KB, Ho H, Peace WJ, Engh CA. Metal-on-metal local tissue reaction is associated with corrosion of the head taper junction. J Arthroplasty 2012; 27:26-31.e1. [PMID: 22554728 DOI: 10.1016/j.arth.2012.03.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/13/2012] [Indexed: 02/01/2023] Open
Abstract
We evaluated taper corrosion in 36-mm diameter metal-on-metal (MOM) and metal-on-polyethylene (MOP) femoral heads from a single manufacturer retrieved for various reasons. Three reviewers visually graded taper corrosion with a 5-point scale on 19 MOM heads and 14 MOP heads. The MOM group had a higher corrosion score than the MOP group (mean, 3.5 vs 1.9; P < .001). There were 8 MOM heads (42%) and only 1 MOP head (7%) that demonstrated corrosion outside of the taper zone. Metal-on-metal patients revised secondary to adverse local tissue reactions (ALTRs) had greater scores than patients without ALTRs (mean, 4.36 vs 2.38; P < .01). Adverse local tissue reactions MOM patients were also likely to have corrosion outside of the taper junction. The corrosion score increased with implantation time, and at all time intervals, the corrosion score for the MOM group was greater. Because corrosion worsens with time, we are concerned that MOM ALTR failures will increase with longer follow-up.
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Affiliation(s)
- Kevin B Fricka
- Inova Center for Joint Replacement, Mount Vernon Hospital, Alexandria, VA, USA
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345
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Kop AM, Keogh C, Swarts E. Proximal component modularity in THA--at what cost? An implant retrieval study. Clin Orthop Relat Res 2012; 470:1885-94. [PMID: 22048865 PMCID: PMC3369081 DOI: 10.1007/s11999-011-2155-9] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND While modular femoral heads have been used in THA for decades, a recent innovation is a second neck-stem taper junction. Clinical advantages include intraoperative adjustment of leg length, femoral anteversion, and easier revision, all providing flexibility to the surgeon; however, there have been reports of catastrophic fracture, cold welding, and corrosion and fretting of the modular junction. QUESTIONS/PURPOSES We asked whether (1) the neck-stem junction showed the same degradation mechanisms, if any, as the head-neck junction, (2) the junction contributed to THA revision, (3) the alloy affected the degree of degradation, and (4) the trunion machine finish affected the degradation mechanisms. METHODS We compared 57 retrievals from seven total hip modular designs, three cobalt-chromium-molybdenum and four titanium based: Bionik(®) (four), GMRS(®) (four), Margron(®) (22), Apex(®) (five), M-series(®) (five), ZMR(®) (two), and S-ROM(®) (15). Macroscopic inspection, microscopy, and micro-CT were conducted to determine the effects of materials and design. RESULTS The cobalt-chromium-molybdenum components showed crevice corrosion and fretting of the neck-stem taper, whereas the titanium components had less corrosion; however, there were several cases of cold welding where disassembly could not be achieved in theater. CONCLUSIONS Even with modern taper designs and corrosion-resistant materials, corrosion, fretting, and particulate debris were observed to a greater extent in the second neck-stem junction. Titanium-based modular arthroplasty may lessen the degree of degradation, but cold welding of the components may occur. CLINICAL RELEVANCE Degradation of the second junction contributed to 8 cases of metallosis and two cases of aseptic lymphocyte-laminated vascular-associated lesions contributing to revision.
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Affiliation(s)
- A. M. Kop
- Department of Medical Engineering and Physics, Royal Perth Hospital, Wellington Street, Perth, 6000 Western Australia
| | - C. Keogh
- Department of Medical Engineering and Physics, Royal Perth Hospital, Wellington Street, Perth, 6000 Western Australia
| | - E. Swarts
- Department of Medical Engineering and Physics, Royal Perth Hospital, Wellington Street, Perth, 6000 Western Australia
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346
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Swaminathan V, Gilbert JL. Fretting corrosion of CoCrMo and Ti6Al4V interfaces. Biomaterials 2012; 33:5487-503. [PMID: 22575833 DOI: 10.1016/j.biomaterials.2012.04.015] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 04/04/2012] [Indexed: 11/17/2022]
Abstract
Mechanically assisted corrosion (fretting corrosion, tribocorrosion etc.,) of metallic biomaterials is a primary concern for numerous implant applications, particularly in the performance of highly-loaded medical devices. While the basic underlying concepts of fretting corrosion or tribocorrosion and fretting crevice corrosion are well known, there remains a need to develop an integrated systematic method for the analysis of fretting corrosion involving metal-on-metal contacts. Such a method can provide detailed and quantitative information on the processes present and explore variations in surfaces, alloys, voltages, loadings, motion and solution conditions. This study reports on development of a fretting corrosion test system and presents elements of an in-depth theoretical fretting corrosion model that incorporates both the mechanical and the electrochemical aspects of fretting corrosion. To demonstrate the capabilities of the new system and validate the proposed model, experiments were performed to understand the effect of applied normal load on fretting corrosion performance of Ti6Al4V/Ti6Al4V, CoCrMo/Ti6Al4V, and CoCrMo/CoCrMo material couples under potentiostatic conditions with a fixed starting surface roughness. The results of this study show that fretting corrosion is affected by material couples, normal load and the motion conditions at the interface. In particular, fretting currents and coefficient of friction (COF) vary with load and are higher for Ti6Al4V/Ti6Al4V couple reaching 3 mA/cm(2) and 0.63 at about 73 MPa nominal contact stress, respectively. Ti6Al4V coupled with CoCrMo displayed lower currents (0.6 mA/cm(2)) and COF (0.3), and the fretting corrosion behavior was comparable to CoCrMo/CoCrMo couple (1.2 mA/cm(2) and 0.3, respectively). Information on the mechanical energy dissipated at the interface, the sticking behavior, and the load dependence of the inter-asperity distance calculated using the model elucidated the influence of mechanical factors on the experimental results. It was observed that the lowest amount of work was required to generate some of the highest fretting corrosion currents in Ti6Al4V/Ti6Al4V couples compared to the other combinations. The elements of the model presented here provide an excellent basis to explain many of the observed behaviors of these interfaces.
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Affiliation(s)
- Viswanathan Swaminathan
- Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, NY 13210, USA
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347
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Shah RR, Barrack RL. Total hip arthroplasty in a patient with myelomeningocele. J Arthroplasty 2012; 27:820.e13-6. [PMID: 22019325 DOI: 10.1016/j.arth.2011.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 09/08/2011] [Indexed: 02/01/2023] Open
Abstract
The pathophysiology of hip subluxation and advanced arthritic changes in patients with myelomeningocele is usually due to a muscle imbalance between intact hip flexor and adductor muscles and weak gluteal and abductor muscles. Operative options include resection arthroplasty, hip arthrodesis, and total hip arthroplasty (THA). Each option has been reported to be fraught with complications. Previous reports of THA in these patients have largely been unsuccessful with catastrophic failures characterized by instability and early loosening. We report a case of a 46-year-old woman with L4 level myelomeningocele with a neurogenic dysplastic advanced arthritic left hip with subluxation. She underwent a successful THA with unique combination of implants that allowed for maximal options in this challenging clinical situation.
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Affiliation(s)
- Ritesh R Shah
- Department of Orthopaedics, Washington University School of Medicine/Barnes-Jewish Hospital, Saint Louis, Missouri 63110, USA
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348
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Langton DJ, Sidaginamale R, Lord JK, Nargol AVF, Joyce TJ. Taper junction failure in large-diameter metal-on-metal bearings. Bone Joint Res 2012. [PMID: 23610672 DOI: 10.1302/2046-3758.14.200004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES An ongoing prospective study to investigate failing metal-on-metal hip prostheses was commenced at our centre in 2008. We report on the results of the analysis of the first consecutive 126 failed mated total hip prostheses from a single manufacturer. METHODS Analysis was carried out using highly accurate coordinate measuring to calculate volumetric and linear rates of the articular bearing surfaces and also the surfaces of the taper junctions. The relationship between taper wear rates and a number of variables, including bearing diameter and orientation of the acetabular component, was investigated. RESULTS The measured rates of wear and distribution of material loss from the taper surfaces appeared to show that the primary factor leading to taper failure is the increased lever arm acting on this junction in contemporary large-diameter metal-on-metal hip replacements. CONCLUSIONS Our analysis suggests that varus stems, laterally engaging taper systems and larger head diameters all contribute to taper failure.
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Affiliation(s)
- D J Langton
- University Hospital of North Tees, Hardwick Road, Stockton TS19 8PE, UK
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349
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Abstract
Modular femoral components have been developed to aid in recreating native femoral version, limb length, and offset in total hip arthroplasty. Use of modular implants results in cost savings, as well. Inventory can be reduced while allowing intraoperative flexibility and options. With modular implants, the femoral prosthesis can be built in situ, which is helpful in minimizing incision length and surgical dissection. However, additional modular junctions are associated with increased concern for component failure through taper fretting, fatigue fracture, and local corrosion, which may contribute to elevated serum metal ion levels. The recent trend toward using larger diameter femoral heads may impart higher loads and stress than were seen previously. Although modular components offer a plethora of intraoperative options in primary and revision total hip arthroplasty, the long-term effects of these additional junctions remains unknown.
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350
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Langton DJ, Sidaginamale R, Lord JK, Nargol AVF, Joyce TJ. Taper junction failure in large-diameter metal-on-metal bearings. Bone Joint Res 2012; 1:56-63. [PMID: 23610672 PMCID: PMC3626207 DOI: 10.1302/2046-3758.14.2000047] [Citation(s) in RCA: 226] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 03/29/2012] [Indexed: 12/14/2022] Open
Abstract
Objectives An ongoing prospective study to investigate failing metal-on-metal
hip prostheses was commenced at our centre in 2008. We report on
the results of the analysis of the first consecutive 126 failed
mated total hip prostheses from a single manufacturer. Methods Analysis was carried out using highly accurate coordinate measuring
to calculate volumetric and linear rates of the articular bearing
surfaces and also the surfaces of the taper junctions. The relationship
between taper wear rates and a number of variables, including bearing
diameter and orientation of the acetabular component, was investigated. Results The measured rates of wear and distribution of material loss
from the taper surfaces appeared to show that the primary factor
leading to taper failure is the increased lever arm acting on this
junction in contemporary large-diameter metal-on-metal hip replacements. Conclusions Our analysis suggests that varus stems, laterally engaging taper
systems and larger head diameters all contribute to taper failure.
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Affiliation(s)
- D J Langton
- University Hospital of North Tees, Hardwick Road, Stockton TS19 8PE, UK
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