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Meier J, Hembus J, Bader R, Vogel D. Computer-based analysis of the taper connection strength of different revision head and adapter sleeve designs. BIOMED ENG-BIOMED TE 2024; 69:199-209. [PMID: 37698840 DOI: 10.1515/bmt-2023-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES Ceramic revision heads, equipped with titanium adapter sleeves, are used in femoral head revision in total hip arthroplasty to avoid ceramic fracture due to the damaged taper. METHODS A finite element analysis of the taper connection strength of revision heads with varying head diameters combined with adapter sleeves of different lengths was conducted. The influence of various assembly forces, head diameter, and length of the adapter sleeves was evaluated. For two combinations, the pattern of contact pressure was evaluated when applying a simplified joint load (3 kN, 45° load angle). Experimental validation was conducted with 36 mm heads and adapter sleeves in size S, as well as 28 mm heads and adapter sleeves in size XL. RESULTS The pull-off force increased with higher assembly forces. Using larger head diameters and adapter sleeves led to decreased pull-off forces, a reduced contact surface, and less contact pressure. The contact pressure showed significant peaks and a diagonal pattern under 45° angle loading when assembly forces were less than 4 kN, and larger adapter sleeves were utilized. CONCLUSION A sufficient assembly force should be ensured intraoperatively, especially with an increasing head diameter and adapter sleeve size, as lower assembly forces might lead to reduced taper connection strength.
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Affiliation(s)
- Johanna Meier
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Jessica Hembus
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Danny Vogel
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
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Diaz-Lopez RA, Wen PH, Shelton JC. Influence of Taper surface topographies on contact deformation and stresses. J Mech Behav Biomed Mater 2023; 148:106213. [PMID: 37952504 DOI: 10.1016/j.jmbbm.2023.106213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
The role of bore and trunnion surface topography on the failure rate of total hip joint replacements due to trunnionosis is not clear despite significant variations in the design of taper components between manufacturers. Taper surface topography, along with other taper design parameters such as clearance, diameter, and assembly force, determine the initial interlock of the contacting surfaces after assembly; this has been related to relative motions that can cause fretting and corrosion at the taper interface. However, in most in-silico parametrical taper studies associated with taper micromotions, the bore and trunnion surfaces have been simplified using a flat surface and/or sinusoidal functions to mimic the surface roughness. The current study tests the hypothesis that the use of simple geometrical functions for the taper surface topography can predict the surface mechanics developed in assembled tapers. Measured and simulated surfaces of bores and trunnions were characterised using common roughness parameters and spectral density estimations. Using the same characterised surface profiles, 2D Finite Element (FE) models of CoCr alloy femoral heads and Ti alloy trunnions were developed. Models simulated assembly conditions at different resultant forces ranging from 0.5 to 4.0 kN, contact conditions were determined and associated with their topographical characteristics. Measured surfaces of bore and trunnion components comprise up to seven dominant spatial frequencies. Flattening of the trunnion microgrooved peaks was observed during the assembly of the taper. When the femoral head bore and trunnion topography were both considered a reduced number of microgrooved peaks were in contact, from 51 in an idealised taper surfaces to 35 in measured surfaces using an assembly reaction force of 4 kN. The contact points in the models developed high plastic strains, which were greater than that associated with failure of the material. Results showed that line and sine wave functions over estimate contact points at the taper interface compared to those surfaces that consider roughness and peak variation. These findings highlight the important role of modelling the full surface topography on the taper contact mechanics, as surface variations in the roughness and waviness change the performance of tapers.
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Affiliation(s)
- R A Diaz-Lopez
- School of Engineering and Materials Science, Queen Mary University of London, UK
| | - P H Wen
- School of Engineering and Materials Science, Queen Mary University of London, UK
| | - J C Shelton
- School of Engineering and Materials Science, Queen Mary University of London, UK.
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McCarthy CJ, Moore J, Condon F. Large head metal-on-metal bearing surface with a TMZF titanium alloy femoral stem with high rates of revision and trunnion failure. J Orthop 2023; 46:164-168. [PMID: 38031627 PMCID: PMC10682508 DOI: 10.1016/j.jor.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Background Mechanically assisted crevice corrosion at the head-neck interface puts implants at risk of trunnionosis, femoral head dissociation, implant failure and the development of metallosis. Metal-on-Metal bearings have very low wear rates, significantly lower than metal-on-polytethylene, but their wear results in cobalt and chromium ion systemic distribution. This is a study of the MITCH metal-on-metal bearing surface coupled with an Accolade TMZF stem. Methods This was a retrospective review of 24 total hip replacements 21 patients in that underwent MITCH TRH/Accolade TMZF implantation at a minimum of 12 years post operatively. The primary outcome of this study was all-cause revision with particular attention to revision due to trunnion failure and/or cobalt and chromium ion level. Results There was a revision rate of 66.7 % (n = 16) at a minimum of twelve years post operatively. Most notably there were six revisions for a gross trunnion failure. Two cases were revised for impending trunnion failure. There were seven cases revised for elevated serum cobalt and chromium levels and one was revised for unexplained pain. Discussion Patients in our study that underwent TMZF alloy cementless stems coupled with large cobalt chromium alloy heads are at high risk of catastrophic trunnion failure. The high rate of trunnnionosis in this implant combination is thought to be related to a significantly different Young's modulus due to a material mismatch coupled with galvanic corrosion.
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Affiliation(s)
- Cathal J McCarthy
- University Hospital Limerick, Limerick, Ireland
- Croom Orthopaedic Hospital, Limerick, Ireland
| | - Joss Moore
- University Hospital Limerick, Limerick, Ireland
- Croom Orthopaedic Hospital, Limerick, Ireland
| | - Finbarr Condon
- University Hospital Limerick, Limerick, Ireland
- Croom Orthopaedic Hospital, Limerick, Ireland
- University of Limerick, Limerick, Ireland
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Abstract
» Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with metal-on-metal implants.» It is characterized by the visible staining, necrosis, and fibrosis of the periprosthetic soft tissues, along with the variable presence of aseptic cysts and solid soft tissue masses called pseudotumors secondary to the corrosion and deposition of metal debris.» Metallosis can present with a spectrum of complications ranging from pain and inflammation to more severe symptoms such as osteolysis, soft tissue damage, and pseudotumor formation.» Workup of metallosis includes a clinical evaluation of the patient's symptoms, imaging studies, serum metal-ion levels, and intraoperative visualization of the staining of tissues. Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein along with intraoperative frozen slice analysis may be useful in certain cases to rule out concurrent periprosthetic joint infection.» Management depends on the severity and extent of the condition; however, revision THA is often required to prevent rapid progression of bone loss and tissue necrosis.
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Affiliation(s)
- Anderson Lee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Mathew MT, Cheng KY, Sun Y, Barao VAR. The Progress in Tribocorrosion Research (2010-21): Focused on the Orthopedics and Dental Implants. JOURNAL OF BIO- AND TRIBO-CORROSION 2023; 9:48. [PMID: 38525435 PMCID: PMC10959289 DOI: 10.1007/s40735-023-00767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/20/2023] [Accepted: 05/05/2023] [Indexed: 03/26/2024]
Abstract
Tribocorrosion is an integration of two areas-tribology and corrosion. It can be defined as the material degradation caused by the combined effect of corrosion and tribological process at the material interfaces. Significant development has occurred in the field of tribocorrosion over the past years. This development is due to its applications in various fields, such as aerospace, marine, biomedical, and space. Focusing on biomedical applications, tribocorrosion finds its applications in the implants used in cardiovascular, spine, orthopedics, trauma, and dental areas. It was reported that around 7.2 million Americans are living with joint implants. Implant surgery is a traumatic and expensive procedure. Tribocorrosion can affect the lifespan of the implants, thus leading to implant failure and a potential cause of revision surgery. Hence, it is essential to understand how tribocorrosion works, its interaction with the implants, and what procedures can be implemented to protect materials from tribocorrosion. This paper discusses how tribocorrosion research has evolved over the past 11 years (2010-2021). This is a comprehensive overview of tribocorrosion research in biomedical applications.
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Affiliation(s)
- Mathew T. Mathew
- Department of Biomedical Science, UIC College of Medicine, Rockford, IL 61107, USA
- Department of Biomedical Engineering, UIC, Chicago, IL 60612, USA
- Department of Restorative Dentistry, College of Dentistry, UIC, Chicago, IL 60612, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kai-yuan Cheng
- Department of Biomedical Science, UIC College of Medicine, Rockford, IL 61107, USA
| | - Yani Sun
- Department of Biomedical Science, UIC College of Medicine, Rockford, IL 61107, USA
| | - Valentim A. R. Barao
- Departament of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo 13414-903, Brazil
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Wight CM, Schemitsch EH. In vitro testing for hip head-neck taper tribocorrosion: A review of experimental methods. Proc Inst Mech Eng H 2022; 236:9544119221074582. [PMID: 35139678 PMCID: PMC8915230 DOI: 10.1177/09544119221074582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In vitro test methods are challenged by the multi-factorial nature of head-neck taper connection tribocorrosion due to the consequences of simplification. Incorrect study design and misinterpretation of results has led to contradictory findings regarding important factors affecting head-neck taper tribocorrosion. This review seeks to highlight important considerations when developing in vitro test methods, to help researchers strengthen their study design and analyze the implications of others' design decisions. The advantages, disadvantages, limitations and procedural considerations for finite element analyses, electrochemical studies and in vitro simulations related to head-neck taper connection tribocorrosion are discussed. Finite element analysis offers an efficient method for studying large ranges of mechanical parameters. However, they are limited by neglecting electrochemical, biological and fluid flow factors. Electrochemical studies may be preferred if these factors are considered important. Care must be taken in interpreting data from electrochemical studies, particularly when different materials are compared. Differences in material valence and toxicity affect clinical translation of electrochemical studies' results. At their most complex, electrochemical studies attempt to simulate all aspects of headneck taper connection tribocorrosion in a bench top study. Effective execution requires in-depth knowledge of the tribocorrosion phenomenon, the involved mechanisms, and their measures such that each study design decision is fully informed.
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Affiliation(s)
- Christian M Wight
- Institute of Biomaterial and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Wight CM, Whyne CM, Bogoch ER, Zdero R, Chapman RM, van Citters DW, Walsh WR, Schemitsch E. Effect of head size and rotation on taper corrosion in a hip simulator. Bone Jt Open 2021; 2:1004-1016. [PMID: 34825826 PMCID: PMC8636299 DOI: 10.1302/2633-1462.211.bjo-2021-0147.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIMS This study investigates head-neck taper corrosion with varying head size in a novel hip simulator instrumented to measure corrosion related electrical activity under torsional loads. METHODS In all, six 28 mm and six 36 mm titanium stem-cobalt chrome head pairs with polyethylene sockets were tested in a novel instrumented hip simulator. Samples were tested using simulated gait data with incremental increasing loads to determine corrosion onset load and electrochemical activity. Half of each head size group were then cycled with simulated gait and the other half with gait compression only. Damage was measured by area and maximum linear wear depth. RESULTS Overall, 36 mm heads had lower corrosion onset load (p = 0.009) and change in open circuit potential (OCP) during simulated gait with (p = 0.006) and without joint movement (p = 0.004). Discontinuing gait's joint movement decreased corrosion currents (p = 0.042); however, wear testing showed no significant effect of joint movement on taper damage. In addition, 36 mm heads had greater corrosion area (p = 0.050), but no significant difference was found for maximum linear wear depth (p = 0.155). CONCLUSION Larger heads are more susceptible to taper corrosion; however, not due to frictional torque as hypothesized. An alternative hypothesis of taper flexural rigidity differential is proposed. Further studies are necessary to investigate the clinical significance and underlying mechanism of this finding. Cite this article: Bone Jt Open 2021;2(11):1004-1016.
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Affiliation(s)
- Christian M. Wight
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Cari M. Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Earl R. Bogoch
- Department of Surgery, University of Toronto, Brookfield Chair in Fracture Prevention, Toronto, Ontario, Canada
| | - Radovan Zdero
- London Health Science Centre, Western University, London, Ontario, Canada
| | - Ryan M. Chapman
- London Health Science Centre, Western University, London, Ontario, Canada
| | - Douglas W. van Citters
- Thayer School of Engineering at Dartmouth College, Western University, Hanover, New Hampshire, USA
| | - William R. Walsh
- Surgical and Orthopaedic Research Laboratory, UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Emil Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Radzik B, Bijukumar D, Cheng KY, Badhe RV, Barba M, Mathew MT. The role of fretting-frequency on the damage modes of THR modular junction: In-vitro study. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 126:112128. [PMID: 34082945 DOI: 10.1016/j.msec.2021.112128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 12/28/2022]
Abstract
According to the National Center for Health Statistics, currently, more than 250,000 total hip replacements annually in the US alone, with an estimated increase to 500,000 by the year 2030. The usage of tapered junctions between the femoral neck and head gives the surgeon flexibility in implant assembly. However, these modular junctions are subjected to micro-motion that may cause chemical and fretting-corrosion at the modular junction. Therefore, it is imperative to study these forces to mitigate their effects. The current study aims to understand the effects of fretting-corrosion as a function of fretting frequencies caused by common physical activities in an in-vitro model of hip modular junctions. The fretting system has a tribological contact condition of flat-on-flat, mounted to a load frame. CoCrMo pins were polished and immersed in a synovial fluid-like electrolyte solution (Bovine calf serum 30 g/l). Electrochemical measurements were made using a potentiostat. Samples then undergo 3600 cycles at 50 μm (to simulate gross slips), with a horizontal load at 200 N, and a frequency of 0.5 Hz, 0.7 Hz, 1 Hz, and 1.5 Hz to simulate Sit Down-Stand Up, Stair Climb, Walking, and Jogging, respectively. Worn surfaces were then examined under optical and scanning electron microscopy. The evolution of free potential as a function of time for tested frequencies shows the initial potential drop and stabilized trend in the potential evolution. The sample group at a higher frequency displays a higher tendency of corrosion than a lower frequency; however, the dissipation energy decreases as a function of fretting frequency. Both electrochemical and mechanical responses correlate to the variation in the fretting frequencies. Organometallic complexes were found on the surfaces of the samples that were subjected to a slower frequency of fretting, whereas mechanical grooving was noticed on samples with a faster frequency. Hence, these preliminary studies suggest that implant failure rates may be altered based on fretting-frequencies induced by physical activity. Further studies will be required to verify the findings and explore the potential role of fretting frequency in the damage modes of the modular junction.
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Affiliation(s)
- Bartlomiej Radzik
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UIC College of Medicine at Rockford, IL, United States of America
| | - Divya Bijukumar
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UIC College of Medicine at Rockford, IL, United States of America
| | - Kai-Yuan Cheng
- Department of Civil and Material Engineering, College of Engineering, UIC, Chicago, United States of America
| | - Ravindra V Badhe
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UIC College of Medicine at Rockford, IL, United States of America
| | - Mark Barba
- OrthoIllinois, Rockford, IL, United States of America
| | - Mathew T Mathew
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UIC College of Medicine at Rockford, IL, United States of America; Department of Civil and Material Engineering, College of Engineering, UIC, Chicago, United States of America; Rush University Medical Center, Chicago, IL, United States of America.
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Ouellette ES, Smith SM, Gilbert JL. Self-reinforced poly(ether ether ketone) and polyethylene composite gaskets for prevention of mechanically-assisted corrosion in modular taper junctions: Seating, micromotion and short-term fretting corrosion. J Mech Behav Biomed Mater 2021; 119:104454. [PMID: 33826987 DOI: 10.1016/j.jmbbm.2021.104454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
Abstract
Mechanically-assisted crevice corrosion (MACC) is a phenomenon known to cause complications in modular orthopedic implants, particularly at metal-metal taper junctions. Previous studies of the properties and corrosion performance of an interfacial polymeric self-reinforced composite (SRC) gaskets have shown its capability as a high-strength, insulating barrier against oxide abrasion and metal degradation of metal-metal (or metal-hard) contacts in MACC conditions. This study characterizes the short-term tribocorrosion performance of poly (ether ether ketone) SRCs (SRC-PEEK) and polyethylene SRC (SRC-PE) films under in vitro test conditions for head-neck modular junction designs in hip replacement devices. SRC films composed of SRC-PEEK and SRC-PE were seated between 9/10 femoral head bores and stem tapers as thin interfacial gaskets and tested against metal-metal controls under short-term cyclic loading conditions in a custom in vitro test setup. Head-neck seating mechanics were measured, followed by incremental cyclic fretting corrosion testing with monitoring of fretting current, force, and relative micromotion between head and neck components during cyclic loading. SRC-PEEK tapers had a seating subsidence that was approximately three times that of the SRC-PE tapers and nine times that of controls. SRC-PE tapers, likely due to low friction, partially failed to lock during seating resulting in a pushing up of the head on the taper. Average fretting currents were significantly lower for both SRC groups (less than 0.3 μA at 4000 N) compared to control tapers experiencing fretting corrosion currents between 1.7 μA and 32 μA, (p < 0.05). SRC-PEEK gaskets exhibited similar subsidence and micromotion performance as controls while SRC-PE tapers experienced over 240 μm of subsidence during seating and loading conditions. The SRC-PE low-friction properties likely caused insufficient taper locking, which may increase the risk of improper head seating or head disassociation. These results show that SRC-PEEK gaskets, unlike SRC-PE gaskets, can maintain adequate frictional locking at the taper junction and prevent the onset of MACC. SRC-PEEK gaskets improve the performance of modular taper junctions and could be considered as a potential solution to mitigate fretting corrosion.
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Affiliation(s)
- Eric S Ouellette
- Syracuse Biomaterials Institute, Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, NY, 13244, USA; Exponent, Inc, Philadelphia, PA, 19104, USA
| | - Stephanie M Smith
- Syracuse Biomaterials Institute, Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, NY, 13244, USA; Clemson Department of Bioengineering, USA; Clemson - Medical University of South Carolina Bioengineering Program, USA
| | - Jeremy L Gilbert
- Syracuse Biomaterials Institute, Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, NY, 13244, USA; Clemson Department of Bioengineering, USA; Clemson - Medical University of South Carolina Bioengineering Program, USA.
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Eichler D, Barry J, Lavigne M, Massé V, Vendittoli PA. No radiological and biological sign of trunnionosis with Large Diameter Head Ceramic Bearing Total Hip Arthroplasty after 5 years. Orthop Traumatol Surg Res 2021; 107:102543. [PMID: 32276843 DOI: 10.1016/j.otsr.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Trunnionosis of large diameter (LDH) metal-on-metal total hip arthroplasty (THA) was linked to high systemic chromium (Cr) and cobalt (Co) ion levels and local adverse reactions to metal debris (ARMD). The safety of CoC LDH THA is not yet available at mid-term. Measuring whole blood Ti level of ceramic on ceramic (CoC) LDH THA with a titanium (Ti) stem is an indirect way to assess the performance of its head-neck taper modular junction. Therefore, we wanted to determine: (1) if the whole blood Ti ion levels in patients with LDH CoC THA after a minimum of 5 years of implantation is within the expected values for similar well performing Ti THA, (2) if Ti level scientifically increases over time, which would suggest the presence of a progressive modular head/neck junction wear process, (3) if clinical or radiographical manifestations of implant dysfunction are present? HYPOTHESIS Ti blood levels of LDH CoC THA will indirectly reflect the expected levels due to passive corrosion of the implants and will be stable over time. PATIENTS AND METHODS We report the whole blood Ti, Cr, and Co levels at 5years minimum for 57 patients with unilateral primary LDH CoC THA with head sizes ranging from 36 to 48mm using Ti stem and acetabular component. To compare Ti ion levels modification over time, in 25 patients were a previous measurement (1-3years) was available, we compared it to their last follow-up results (>5 years). Mean Ti level in well performing Ti THAs is recognized to be around 2.0 ug/L. Although, there are no universally accepted Ti levels associated with problematic implant, we used safety threshold of 10 ug/L. Clinical and radiological outcomes were recorded at last follow-up. RESULTS At 79 months mean follow-up, all mean Ti levels were 1.9μg/L (min 1.2, max 4.4) and all subject had values below the safety threshold of 10ug/L. In the subgroup of 25 cases with a previous measurement, there was a decrease in mean Ti levels between 20 months and 78 months follow-up (2.2μg/L (1.6-3.9) versus 2.0μg/L (1.4-2.8), p=0.007). No statistically significant relation was observed between Ti level at last FU and bearing diameter (rho=0.046, p=0.0734) or the presence or absence of a Ti adaptor sleeve (p=0.454): 1.94ug/L (min 1.20, max 2.80) versus 1.90ug/L (min 1.20, max 4.40). At last follow up, no patients presented osteolysis signs on radiographs, clinical signs of ARMD or were reoperated. Most patients had excellent clinical with 98% of them reporting minor (29%) or no functional limitation (69%) and 44% perceive their THA as a natural hip joint. However, 3/57patients (5%) temporarily experienced hip squeaking and 18/57 (31%) reported clicking sound. CONCLUSION With the tested LDH CoC THA, Ti levels were low and related the uneventful and unavoidable passive corrosion of implant surfaces. Mid-term measurement of Ti in subjects with LDH CoC did not reveal any indirect signs of trunnionosis, which should already be observable by this time. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- David Eichler
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Janie Barry
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Martin Lavigne
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Vincent Massé
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Pascal-André Vendittoli
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada.
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Accolade TMZF trunnion corrosion and mechanical failure 9 yr after primary surgery: A case report and treatment options. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Acute trunnion failure of a TMZF alloy stem with large diameter femoral heads. J Orthop 2020; 20:17-20. [PMID: 32021050 DOI: 10.1016/j.jor.2020.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/06/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Femoral head-neck modularity in total hip arthroplasty (THA) is advantageous but taper corrosion at the trunnion can result in implant failure. We report two cases of acute catastrophic trunnion failure with a TMZF alloy cementless stem. Methods Demographic, clinical, radiographic and operative data including implant retrieval was recorded and is presented. Results Case 1: A 79 year old farmer presented with sudden onset of hip pain and an inability to weight bear. He underwent a cementless large diameter stemmed metal-on-metal system (MITCH acetabular component, 56mm cobalt chrome head 4.5 lateralised Accolade TMZF, Stryker) nine years previously. He denied symptoms prior to his presentation to the Emergency Department.Case 2: An 86 year old gentleman presented with sudden onset of hip pain and inability to weight bear. He underwent a cementless large diameter stemmed metal-on-poly THA (Trident acetabular component, X3 polyethylene insert, 44mm cobalt chrome head, 4.5 lateralised Accolade TMZF, Stryker)nine years previously. This man had been complaining of mild hip symptoms prior to presentation. Conclusion Patients that have received TMZF alloy cementless stems coupled with CoCr alloy heads are at risk of catastrophic trunnion failure. Importantly, background trunnion corrosion may occur silently and present emergently irrespective of surveillance.
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Falkenberg A, Biller S, Morlock MM, Huber G. Micromotion at the head-stem taper junction of total hip prostheses is influenced by prosthesis design-, patient- and surgeon-related factors. J Biomech 2020; 98:109424. [DOI: 10.1016/j.jbiomech.2019.109424] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/25/2019] [Accepted: 10/13/2019] [Indexed: 12/28/2022]
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Gilbert JL. Metallic Degradation and the Biological Environment. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00063-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Hallab NJ, Jacobs JJ. Orthopedic Applications. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Valente G, Lanting B, MacDonald S, Teeter MG, Van Citters D, Howard J. Femoral head material loss at the head-neck junction in total hip arthroplasty: the effect of head size, stem material and stem offset. Hip Int 2019; 29:647-651. [PMID: 30499342 DOI: 10.1177/1120700018814473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Material loss at the head-neck junction in total hip arthroplasty may cause adverse clinical symptoms and implant failure. The purpose of this study was to quantitatively examine the effects of head size, stem material and stem offset on material loss of the head-neck taper interface of a single trunnion design in retrieval implants of metal on polyethylene bearing surfaces. METHODS A retrieval study was performed to identify all 28-mm and 32-mm femoral heads from a single implant/taper design implanted for >2 years. This included n = 56 of the 28-mm heads and n = 23 of the 32-mm heads. The 28-mm femoral heads were matched to 32-mm femoral heads based on time in vivo and head length. A coordinate measuring machine was used to determine maximum linear corrosion depth (MLD). Differences in MLD for head diameter, stem material, and stem offset were determined. RESULTS There were no differences between groups for age, gender, BMI, or implantation time. There was no difference in MLD between 28 mm and 32 mm matched paired head diameters (p = 0.59). There was also no difference in MLD between titanium or cobalt-chromium stems (p = 0.79), and regular or high-offset stems (p = 0.95). CONCLUSION There is no statistical difference in femoral head MLD at the head-neck junction in THA between 28-mm and 32-mm matched paired femoral heads, similar or mixed alloy coupled femoral head stem constructs, and regular or high offset stems.
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Affiliation(s)
- Giuseppe Valente
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
| | - Brent Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
| | - Steven MacDonald
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | | | - James Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
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Liu Y, Zhu D, Pierre D, Gilbert JL. Fretting initiated crevice corrosion of 316LVM stainless steel in physiological phosphate buffered saline: Potential and cycles to initiation. Acta Biomater 2019; 97:565-577. [PMID: 31374339 DOI: 10.1016/j.actbio.2019.07.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
Mechanically assisted crevice corrosion (MACC) has been associated with implant failure in vivo and is a serious concern in numerous metallic implant systems. Stainless steel medical devices may be subjected to fretting and crevice corrosion in the human body as are titanium and CoCrMo alloys due to the presence of a passive oxide film on their surface. One mechanism of MACC that has not been clearly identified and studied is fretting-initiated crevice corrosion (FICC) of stainless steel where an initial fretting event can initiate a rapid propagating crevice corrosion process even when fretting has ceased. FICC pin-on-disk experiments were performed at varying potential conditions and duration of fretting to explore the role of potential and fretting duration on the initiation of crevice corrosion. Triggering of a propagating crevice corrosion reaction on stainless steel at 250 mV vs Ag/AgCl/KCl (saturated) in PBS solution required only 2 s (2 cycles at 1 Hz) of fretting. Crevice corrosion continued to propagate under a 1.8 mm diameter pin with only 100 μm of direct contact, dissolving in both the depth and width dimension away from the fretting contact while the currents rose from 0.2 μA to 15 μA within 5 min. Three different potential-dependent FICC regions were identified that included unstable crevice corrosion (50 mV and above), metastable crevice corrosion (-100 mV to 0 mV) and stable fretting corrosion (between -500 mV and -150 mV). Crevice corrosion can be induced by fretting at potentials as low as -100 mV. Below -100 mV, there was no FICC, but rather fretting corrosion stopped immediately after fretting ceased and returned to a stable baseline current. Metastable FICC was shown at potentials between -100 mV and 0 mV, when the crevice corrosion current gradually decreased over several seconds or longer after fretting ceased. Self-sustained, unstable crevice corrosion started at 50 mV, where prior to fretting the currents were low, and after just a few cycles of fretting the crevice current rose rapidly and continued to increase after fretting stopped. Increase of potential increased the susceptibility of stainless steel to FICC. Scanning electron microscopy and digital optical microscopy revealed pitting and crevice corrosion on samples at -100 mV and higher potentials, where FICC was developing. By removing the oxide film, fretting motion significantly facilitates the critical crevice solution development, lowering the critical crevice potential and decreasing the initiation time for crevice corrosion. These results indicate that fretting initiated crevice corrosion may affect the performance of stainless steel in vivo. STATEMENT OF SIGNIFICANCE: AISI 316L stainless steel has been widely used as a metallic biomaterial for orthopaedic, spinal, dental and cardiovascular implants. Crevice corrosion has been a serious concern for stainless steel implants. For the first time we demonstrated and systematically studied the process of fretting-initiated crevice corrosion (FICC) in 316L stainless steel in simulated physiological solution of phosphate buffered saline. By removing the oxide film, fretting motion significantly facilitates the critical crevice solution development, lowering the critical crevice potential and decreasing the initiation time for crevice corrosion. Our findings indicate fundamental differences between the FICC mechanism and conventional crevice corrosion theory, showing that fretting can play a significant role in the initiation of crevice corrosion of stainless steel.
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18
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Snethen K, Hernandez J, Harman M. The effect of manufacturing tolerances on the mechanical environment of taper junctions in modular TKR. J Mech Behav Biomed Mater 2019; 97:49-57. [PMID: 31100485 DOI: 10.1016/j.jmbbm.2019.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/19/2018] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
Taper design is known to influence corrosive behavior in taper junctions used in modular orthopaedic devices. Manufacturing tolerance of bore-cone tapers is a critical design parameter due to the effect on taper fit, but the effect of variations in manufacturing tolerance on the mechanics of taper junctions has not been well characterized, particularly in modular total knee replacement (TKR). The purpose of this study was to investigate the effect of manufacturing tolerance on stress and micromotion of modular TKR taper junctions. A 3D finite element (FE) model of a modular TKR taper junction was developed and assigned elastoplastic material properties. Model taper geometry was varied by perturbing the angle mismatch by 0.05° between ±0.25° and represented expected variation in manufacturing tolerance. Stress and micromotion were calculated during dynamic FE simulations for each taper junction geometry under varying activity loads and material combinations. Although an increase in angle mismatch generally resulted in higher stress and micromotion, plastic material behavior disrupted this trend for larger angle mismatches. Model predictions corresponded with corrosion behavior evident in vitro. If the FE results obtained here apply in vivo, the absence of elastoplastic material properties in a taper model may grossly overestimate the micromotion and underestimate corrosion behavior and ion release. It is recommended that manufacturing tolerances of bore-cone tapers in modular TKR designs should produce angle mismatches within 0.1° at the taper junction.
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Affiliation(s)
- Kyle Snethen
- Bioengineering Department, Clemson University, Clemson, USA
| | | | - Melinda Harman
- Bioengineering Department, Clemson University, Clemson, USA.
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19
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Design, Material, and Seating Load Effects on In Vitro Fretting Corrosion Performance of Modular Head-Neck Tapers. J Arthroplasty 2019; 34:991-1002. [PMID: 30827717 DOI: 10.1016/j.arth.2019.01.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/03/2019] [Accepted: 01/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The short-term corrosion and micromechanical behavior of 32 unique head-neck taper design/material/assembly conditions was tested using an incremental cyclic fretting corrosion (ICFC) test method previously developed. METHODS Seven materials, design, and simulated surgical parameters were evaluated, each being assigned 2 conditions for testing, using a 27-2 (7 factor, quarter factorial) design of experiments test matrix. The factors explored were (1) seating load, (2) head-neck offset, (3) material combination, (4) taper diameter, (5) taper roughness, (6) angular mismatch/engagement, and (7) taper length. Each sample underwent assembly, ICFC testing, pull off. RESULTS Low seating load and high head offset correlated with increased fretting corrosion (P < .05). High head offset also contributed to a lower onset load for fretting current and higher micromotion (P < .05). Head subsidence measured over the ICFC test for samples seated at 100 N was significantly higher than samples seated at 4000 N. Micromotion for 12-mm head offsets was statistically higher than samples with a 1.5-mm head offset. A number of interactive effects were observed. For example, samples seated at 4000 N were less sensitive to head offset than samples seated at 100 N in terms of the resulting fretting current. CONCLUSION Taper locking position, material combination, taper engagement length, taper roughness, and taper dimensions all had weak or no correlation with fretting current and taper micromotion. This test method and experimental design is a versatile means of assessing potential new taper designs in the future.
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20
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Falkenberg A, Drummen P, Morlock MM, Huber G. Determination of local micromotion at the stem-neck taper junction of a bi-modular total hip prosthesis design. Med Eng Phys 2019; 65:31-38. [PMID: 30679024 DOI: 10.1016/j.medengphy.2019.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/26/2022]
Abstract
High rates of clinical complications with bi-modular hip prostheses are attributed to failure of the stem-neck taper junction. Taper wear analyses have shown extensive material loss as a result of corrosion, potentially initiated by micromotion. The purpose of the study was to determine the amount of micromotion at this junction for different loading, assembly and material conditions. Micromotion between the neck adapter (CoCr29Mo6-alloy) and the stem (TiMo12Zr6Fe2-alloy; both Rejuvenate, Stryker) within the taper junction of a bi-modular hip stem were determined by image matching analysis of consecutively recorded images through windows in the stem component. A finite element model was used to determine the micromotion in the taper regions outside the windows and validated with the measured micromotion. With the model, the influence of the load amplitude, assembly force and component materials were then investigated. Determined micromotion (14-79 µm) by far exceeded critical values (5 µm) associated with the onset of fretting corrosion. Increasing assembly forces achieved a significant reduction in micromotion. The numerical model revealed insufficient assembly to cause the neck to perform rocking motions under load, repetitively changing taper contact in combination with gap opening, which facilitates fluid ingress into the junction. Changing the stem material to a stiffer Ti-alloy achieved a reduction of the micromotion of about 30%. This study emphasises the high importance of material selection, assembly force and loading on the susceptibility of bi-modular hip stems to fretting and crevice corrosion. These findings can serve to explain the increased rate of clinically reported problems with this particular prosthesis design.
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Affiliation(s)
- Adrian Falkenberg
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Denickestrasse 15, Hamburg 21073, Germany.
| | - Paul Drummen
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Denickestrasse 15, Hamburg 21073, Germany
| | - Michael M Morlock
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Denickestrasse 15, Hamburg 21073, Germany
| | - Gerd Huber
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Denickestrasse 15, Hamburg 21073, Germany
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21
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Herndon CL, Shah RP, Cooper HJ, Geller JA. A case of bilateral hip mechanically assisted crevice corrosion after staged total hip arthroplasty. Arthroplast Today 2018; 4:261-265. [PMID: 30186901 PMCID: PMC6123318 DOI: 10.1016/j.artd.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 12/27/2022] Open
Abstract
Mechanically assisted crevice corrosion (MACC), also known as trunnionosis, and adverse local tissue reaction (ALTR) are entities that can lead to pain and necessitate revision in total hip arthroplasty (THA). We present a case of a 75-year-old female who received a bilateral staged primary THA with metal on cross-linked polyethylene implants and had subsequent bilateral revisions for MACC and ALTR. In both instances, she presented with anterior thigh pain, weakness, and difficulty ambulating, and she was revised to ceramic on cross-linked polyethylene implants. This case may suggest a biologic predisposition or systemic immunogenic reaction to metal debris in some patients with ALTR or represent an implant-specific complication. To our knowledge, this is the first case reported of a patient having bilateral MACC from staged THA performed by 2 different surgeons using the same brand implant.
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Affiliation(s)
- Carl L Herndon
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
| | - Roshan P Shah
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
| | - H John Cooper
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
| | - Jeffrey A Geller
- The Center for Hip and Knee Replacement, Columbia University Department of Orthopedic Surgery, New York, NY, USA
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22
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Frisch NB, Lynch JR, Pourzal R, Banglmaier RF, Silverton CD. Dual-taper modular hip implant: Investigation of 3-dimensional surface scans for component contact, shape, and fit. Arthroplast Today 2018; 4:370-375. [PMID: 30186924 PMCID: PMC6123237 DOI: 10.1016/j.artd.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/24/2018] [Accepted: 06/04/2018] [Indexed: 11/25/2022] Open
Abstract
Background The etiology of wear particle generation and subsequent corrosion in modular total hip arthroplasty implants likely begins with mechanical fretting. The purpose of this study was to determine geometric features of the male and female taper surfaces that drive stability within the neck-stem junction. Methods Eighteen modular hip components received 3-dimensional surface scans to examine the neck-stem taper junction using an optical scanner. The normal distance between the surfaces of the neck taper as seated in the stem slot was measured and produced a color map of the contact proximity. Contour plots identified surface shape variation and contact. Angle measurements and neck seated depth were analyzed by regression. Results The typical features observed were (1) a vertical line of contact at one end of the transition from the flat surface to the radius surface; (2) a vertical line of contact in the radius surface just past the centerline; (3) a concavity along the flat surface between the neck and stem components; and (4) one of the neck flat surfaces was closer to its mating surface on the stem. The seated depth of the neck was dependent on the taper angles in the flat section of the neck (R2 = 0.5000, P = .0332). Conclusions The shape of the neck and stem tapers deviate from ideal design dimensions, contributing to relative motions between the neck and stem. While these processes are not proven to directly cause implant failure, they may place the implants at higher risk for failure.
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Affiliation(s)
| | - Jonathan R Lynch
- Henry Ford Health System Department of Orthopaedic Surgery, Detroit, MI, USA
| | - Robin Pourzal
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, IL, USA
| | | | - Craig D Silverton
- Henry Ford Health System Department of Orthopaedic Surgery, Detroit, MI, USA
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23
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Pierre D, Swaminathan V, Scholl LY, TenHuisen K, Gilbert JL. Effects of Seating Load Magnitude on Incremental Cyclic Fretting Corrosion in 5°40' Mixed Alloy Modular Taper Junctions. J Arthroplasty 2018; 33:1953-1961. [PMID: 29486910 DOI: 10.1016/j.arth.2018.01.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/20/2017] [Accepted: 01/11/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Mechanically assisted crevice corrosion of modular tapers continues to be a concern in total joint arthroplasties. A surgical factor that may affect taper fretting corrosion during cyclic loading is seating load magnitude. In this study, modular head-neck taper junctions were seated, capturing load-displacement, over a range of axially oriented loads, and electrochemical and micromotion data were captured during short-term incremental cyclic fretting corrosion (ICFC) tests. The hypothesis is low seating loads result in greater motion and fretting corrosion in ICFC tests. The effect of assembly load on pull-off force post-ICFC testing was also evaluated. METHODS The study employed custom-built test fixtures which measured head-neck micromotion and an electrochemical chamber to monitor electrochemical reactions. Head-neck motion measurements were captured using 2 noncontact differential variable reluctance transducers mounted to the head. Seating experiments ranged from 1000 to 8000 N. RESULTS Significant differences due to seating loads were reported in seating displacement, ICFC subsidence, and fretting current at 4000 N cyclic load. Seating load decreased but did not eliminate currents. Fretting onset load remained fixed (approximately 1200 N) for tapers seated above 2000 N. Fretting subsidence was negligible for seating loads of 4000 N or higher, and increased subsidence was observed below 4000 N. CONCLUSION This short-term test method evaluated the acute performance of modular implants which were assembled under various loads and demonstrated the link between seating loads, fretting motions, and electrochemical reactions. While increased seating loads reduced fretting corrosion and taper subsidence, it did not prevent fretting corrosion even at 8 kN seating.
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Affiliation(s)
- David Pierre
- Syracuse Biomedical Institute, Syracuse University, Syracuse, NY; Department of Bioengineering, Clemson University, Charleston, SC
| | | | | | | | - Jeremy L Gilbert
- Syracuse Biomedical Institute, Syracuse University, Syracuse, NY; Department of Bioengineering, Clemson University, Charleston, SC
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24
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Assessment of a press-fit proximal femoral modular reconstruction implant (PFMR ®) at 14.5 years. A 48-case series with a disturbing rate of implant fracture. Orthop Traumatol Surg Res 2018; 104:317-323. [PMID: 29474948 DOI: 10.1016/j.otsr.2017.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 11/18/2017] [Accepted: 11/28/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The PFMR® proximal femoral modular reconstruction implant (Protek, Sulzer Orthopedics, Switzerland) is a straight modular stem in sanded titanium with press-fit anchorage, intended to achieve spontaneous bone reconstruction following Wagner's principle. The aim of the present study was to analyze long-term clinical and radiological outcome. MATERIAL AND METHOD A single-center retrospective study included 48 PFMR stems implanted in 47 patients between 1998 and 2002. Results in this series were previously reported at 7 years' follow-up. Clinical assessment used PMA and Harris scores. Radiologic assessment focused on stem stability and osseointegration, and bone stock following Le Béguec. RESULTS Twenty-three patients were seen at a mean 14.5 years' follow-up (13 deceased, 11 lost to follow-up), including 1 with bilateral implants, i.e., 24 stems. PMA and Harris scores, stem stability and osseointegration and bone stock were stable with respect to the 7-year findings. Radiology found 7 stem fractures in the Morse taper, i.e., in 29% of implants. Two of these cases required femoral implant replacement; 5 were asymptomatic. DISCUSSION AND CONCLUSION Long-term outcome for PFMR stems was clinically and radiologically satisfactory for the 16 patients free of mechanical complications. The Morse taper fracture rate was high, and higher than reported elsewhere. The usual risk factors for implant fracture were not found in the present series. The modular design of the press-fit revision implant is its weak point; monoblock implants should be used in patients with good life-expectancy. LEVEL OF EVIDENCE IV (retrospective study).
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25
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Ouellette ES, Shenoy AA, Gilbert JL. The seating mechanics of head-neck modular tapers in vitro: Load-displacement measurements, moisture, and rate effects. J Orthop Res 2018; 36:1164-1172. [PMID: 28885735 DOI: 10.1002/jor.23725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/29/2017] [Indexed: 02/04/2023]
Abstract
The mechanically assisted crevice corrosion performance of head-neck modular tapers is a significant concern in orthopedic biomaterials. Fretting crevice corrosion processes in modular tapers are thought to be influenced by a wide array of factors including seating mechanics of the junction, hence there is a need for in vitro test methods that can assess their performance. This study presented a test method to directly measure the load-displacement seating mechanics of modular tapers and used this method to compare the seating mechanics for different tapers, moisture, seating loads and seating rates. Seating mechanics were explored whereby the instantaneous load-displacement behavior of the head seating onto the neck is captured and used to define the mechanics of seating. Two distinct taper design/material combinations were assembled wet or dry using axially applied loads (500, 1,000, 2,000, and 4,000 N) at two loading rates of 100 and 104 N/s (n = 5 for each condition) using a servohydraulic test frame. The results showed that pull-off strength scaled with seating load and ranged between 43% and 68% of seating load depending on sample and wetness. Tapers seated wet had higher pull-off strengths (2,200 ± 300 N) than those seated dry (1,800 ± 200 N, p < 0.05). Seating mechanics (load-displacement plots) varied due to sample type and due to wetness with differences in seating energy, seating stiffness, and seating displacement. These results show the detailed mechanics of seating during assembly and provide significant insight into the complex interplay of factors associated with even "ideal" seating (axial, quasistatic) loading. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1164-1172, 2018.
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Affiliation(s)
- Eric S Ouellette
- Department of Biomedical & Chemical Engineering, Syracuse University, Syracuse, 13244, New York.,Syracuse Biomaterials Institute, Syracuse University, Syracuse, 13244, NewYork
| | - Aarti A Shenoy
- Department of Biomedical & Chemical Engineering, Syracuse University, Syracuse, 13244, New York.,Syracuse Biomaterials Institute, Syracuse University, Syracuse, 13244, NewYork
| | - Jeremy L Gilbert
- Department of Biomedical & Chemical Engineering, Syracuse University, Syracuse, 13244, New York.,Syracuse Biomaterials Institute, Syracuse University, Syracuse, 13244, NewYork.,Institute of Medical and Biological Engineering, University of Leeds, Leeds, United Kingdom
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26
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Alrabeah GO, Knowles JC, Petridis H. Reduction of Tribocorrosion Products When Using the Platform-Switching Concept. J Dent Res 2018; 97:995-1002. [PMID: 29578825 DOI: 10.1177/0022034518765751] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The reduced marginal bone loss observed when using the platform-switching concept may be the result of reduced amounts of tribocorrosion products released to the peri-implant tissues. Therefore, the purpose of this study was to compare the tribocorrosion product release from various platform-matched and platform-switched implant-abutment couplings under cyclic loading. Forty-eight titanium implants were coupled with pure titanium, gold alloy, cobalt-chrome alloy, and zirconia abutments forming either platform-switched or platform-matched groups ( n = 6). The specimens were subjected to cyclic occlusal forces in a wet acidic environment for 24 h followed by static aqueous immersion for 6 d. The amount of metal ions released was measured using inductively coupled plasma mass spectrometry. Microscopic evaluations were performed pre- and postimmersion under scanning electron microscope (SEM) equipped with energy-dispersive spectroscopy X-ray for corrosion assessment at the interface and wear particle characterization. All platform-switched groups showed less metal ion release compared with their platform-matched counterparts within each abutment material group ( P < 0.001). Implants connected to platform-matched cobalt-chrome abutments demonstrated the highest total mean metal ion release (218 ppb), while the least total mean ion release (11 ppb) was observed in the implants connected to platform-switched titanium abutments ( P ≤ 0.001). Titanium was released from all test groups, with its highest mean release (108 ppb) observed in the implants connected to platform-matched gold abutments ( P < 0.001). SEM images showed surface tribocorrosion features such as pitting and bands of fretting scars. Wear particles were mostly titanium, ranging from submicron to 48 µm in length. The platform-matched groups demonstrated a higher amount of metal ion release and more surface damage. These findings highlight the positive effect of the platform-switching concept in the reduction of tribocorrosion products released from dental implants, which consequently may minimize the adverse tissue reactions that lead to peri-implant bone loss.
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Affiliation(s)
- G O Alrabeah
- 1 Prosthodontic Unit, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK.,2 Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK.,3 Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - J C Knowles
- 2 Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK.,4 Institute of Tissue Regeneration Engineering (ITREN) and Department of Nanobiomedical Science and BK21 Plus NBM, Global Research Center for Regenerative Medicine, Dankook University, 518-10 Anseo-dong, Dongnam-gu, Cheonan, Chungcheongnam-do, Republic of Korea.,5 The Discoveries Centre for Regenerative and Precision Medicine, UCL Campus, Gower Street, London, UK
| | - H Petridis
- 1 Prosthodontic Unit, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK
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27
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Bingley R, Martin A, Manfredi O, Nejadhamzeeigilani M, Oladokun A, Beadling AR, Siddiqui S, Anderson J, Thompson J, Neville A, Bryant M. Fretting-corrosion at the modular tapers interface: Inspection of standard ASTM F1875-98. Proc Inst Mech Eng H 2018. [PMID: 29529933 DOI: 10.1177/0954411918760958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interest in the degradation mechanisms at the modular tapers interfaces has been renewed due to increased reported cases of adverse reactions to metal debris and the appearance of wear and corrosion at the modular tapers interfaces at revision. Over the past two decades, a lot of research has been expended to understand the degradation mechanisms, with two primary implant loading procedures and orientations used consistently across the literature. ASTM F1875-98 is often used as a guide to understand and benchmark the tribocorrosion processes occurring within the modular tapers interface. This article presents a comparison of the two methods outlined in ASTM F1875-98 as well as a critique of the standard considering the current paradigm in pre-clinical assessment of modular tapers.
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Affiliation(s)
- Rachel Bingley
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Alan Martin
- 2 School of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Olivia Manfredi
- 2 School of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | | | - Abimbola Oladokun
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Andrew Robert Beadling
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Sohail Siddiqui
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | | | | | - Anne Neville
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Michael Bryant
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
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Abstract
INTRODUCTION Metal ion release from wear and corrosion at the femoral head-stem taper junction can evoke local adverse reactions to metal debris (ARMD). In a specific large-diameter head (LDH) total hip arthroplasty (THA) system, ceramic femoral heads of 44 to 48 mm are available with a titanium (Ti) adaptor sleeve, while heads of 36- to 40-mm come without sleeves. The hypothesis of this study is that the Ti adaptor sleeve with LDH ceramic-on-ceramic (CoC) bearings will not cause wear or corrosion at the taper junction and, thus, will not generate high whole blood Ti ion levels. METHODS We compared whole blood Ti levels at minimum 1-year follow-up in 27 patients with unilateral primary LDH CoC THA with head sizes ranging from 36 to 48 mm using a Ti stem and acetabular component. RESULTS Although Ti ion levels in patients with 36- to 40-mm head diameters without Ti sleeve were found to be statistically significantly higher (2.3 μg/l: 1.6-3.1, SD 0.44) compared to those with a Ti sleeve (1.9 μg/l: 1.6-2.2, SD 0.19) (p = 0.020), the found difference has no clinical importance. No patients presented clinical signs of ARMD, and the clinical results in both groups were similar. CONCLUSIONS LDH CoC THA Ti levels were low and probably related to unavoidable passive corrosion of implant surfaces. Measurement of Ti in subjects with ceramic LDH, with or without Ti adaptor sleeve, did not disclose undirected signs of trunnionosis.
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Berstock JR, Whitehouse MR, Duncan CP. Trunnion corrosion: what surgeons need to know in 2018. Bone Joint J 2018; 100-B:44-49. [PMID: 29292339 PMCID: PMC6424439 DOI: 10.1302/0301-620x.100b1.bjj-2017-0569.r1] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/19/2017] [Indexed: 11/05/2022]
Abstract
AIMS To present a surgically relevant update of trunnionosis. MATERIALS AND METHODS Systematic review performed April 2017. RESULTS Trunnionosis accounts for approximately 2% of the revision total hip arthroplasty (THA) burden. Thinner (reduced flexural rigidity) and shorter trunnions (reduced contact area at the taper junction) may contribute to mechanically assisted corrosion, exacerbated by high offset implants. The contribution of large heads and mixed metallurgy is discussed. CONCLUSION Identifying causative risk factors is challenging due to the multifactorial nature of this problem. Cite this article: Bone Joint J 2018;100-B(1 Supple A):44-9.
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Affiliation(s)
- J R Berstock
- Musculoskeletal Research Unit, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - M R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - C P Duncan
- Vancouver General Hospital, University of British Columbia, JP North 3rd floor, Room 3114, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada
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Bitter T, Khan I, Marriott T, Lovelady E, Verdonschot N, Janssen D. Finite element wear prediction using adaptive meshing at the modular taper interface of hip implants. J Mech Behav Biomed Mater 2018; 77:616-623. [DOI: 10.1016/j.jmbbm.2017.10.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/04/2017] [Accepted: 10/26/2017] [Indexed: 11/25/2022]
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Bead debonding from a modern cementless total hip femoral component with concomitant taper corrosion. Arthroplast Today 2017; 3:215-219. [PMID: 29204483 PMCID: PMC5712029 DOI: 10.1016/j.artd.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 11/20/2022] Open
Abstract
We report a case of bead shedding from a cylindrical extensively porous-coated cementless femoral component with concomitant taper corrosion at the modular head-neck junction of a metal-on-polyethylene total hip prosthesis. The patient presented with chronic thigh pain 4 years after primary total hip arthroplasty, and radiographs revealed significant osteolysis and metallic debris around the femoral stem. Intraoperatively, the patient had a grossly loose femoral component with debonding of sintered beads from the femoral stem, as well as evidence of taper corrosion. We identify a failure of a modern beaded femoral component in conjunction with taper corrosion.
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Evidence based recommendations for reducing head-neck taper connection fretting corrosion in hip replacement prostheses. Hip Int 2017; 27:523-531. [PMID: 29027189 DOI: 10.5301/hipint.5000545] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This systematic review seeks to summarise the published studies investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion at the head-neck taper connection, and provide clinical recommendations to reduce its occurrence. METHODS PubMed, MEDLINE and EMBASE electronic databases were searched using the terms taper, trunnion, cone and head-neck junction. Articles investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion were retrieved, reviewed and graded according to OCEBM levels of evidence and grades of recommendation. RESULTS The initial search yielded 1,224 unique articles, and 91 were included in the analysis. CONCLUSIONS There is fair evidence to recommend against the use of high offset femoral heads, larger diameter femoral heads, and to pay particular consideration to fretting corrosion's progression with time and risk with heavier or more active patients. Particular to metal-on-metal hip prostheses, there is fair evidence to recommend positioning the acetabular component to minimise edge loading. Particular to metal-on-polyethylene hip prostheses, there is fair evidence to recommend the use of ceramic femoral heads, against use of cast cobalt alloy femoral heads, and against use of low flexural rigidity femoral stems. Evidence related to taper connection design is largely conflicting or inconclusive. Head-neck taper connection fretting corrosion is a multifactorial problem. Strict adherence to the guidelines presented herein does not eliminate the risk. Prosthesis selection is critical, and well-controlled studies to identify each design parameter's relative contribution to head-neck taper connection fretting corrosion are required.
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Farhoudi H, Fallahnezhad K, Oskouei RH, Taylor M. A finite element study on the mechanical response of the head-neck interface of hip implants under realistic forces and moments of daily activities: Part 1, level walking. J Mech Behav Biomed Mater 2017; 75:470-476. [DOI: 10.1016/j.jmbbm.2017.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
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Vierra BM, Blumenthal SR, Amanatullah DF. Modularity in Total Hip Arthroplasty: Benefits, Risks, Mechanisms, Diagnosis, and Management. Orthopedics 2017; 40:355-366. [PMID: 28598491 DOI: 10.3928/01477447-20170606-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 11/07/2016] [Indexed: 02/03/2023]
Abstract
Modular implants are currently widely used in total hip arthroplasty because they give surgeons versatility during the operation, allow for easier revision surgery, and can be adjusted to better fit the anatomy of the specific patient. However, modular implants, specifically those that have metal-on-metal junctions, are susceptible to crevice and fretting corrosion. This can ultimately cause implant failure, inflammation, and adverse local tissue reaction, among other possible side effects. Surgeons should be aware of the possibility of implant corrosion and should follow a set of recommended guidelines to systematically diagnose and treat patients with corroded implants. Ultimately, surgeons will continue to use modular implants because of their widespread benefits. However, more research is needed to determine how to minimize corrosion and the negative side effects that have been associated with modular junctions in total hip arthroplasty. [Orthopedics. 2017; 40(6):355-366.].
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Affiliation(s)
- Mitchell C Weiser
- 1Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Diseases, and Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, NY 2Department of Orthopedics & Rehabilitation, University of Miami, Coral Gables, Florida 3Department of Mechanical and Materials Engineering and Department of Physical Therapy, Florida International University, Coral Gables, Florida
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Ilo KC, Derby EJ, Whittaker RK, Blunn GW, Skinner JA, Hart AJ. Fretting and Corrosion Between a Metal Shell and Metal Liner May Explain the High Rate of Failure of R3 Modular Metal-on-Metal Hips. J Arthroplasty 2017; 32:1679-1683. [PMID: 28159422 DOI: 10.1016/j.arth.2016.12.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/24/2016] [Accepted: 12/13/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The R3 acetabular system used with its metal liner has higher revision rates when compared to its ceramic and polyethylene liner. In June 2012, the medical and healthcare products regulatory agency issued an alert regarding the metal liner of the R3 acetabular system. METHODS Six retrieved R3 acetabular systems with metal liners underwent detailed visual analysis using macroscopic and microscopic techniques. RESULTS Visual analysis discovered corrosion on the backside of the metal liners. There was a distinct border to the areas of corrosion that conformed to antirotation tab insertions on the inner surface of the acetabular shell, which are for the polyethylene liner. Scanning electron microscopy indicated evidence of crevice corrosion, and energy-dispersive X-ray analysis confirmed corrosion debris rich in titanium. CONCLUSION The high failure rate of the metal liner option of the R3 acetabular system may be attributed to corrosion on the backside of the liner which appear to result from geometry and design characteristics of the acetabular shell.
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Affiliation(s)
- Kevin C Ilo
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Emma J Derby
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Robert K Whittaker
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Gordon W Blunn
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - John A Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
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Abstract
INTRODUCTION Modular total hip arthroplasty implants can help the operating surgeon reproduce the optimum limb length and offset; however, the modularity can lead to fretting and corrosion with associated metal-related problems. Although metal-on-metal bearings are often reported to have problems, recent case reports suggest that the problems can occur with any articulation, usually as a result of problems at the head/neck junction. METHODS We retrospectively reviewed three cases of a specific implant combination with nontraumatic trunnion failure, with two cases presenting as acute complete dissociation of the femoral head from the neck. RESULTS All three cases had failure of the Accolade TMZF plus stem and trunnion (Stryker) that progressed rapidly from the onset of symptoms. The most likely contributing factors to failure were large femoral head size, high horizontal offset, a low angled neck, and a β titanium alloy taper with a cobalt-chromium head. CONCLUSION We recommend regular follow-up of all patients with Accolade TMZF stems, and patients should be advised to seek immediate medical attention if they have any new mechanical symptoms in a metal-on-polyethylene total hip arthroplasty. Providers should specifically look for any alteration of alignment between the femoral head and neck in follow-up radiographs.
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An Analytical Calculation of Frictional and Bending Moments at the Head-Neck Interface of Hip Joint Implants during Different Physiological Activities. MATERIALS 2016; 9:ma9120982. [PMID: 28774104 PMCID: PMC5456991 DOI: 10.3390/ma9120982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 01/20/2023]
Abstract
This study predicts the frictional moments at the head-cup interface and frictional torques and bending moments acting on the head-neck interface of a modular total hip replacement across a range of activities of daily living. The predicted moment and torque profiles are based on the kinematics of four patients and the implant characteristics of a metal-on-metal implant. Depending on the body weight and type of activity, the moments and torques had significant variations in both magnitude and direction over the activity cycles. For the nine investigated activities, the maximum magnitude of the frictional moment ranged from 2.6 to 7.1 Nm. The maximum magnitude of the torque acting on the head-neck interface ranged from 2.3 to 5.7 Nm. The bending moment acting on the head-neck interface varied from 7 to 21.6 Nm. One-leg-standing had the widest range of frictional torque on the head-neck interface (11 Nm) while normal walking had the smallest range (6.1 Nm). The widest range, together with the maximum magnitude of torque, bending moment, and frictional moment, occurred during one-leg-standing of the lightest patient. Most of the simulated activities resulted in frictional torques that were near the previously reported oxide layer depassivation threshold torque. The predicted bending moments were also found at a level believed to contribute to the oxide layer depassivation. The calculated magnitudes and directions of the moments, applied directly to the head-neck taper junction, provide realistic mechanical loading data for in vitro and computational studies on the mechanical behaviour and multi-axial fretting at the head-neck interface.
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Jauch-Matt SY, Miles AW, Gill HS. Effect of trunnion roughness and length on the modular taper junction strength under typical intraoperative assembly forces. Med Eng Phys 2016; 39:94-101. [PMID: 27913177 DOI: 10.1016/j.medengphy.2016.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 10/15/2016] [Accepted: 11/13/2016] [Indexed: 01/24/2023]
Abstract
Modular hip implants are at risk of fretting-induced postoperative complications most likely initiated by micromotion between adjacent implant components. A stable fixation between ball head and stem-neck taper is critical to avoid excessive interface motions. Therefore, the aim of this study was to identify the effect of trunnion roughness and length on the modular taper strength under typical intraoperative assembly forces. Custom-made Titanium trunnions (standard/mini taper, smooth/grooved surface finish) were assembled with modular Cobalt-chromium heads by impaction with peak forces ranging from 2kN to 6kN. After each assembly process these were disassembled with a materials testing machine to detect the pull-off force as a measure for the taper strength. As expected, the pull-off forces increased with rising peak assembly force (p < 0.001). For low and moderate assembly forces, smooth standard tapers offered higher pull-off forces compared to grooved tapers (p < 0.038). In the case of an assembly force of 2kN, mini tapers showed a higher taper strength than standard ones (p=0.037). The results of this study showed that smooth tapers provided a higher strength for taper junctions. This higher taper strength may reduce the risk of fretting-related complications especially in the most common range of intraoperative assembly forces.
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Affiliation(s)
- S Y Jauch-Matt
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, United Kingdom.
| | - A W Miles
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, United Kingdom.
| | - H S Gill
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, United Kingdom.
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Properties and Corrosion Performance of Self-reinforced Composite PEEK for Proposed Use as a Modular Taper Gasket. Clin Orthop Relat Res 2016; 474:2414-2427. [PMID: 27146655 PMCID: PMC5052187 DOI: 10.1007/s11999-016-4861-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fretting corrosion in medical alloys is a persistent problem, and the need for biomaterials that can effectively suppress mechanically assisted crevice corrosion in modular taper junctions or otherwise insulate metal-on-metal interfaces in mechanically demanding environments is as yet unmet. QUESTIONS/PURPOSES The purpose of this study is to characterize a novel material, self-reinforced composite polyetheretherketone (SRC-PEEK) and to evaluate its ability to inhibit fretting corrosion in a pin-on-disk metal-on-metal interface test. METHODS SRC-PEEK was fabricated by hot compaction of in-house-made PEEK fibers by compacting uniaxial layups at 344°C under a load of 18,000 N for 10 minutes. SRC-PEEK, bulk isotropic PEEK, and the in-house-made PEEK fibers were analyzed for thermal transitions (Tg, Tm) through differential scanning calorimetry, crystallinity, crystal size, crystalline orientation (Hermanns orientation parameter) through wide-angle x-ray scattering, and modulus, tensile strength, yield stress, and strain to failure through monotonic tensile testing. SRC-insulated pin-on-disk samples were compared with metal-on-metal control samples in pin-on-disk fretting corrosion experiments using fretting current and fretting mechanics measurements. Fifty-micron cyclic motion at 2.5 Hz was applied to the interface, first over a range of loads (0.5-35 N) while held at -0.05 V versus Ag/AgCl and then over a range of voltages (-0.5 to 0.5 V) at a constant contact stress of 73 ± 19 MPa for SRC-PEEK and 209 ± 41 MPa for metal-on-metal, which were different for each group as a result of changes in true contact area due to variations in modulus between sample groups. Pins, disks, and SRC samples were imaged for damage (on alloy and SRC surfaces) and evidence of corrosion (on alloy pin and disk surfaces). SRC specimens were analyzed for traces of alloy transferred to the surface using energy dispersive spectroscopy after pin-on-disk testing. RESULTS SRC-PEEK showed improved mechanical properties to bulk PEEK (modulus = 5.0 ± 0.3 GPa, 2.8 ± 0.1 GPa, respectively, p < 0.001) and higher crystallinity to bulk PEEK (44.2% ± 3%, 39.5% ± 0.5%, respectively, p = 0.039), but had comparable crystalline orientation as compared with the initial PEEK fibers. SRC-PEEK reduced fretting currents compared with metal-on-metal controls by two to three orders of magnitude in both variable load (4.0E-5 ± 3.8E-5 μA versus 2.9E-3 ± 7.1E-4 μA, respectively, p = 0.018) and variable potential (7.5E-6 ± 4.7E-6 μA versus 5.3E-3 ± 1.4E-3 μA, respectively, p = 0.022) fretting corrosion testing. Minimal damage was observed on surfaces insulated with SRC-PEEK, whereas control surfaces showed considerable fretting corrosion damage and metal transfer. CONCLUSIONS The SRC-PEEK gaskets in this study demonstrated higher crystallinity and crystalline orientation and improved monotonic tensile properties compared with bulk PEEK with the ability to effectively insulate Ti6Al4V and CoCrMo alloy surfaces and prevent the initiation of fretting corrosion under high contact-stress conditions. CLINICAL RELEVANCE This novel SRC-PEEK material may offer potential as a thin film gasket material for modular tapers. Pending further in vitro and in vivo analyses, this approach may be able to preserve the advantages of modular junctions for surgeons while potentially limiting the downside risks associated with mechanically assisted crevice corrosion.
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The stability of dual-taper modular hip implants: a biomechanical analysis examining the effect of impact location on component stability. Arthroplast Today 2016; 3:119-124. [PMID: 28695184 PMCID: PMC5484971 DOI: 10.1016/j.artd.2016.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/14/2016] [Accepted: 08/17/2016] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to investigate the stability of dual-taper modular implants following impaction forces delivered at varying locations as measured by the distraction forces required to disassemble the components. Methods Distraction of the head-neck and neck-stem (NS) tapers of dual-taper modular implants with 0°, 8°, and 15° neck angles were measured utilizing a custom-made distraction fixture attached to a servohydraulic materials test machine. Distraction was measured after hand pressing the components as well as following a simulated firm hammer blow impaction. Impacts to the 0°, 8°, 15° necks were directed axially in line with the neck, 10° anterior, and 10° proximal to the axis of the neck, respectively. Results Impaction increased the range of NS component distraction forces when compared to hand pressed components (1125-1743 N vs 248-302 N, respectively). Off-axis impacts resulted in significantly reduced mean (±95% confidence interval) distraction forces (8° neck, 1125 ± 117 N; 15° neck, 1212 ± 73 N), which were up to 35% lower than the mean distraction force for axial impacts to the 0° neck (1743 ± 138 N). Conclusions Direction of impaction influences stability of the modular interface. The greatest stability was achieved with impaction directed in line with the longitudinal axis of the taper junction. Off-axis impaction of the 8° and 15° neck led to significantly reduced stability at the NS. Improving stability of dual-taper modular hip prostheses with appropriately directed impaction may help to minimize micromotion, component settling, fretting corrosion, and subsequent failure.
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Pourzal R, Hall DJ, Ha NQ, Urban RM, Levine BR, Jacobs JJ, Lundberg HJ. Does Surface Topography Play a Role in Taper Damage in Head-neck Modular Junctions? Clin Orthop Relat Res 2016; 474:2232-42. [PMID: 27339123 PMCID: PMC5014821 DOI: 10.1007/s11999-016-4933-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are increasing reports of total hip arthroplasty failure subsequent to modular taper junction corrosion. The surfaces of tapers are machined to have circumferential machining marks, resulting in a surface topography of alternating peaks and valleys on the scale of micrometers. It is unclear if the geometry of this machined surface topography influences the degree of fretting and corrosion damage present on modular taper junctions or if there are differences between modular taper junction material couples. QUESTIONS/PURPOSES (1) What are the differences in damage score and surface topography between CoCr/CoCr and CoCr/Ti modular junctions? (2) How are initial surface topography, flexural rigidity, taper angle mismatch, and time in situ related to visual taper damage scores for CoCr/CoCr couples? (3) How are initial surface topography, flexural rigidity, taper angle mismatch, and time in situ related to visual taper damage scores for CoCr/Ti couples? METHODS Damage on stem and head tapers was evaluated with a modified Goldberg score. Differences in damage scores were determined between a group of 140 CoCr/CoCr couples and 129 CoCr/Ti couples using a chi-square test. For a subgroup of 70 retrievals, selected at random, we measured five variables, including initial stem taper machining mark height and spacing, initial head taper roughness, flexural rigidity, and taper angle mismatch. All retrievals were obtained at revision surgeries. None were retrieved as a result of metal-on-metal failures or were recalled implants. Components were chosen so there was a comparable number of each material couple and damage score. Machining marks around the circumference of the tapers were measured using white light interferometry to characterize the initial stem taper surface topography in terms of the height of and spacing between machining mark peaks as well as initial head taper roughness. The taper angle mismatch was assessed with a coordinate measuring machine. Flexural rigidity was determined based on measurements of gross taper dimensions and material properties. Differences of median or mean values of all variables between material couples were determined (Wilcoxon rank-sum tests and t-tests). The effect of all five variables along with time in situ on stem and head taper damage scores was tested with a multiple regression model. With 70 retrievals, a statistical power of 0.8 could be achieved for the model. RESULTS Damage scores were different between CoCr/CoCr and CoCr/Ti modular taper junction material couples. CoCr/CoCr stem tapers were less likely to be mildly damaged (11%, p = 0.006) but more likely to be severely damaged (4%, p = 0.02) than CoCr/Ti stem tapers (28% and 1%, respectively). CoCr/CoCr couples were less likely to have moderately worn head tapers (7% versus 17%, p = 0.003). Stem taper machining mark height and spacing and head taper roughness were 11 (SD 3), 185 (SD 46), and 0.57 (SD 0.5) for CoCr/CoCr couples and 10 (SD 3), 170 (SD 56), and 0.64 (SD 0.4) for CoCr/Ti couples, respectively. There was no difference (p = 0.09, p = 0.1, p = 0.16, respectively) for either factor between material couples. Larger stem taper machining mark heights (p = 0.001) were associated with lower stem taper damage scores, and time in situ (p = 0.006) was associated with higher stem taper damage scores for CoCr/CoCr material couples. Stem taper machining marks that had higher peaks resulted in slower damage progression over time. For CoCr/Ti material couples, head taper roughness was associated with higher stem (p = 0.001) and head taper (p = 0.003) damage scores, and stem taper machining mark height, but not time in situ, was associated with lower stem taper damage scores (p = 0.007). CONCLUSIONS Stem taper surface topography was related to damage scores on retrieved head-neck modular junctions; however, it affected CoCr/CoCr and CoCr/Ti couples differently. CLINICAL RELEVANCE A taper topography of circumferential machining marks with higher peaks appears to enable slower damage progression and, subsequently, a reduction of the reported release of corrosion products. This may be of interest to implant designers and manufacturers in an effort to reduce the effects of metal release from modular femoral components.
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Affiliation(s)
- Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Deborah J. Hall
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Nguyen Q. Ha
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Robert M. Urban
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Brett R. Levine
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Joshua J. Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Hannah J. Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
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Royhman D, Patel M, Runa MJ, Wimmer MA, Jacobs JJ, Hallab NJ, Mathew MT. Fretting-corrosion behavior in hip implant modular junctions: The influence of friction energy and pH variation. J Mech Behav Biomed Mater 2016; 62:570-587. [DOI: 10.1016/j.jmbbm.2016.05.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 02/24/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
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Higgs GB, MacDonald DW, Gilbert JL, Rimnac CM, Kurtz SM, Klein GR, Hamlin BR, Lee GC, Mont MA, Cates HE, Malkani AL, Kraay MJ. Does Taper Size Have an Effect on Taper Damage in Retrieved Metal-on-Polyethylene Total Hip Devices? J Arthroplasty 2016; 31:277-81. [PMID: 27460298 DOI: 10.1016/j.arth.2016.06.053] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/20/2016] [Accepted: 06/26/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Taper design has been identified as a possible contributor to fretting corrosion damage at modular connections in total hip arthroplasty systems, but variations in as-manufactured taper interfaces may confound this analysis. This study characterized taper damage in retrievals with 2 different taper sizes but comparable taper surface finishes and investigated if fretting and corrosion damage is related to taper size in the context of a multivariable analysis for metal-on-polyethylene bearings. METHODS A total of 252 cobalt chromium femoral heads were identified in a collection of retrievals: 77 with taper A and 175 with taper B. Implantation time averaged 5.4 ± 6.0 years (range, 0-26 years). Explants were cleaned and analyzed using a 4-point semiquantitative method. Clinical and device factors related to head taper fretting corrosion damage were assessed using ordinal logistic regression with forward stepwise control. Components were then selected to create 2 balanced cohorts, matched on significant variables from the multivariable analysis. RESULTS Increased head offset (P < .001), longer implantation time (P = .002), heavier patients (P < .001), and more flexible tapers (P < .001) were associated with increased taper fretting and corrosion damage. When damage scores were compared between the balanced groups, no significant differences were found. CONCLUSION These results suggest that fretting and corrosion damage is insensitive to differences in taper size. The final model derived explains almost half of the fretting corrosion damage observed and identifies contributing factors that are consistent with other in vitro and retrieval studies.
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Affiliation(s)
- Genymphas B Higgs
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Daniel W MacDonald
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Jeremy L Gilbert
- Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, New York
| | - Clare M Rimnac
- Mechanical and Aerospace Engineering, Department of Orthopaedics, Case Western Reserve University, Cleveland, Ohio
| | - Steven M Kurtz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania; Exponent, Inc, Philadelphia, Pennsylvania
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45
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Matsen Ko L, Chen AF, Deirmengian GK, Hozack WJ, Sharkey PF. Catastrophic Femoral Head-Stem Trunnion Dissociation Secondary to Corrosion. J Bone Joint Surg Am 2016; 98:1400-4. [PMID: 27535443 DOI: 10.2106/jbjs.15.00914] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Modular femoral heads provide procedural enhancement by allowing accurate restoration of hip offset and limb-length equalization. However, corrosion may lead to adverse local tissue reactions. Severe trunnion corrosion can also lead to femoral head dissociation and catastrophic implant failure following primary total hip arthroplasty. METHODS We describe 5 cases, from our institution, in which the femoral head became dissociated from the femoral stem trunnion secondary to severe corrosion. Possible causes are evaluated. RESULTS Demographic commonalities among the 5 patients included a body mass index (BMI) of ≥30 kg/m(2) and male sex. All femoral heads were made of cobalt-chromium alloy and were larger-diameter implants (≥36 mm). Four of the 5 patients had a femoral head that increased the neck length above the default on a so-called standard head and 3 of the 5 had a stem with a 127° neck-shaft angle. CONCLUSIONS Although dissociation of the femoral head from the femoral trunnion following total hip arthroplasty is exceedingly rare, the prevalence may increase with longer follow-up. The dissociation is likely related to multiple factors, including a BMI of ≥30 kg/m(2), male sex, and corrosion resulting from the use of a larger metal head with a neck length of greater than the default and a stem with high offset. It is critical that surgeons be able to recognize this mode of implant failure and appropriately prepare to remove the femoral component during revision surgery. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Antonia F Chen
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gregory K Deirmengian
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - William J Hozack
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Peter F Sharkey
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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46
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Biomechanics of Posterior Dynamic Fusion Systems in the Lumbar Spine: Implications for Stabilization With Improved Arthrodesis. Clin Spine Surg 2016; 29:E325-30. [PMID: 23059703 DOI: 10.1097/bsd.0b013e31827588b1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A comparative biomechanical human cadaveric spine study of a dynamic fusion rod and a traditional titanium rod. OBJECTIVE The purpose of this study was to measure and compare the biomechanical metrics associated with a dynamic fusion device, Isobar TTL Evolution, and a rigid rod. SUMMARY OF BACKGROUND DATA Dynamic fusion rods may enhance arthrodesis compared with a rigid rod. Wolff's law implies that bone remodeling and growth may be enhanced through anterior column loading (AL). This is important for dynamic fusion rods because their purpose is to increase AL. METHODS Six fresh-frozen lumbar cadaveric specimens were used. Each untreated specimen (Intact) underwent biomechanical testing. Next, each specimen had a unilateral transforaminal lumbar interbody fusion performed at L3-L4 using a cage with an integrated load cell. Pedicle screws were also placed at this time. Subsequently, the Isobar was implanted and tested, and finally, a rigid rod replaced the Isobar in the same pedicle screw arrangement. RESULTS In terms of range of motion, the Isobar performed comparably to the rigid rod and there was no statistical difference found between Isobar and rigid rod. There was a significant difference between the intact and rigid rod and also between intact and Isobar conditions in flexion extension. For interpedicular displacement, there was a significant increase in flexion extension (P=0.017) for the Isobar compared with the rigid rod. Isobar showed increased AL under axial compression compared with the rigid rod (P=0.024). CONCLUSIONS Isobar provided comparable stabilization to a rigid rod when using range of motion as the metric, however, AL was increased because of the greater interpedicular displacement of dynamic rod compared with a rigid rod. By increasing interpedicular displacement and AL, it potentially brings clinical benefit to procedures relying on arthrodesis.
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Bernstein DT, Meftah M, Paranilam J, Incavo SJ. Eighty-six Percent Failure Rate of a Modular-Neck Femoral Stem Design at 3 to 5 Years: Lessons Learned. J Bone Joint Surg Am 2016; 98:e49. [PMID: 27307367 DOI: 10.2106/jbjs.15.01082] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND While innovation drives advancement, it is not immune to failure. Previously, we reported a corrosion-related revision rate of 28% (23 of 81 total hip arthroplasties) among patients who received the Rejuvenate modular-neck stem implant with short-term follow-up. Because we observed a dramatic interval failure rate after our initial report, we undertook this study. METHODS We prospectively followed a cohort of patients who had undergone implantation of the Rejuvenate modular-neck stem, as previously reported. At a minimum of 3 years of follow-up (range, 3.0 to 5.5 years), 73 hips in 63 patients (90% of the original group) were available for analysis. The mean serum cobalt and chromium ion levels were obtained preoperatively and postoperatively. Elevated serum cobalt ion levels (>4 μg/L), pain, or abnormal magnetic resonance imaging (MRI) findings were indications for revision surgery. Patient factors and serum metal ion levels were correlated to revision surgery. Additionally, post-revision serum cobalt and chromium ion level trends were assessed. RESULTS An 86% clinical failure rate (63 of the 73 hips) was observed at a mean follow-up of 4.2 ± 0.6 years (range, 3.0 to 5.5 years); 57 (78%) of the hips underwent revision at a mean of 3.2 ± 1.0 years (range, 1.0 to 5.5 years), and 6 (8%) of the hips were scheduled for revision. Patients who underwent revision surgery were younger and had greater serum metal ion levels and greater pain compared with patients who did not undergo revision. An elevated serum cobalt ion level was the most important independent factor associated with revision surgery. Cobalt ion levels decreased sharply after revision; however, some patients demonstrated persistent elevation with more gradual decline. CONCLUSIONS Emphasizing the reporting of positive results may leave orthopaedic surgeons reticent to publicize negative results; however, the high failure rate of this implant design within 5 years prompted this report. We believe that patients and orthopaedic surgeons should be made aware of this implant's clinical problems and patients should be followed closely. Expedient revision is necessary when failure is identified, to minimize potentially severe tissue damage and metal toxicity. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Derek T Bernstein
- Department of Orthopaedic Surgery (D.T.B., M.M., and S.J.I.) and Institute for Academic Medicine (J.P.), Houston Methodist Hospital, Houston, Texas
| | - Morteza Meftah
- Department of Orthopaedic Surgery (D.T.B., M.M., and S.J.I.) and Institute for Academic Medicine (J.P.), Houston Methodist Hospital, Houston, Texas
| | - Jaya Paranilam
- Department of Orthopaedic Surgery (D.T.B., M.M., and S.J.I.) and Institute for Academic Medicine (J.P.), Houston Methodist Hospital, Houston, Texas
| | - Stephen J Incavo
- Department of Orthopaedic Surgery (D.T.B., M.M., and S.J.I.) and Institute for Academic Medicine (J.P.), Houston Methodist Hospital, Houston, Texas
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Osman K, Panagiotidou AP, Khan M, Blunn G, Haddad FS. Corrosion at the head-neck interface of current designs of modular femoral components. Bone Joint J 2016; 98-B:579-84. [DOI: 10.1302/0301-620x.98b5.35592] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 12/10/2015] [Indexed: 11/05/2022]
Abstract
There is increasing global awareness of adverse reactions to metal debris and elevated serum metal ion concentrations following the use of second generation metal-on-metal total hip arthroplasties. The high incidence of these complications can be largely attributed to corrosion at the head-neck interface. Severe corrosion of the taper is identified most commonly in association with larger diameter femoral heads. However, there is emerging evidence of varying levels of corrosion observed in retrieved components with smaller diameter femoral heads. This same mechanism of galvanic and mechanically-assisted crevice corrosion has been observed in metal-on-polyethylene and ceramic components, suggesting an inherent biomechanical problem with current designs of the head-neck interface. We provide a review of the fundamental questions and answers clinicians and researchers must understand regarding corrosion of the taper, and its relevance to current orthopaedic practice. Cite this article: Bone Joint J 2016;98-B:579–84.
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Affiliation(s)
- K. Osman
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore HA7 4LP, UK
| | - A. P. Panagiotidou
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore HA7 4LP, UK
| | - M. Khan
- University College London, 170 Tottenham
Court Road, London W1T 7HA, UK
| | - G. Blunn
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore HA7 4LP, UK
| | - F. S. Haddad
- University College London Hospitals, 235
Euston Road, London, NW1
2BU, UK
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49
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Biologic Responses to Orthopedic Implants: Innate and Adaptive Immune Responses to Implant Debris. Spine (Phila Pa 1976) 2016; 41 Suppl 7:S30-1. [PMID: 27015070 DOI: 10.1097/brs.0000000000001436] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Almost 20% of joint replacement implants fail at 15 to 20 years. Reports suggest that systemic effects of metal-on-metal implants and local effects of total joint arthroplasty implants contributing to implant failure are immune system based. Sometimes implant wear debris can cause implant failure resulting from bone fracture, infection, or implant fracture/failure; most often, aseptic osteolysis or loosening leads to wear debris. Debris is produced by wear (primary) or by corrosion. Corrosion-chemical oxidation comprising reduction reactions involving electron transport-produces electrochemical degradation. Metallic implant degradation occurs when electrochemical dissolution and mechanical/physical wear are combined (i.e., tribocorrosion). With metal-on-metal implants, even with relatively low levels of wear and particle release, pathology caused by metal debris such as pseudotumor/fibrous tissue growth can lead to early implant failure.
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50
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Triantafyllopoulos GK, Elpers ME, Burket JC, Esposito CI, Padgett DE, Wright TM. Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties. Clin Orthop Relat Res 2016; 474. [PMID: 26208607 PMCID: PMC4709304 DOI: 10.1007/s11999-015-4468-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fretting and corrosion at head-neck junctions of total hip arthroplasties (THAs) have been associated with adverse local tissue reactions in patients with both metal-on-polyethylene (MoP) and metal-on-metal (MoM) prostheses. Femoral head size contributes to the severity of fretting and corrosion in large-diameter MoM THAs, but its impact on such damage in MoP THAs remains unknown. QUESTIONS/PURPOSES (1) Is femoral head size associated with increased fretting or corrosion at the head-neck junction in MoP total hips? (2) Is duration of implantation associated with increased fretting or corrosion? METHODS The severity of fretting/corrosion on surfaces of head tapers and stem trunnions was visually examined in 154 MoP THAs retrieved as part of 3282 revision surgeries performed at our institution between January 1, 2007, and December 31, 2013. Fretting and corrosion damage were subjectively graded by two independent observers on a 1 to 4 scale, and their relations to head size, alloy combinations, taper/trunnion design, length of implantation (LOI), and location were investigated. Differences in scores never exceeded one grade, and this occurred in only 17% of examined implants. With the available implants, the study provided 88% power to detect differences of 0.5 in fretting or corrosion scores in these analyses. RESULTS Fretting and corrosion of the tapers and the trunnions were not affected by head size (p = 0.247, p = 0.471, p = 0.837, and p = 0.868, respectively), although taper/trunnion design affected taper fretting (p = 0.005) and corrosion (p = 0.0031) and trunnion fretting (p = 0.0028). Head taper fretting (observed in 73% of heads) increased with LOI, but head taper corrosion (noted in 93% of heads) was not affected. Trunnion fretting (observed in 86% of stems) was more severe in mixed-alloy combinations and with increased LOI and was more severe proximally. Trunnion corrosion (noted in 72% of stems) was also location-dependent with greater corrosion distally. CONCLUSIONS Fretting and corrosion are regular occurrences in MoP THAs, but neither damage type was related to femoral head size. Conversely, taper design, LOI, and alloy combination affected the severity of both fretting and corrosion. CLINICAL RELEVANCE Although it has been suggested that trunnion corrosion seen in MoP bearings is a function of larger diameter heads, our data suggest that larger femoral heads may be used for increased damage at the modular junction of MoP THAs.
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Affiliation(s)
| | - Marcella E. Elpers
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Jayme C. Burket
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Christina I. Esposito
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Douglas E. Padgett
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Timothy M. Wright
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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