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Darowski M, Ruehrmund L, Kluess D, Klinder A, Bader R, Mittelmeier W. The influence of surgical technique guidance and surgeon's experience on the femoral head assembly in total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:2391-2401. [PMID: 38563982 PMCID: PMC11093847 DOI: 10.1007/s00402-024-05282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION The importance of the assembly procedure on the taper connection strength is evident. However, existent surgical technique guides frequently lack comprehensive and precise instructions in this regard. The aim of our experimental study was to evaluate the influence of the surgical technique guide on the femoral head assembly procedure in surgeons with differing levels of experience in total hip arthroplasty. MATERIALS AND METHODS Twenty-eight participants, divided into four groups based on their lifetime experience in total hip arthroplasty, conducted a femoral head assembly procedure in a simulated intraoperative environment before and after reviewing the surgical technique guide. Demographic information and the number of hammer blows were documented. Hammer velocity and impaction angle were recorded using an optical motion capturing system, while the impaction force was measured using a dynamic force sensor within the impactor. RESULTS We observed a high variation in the number of hammer blows, maximum force, and impaction angle. Overall, the number of hammer blows decreased significantly from 3 to 2.2 after reviewing the surgical technique guide. The only significant intragroup difference in the number of hammer blows was observed in the group with no prior experience in total hip arthroplasty. No correlation was found between individual factors (age, weight, height) or experience and the measured parameters (velocity, maximum force and angle). CONCLUSIONS The present study demonstrated a high variation in the parameters of the femoral head assembly procedure. Consideration of the surgical technique guide was found to be a limited factor among participants with varying levels of experience in total hip arthroplasty. These findings underline the importance of sufficient preoperative training, to standardize the assembly procedure, including impaction force, angle, and use of instruments.
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Affiliation(s)
- Martin Darowski
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany.
| | - Leo Ruehrmund
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany
| | - Daniel Kluess
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany
| | - Annett Klinder
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany
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Bologna FA, Putame G, Audenino AL, Terzini M. Understanding the role of head size and neck length in micromotion generation at the taper junction in total hip arthroplasty. Sci Rep 2024; 14:6397. [PMID: 38493233 PMCID: PMC10944531 DOI: 10.1038/s41598-024-57017-x] [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: 12/20/2023] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
Modular hip implants allow intra-operative adjustments for patient-specific customization and targeted replacement of damaged elements without full implant extraction. However, challenges arise from relative micromotions between components, potentially leading to implant failure due to cytotoxic metal debris. In this study magnitude and directions of micromotions at the taper junction were estimated, aiming to understand the effect of variations in head size and neck length. Starting from a reference configuration adhering to the 12/14 taper standard, six additional implant configurations were generated by varying the head size and/or neck length. A musculoskeletal multibody model of a prothesized lower limb was developed to estimate hip contact force and location during a normal walking task. Following the implant assembly, the multibody-derived loads were imposed as boundary conditions in a finite element analysis to compute the taper junction micromotions as the relative slip between the contacting surfaces. Results highlighted the L-size head as the most critical configuration, indicating a 2.81 μm relative slip at the mid-stance phase. The proposed approach enables the investigation of geometric variations in implants under accurate load conditions, providing valuable insights for designing less risky prostheses and informing clinical decision-making processes.
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Affiliation(s)
- Federico A Bologna
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy
| | - Giovanni Putame
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy
| | - Alberto L Audenino
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy
| | - Mara Terzini
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy.
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy.
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Massardier E, Bauwens PH, Masson JB, Rongieras F, Bertani A. Survival and complications at a minimum 5years' follow-up of the modular Mark-2 Extreme™ cementless femoral stem: Does the reduced modularity resolve the mechanical issues of the Mark-I stem? Orthop Traumatol Surg Res 2023; 109:103613. [PMID: 37004733 DOI: 10.1016/j.otsr.2023.103613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION The Extreme™ modular stem was developed for implant revision with metaphyseal-diaphyseal defect. Due to the high breakage rate, a new "reduced modularity" design has been introduced, but without reported results. We therefore conducted a retrospective assessment of (1) overall stem survival, (2) functional results, (3) osseointegration, and (4) the rate of complications, and notably of mechanical failure. HYPOTHESIS Reduced modularity reduces the risk of revision surgery for mechanical failure. MATERIAL AND METHODS Forty-five prostheses were implanted between January 2007 and December 2010 in 42 patients with severe bone defect (Paprosky≥III) or periprosthetic shaft fracture. Mean age was 69.6years (range: 44-91years). Minimum follow-up was 5years, for a mean 115.4months (range: 60-156months). The main study endpoint was femoral stem survival, counting all-cause explantation as event. Functional assessment comprised subjective rating of satisfaction, Postel Merle d'Aubigné (PMA) and Harris Hip scores, and Forgotten Joint Score (FJS). Whether the revision assembly was carried out in situ, in the patient's hip, or outside, on the operating table, was not known in 2 cases; in the other 43, assembly was in situ in 15 cases (35%) and on the operating table in 28 (65%). RESULTS Five-year stem survival was 75.7% (95% CI: 61.9-89.5%), taking all causes of change together. Seventeen patients (45.9%) had complications, 13 (35.1%) requiring revision surgery, including 10 (27.0%) for stem replacement. Five patients (13.5%) had steam breakage at the junction between the metaphysis and the diaphyseal stem, 4 of which occurred within 2 years of implantation or of fixation of a periprosthetic fracture. Mean preoperative Harris score was 48.4 [IQR (25-75% interquartile range): 37-58] and PMA score 11.1 (IQR: 10-12), compared to respectively 74 (IQR: 67-89) and 13.6 (IQR: 12.5-16) at follow-up. Mean FJS at follow-up was 71.5 (IQR: 61-94.5). In the 15 in situ assemblies, there were 3 breakages (20%), compared to 2 (7.1%) in the 28 table assemblies (p=0.21). DISCUSSION The stem breakage rate was high despite the reduced modularity, which concentrated all stress on a single junction but without reducing the risk of mechanical failure. Surgical technique was faulty in some cases, with in situ assembly of the metaphysis after implanting the diaphyseal stem, which does not respect the manufacturer's recommendations. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Etienne Massardier
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France.
| | - Paul-Henri Bauwens
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
| | - Jean-Baptiste Masson
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
| | - Frédéric Rongieras
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
| | - Antoine Bertani
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
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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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Gustafson JA, Mell S, Levine BR, Pourzal R, Lundberg HJ. Interaction of surface topography and taper mismatch on head-stem modular junction contact mechanics during assembly in modern total hip replacement. J Orthop Res 2023; 41:418-425. [PMID: 35488727 PMCID: PMC9617811 DOI: 10.1002/jor.25357] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/11/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
Implant failure due to fretting corrosion at the head-stem modular junction is an increasing problem in modular total hip arthroplasty. The effect of varying microgroove topography on modular junction contact mechanics has not been well characterized. The aim of this study was to employ a novel, microgrooved finite element (FEA) model of the hip taper interface and assess the role of microgroove geometry and taper mismatch angle on the modular junction mechanics during assembly. A two-dimensional, axisymmetric FEA model was created using a modern 12/14 taper design of a CoCrMo femoral head taper and Ti6Al4V stem taper. Microgrooves were modeled at the contacting interface of the tapers and varied based on height and spacing measurements obtained from a repository of measured retrievals. Additionally, taper angular mismatch between the head and stem was varied to simulate proximal- and distal-locked engagement. Forty simulations were conducted to parametrically evaluate the effects of microgroove surface topography and angular mismatch on predicted contact area, contact pressure, and equivalent plastic strain. Multiple linear regression analysis was highly significant (p < 0.001; R2 > 0.74) for all outcome variables. The regression analysis identified microgroove geometry on the head taper to have the greatest influence on modular junction contact mechanics. Additionally, there was a significant second order relationship between both peak contact pressure (p < 0.001) and plastic strain (p < 0.001) with taper mismatch angle. These modeling techniques will be used to identify the implant parameters that maximize taper interference strength via large in-silico parametric studies.
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Affiliation(s)
| | - Steven Mell
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brett R. Levine
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Hannah J. Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Grothe T, Günther KP, Hartmann A, Blum S, Haselhoff R, Goronzy J. The incidence of adverse local tissue reaction due to head taper corrosion after total hip arthroplasty using V40 taper and 36 mm CoCr head. Bone Joint J 2022; 104-B:852-858. [PMID: 35775169 DOI: 10.1302/0301-620x.104b7.bjj-2021-1769.r1] [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] [Indexed: 11/05/2022]
Abstract
AIMS Head-taper corrosion is a cause of failure in total hip arthroplasty (THA). Recent reports have described an increasing number of V40 taper failures with adverse local tissue reaction (ALTR). However, the real incidence of V40 taper damage and its cause remain unknown. The aim of this study was to evaluate the long-term incidence of ALTR in a consecutive series of THAs using a V40 taper and identify potentially related factors. METHODS Between January 2006 and June 2007, a total of 121 patients underwent THA using either an uncemented (Accolade I, made of Ti12Mo6Zr2Fe; Stryker, USA) or a cemented (ABG II, made of cobalt-chrome-molybdenum (CoCrMo); Stryker) femoral component, both with a V40 taper (Stryker). Uncemented acetabular components (Trident; Stryker) with crosslinked polyethylene liners and CoCr femoral heads of 36 mm diameter were used in all patients. At a mean folllow-up of 10.8 years (SD 1.1), 94 patients (79%) were eligible for follow-up (six patients had already undergone a revision, 15 had died, and six were lost to follow-up). A total of 85 THAs in 80 patients (mean age 61 years (24 to 75); 47 (56%) were female) underwent clinical and radiological evaluation, including the measurement of whole blood levels of cobalt and chrome. Metal artifact reduction sequence MRI scans of the hip were performed in 71 patients. RESULTS A total of 20 ALTRs were identified on MRI, with an incidence of 26%. Patients with ALTR had significantly higher median Co levels compared with those without ALTR (2.96 μg/l (interquartile range (IQR) 1.35 to 4.98) vs 1.44 μg/l (IQR 0.79 to 2.5); p = 0.019). Radiological evidence of osteolysis was also significantly associated with ALTR (p = 0.014). Median Cr levels were not significantly higher in those with ALTR compared with those without one (0.97 μg/l (IQR 0.72 to 1.9) v 0.67 μg/l (IQR 0.5 to 1.19; p = 0.080). BMI, sex, age, type of femoral component, head length, the inclination of the acetabular component, and heterotopic ossification formation showed no significant relationship with ALTR. CONCLUSION Due to the high incidence of local ALTR in our cohort after more than ten years postoperatively, we recommend regular follow-up investigation even in asymptomatic patients with V40 taper and metal heads. As cobalt levels correlate with ALTR occurrence, routine metal ion screening and consecutive MRI investigation upon elevation could be discussed. Cite this article: Bone Joint J 2022;104-B(7):852-858.
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Affiliation(s)
- Tim Grothe
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Albrecht Hartmann
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Sophia Blum
- Department of Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Richard Haselhoff
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jens Goronzy
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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Herbster M, Berth A, Märtens N, Robra M, Welzel F, Dallmann F, Lohmann CH, Halle T, Bertrand J, Döring J. Intraoperative assembly of anatomical shoulder prosthesis frequently results in malalignment of the modular taper junction. J Orthop Res 2021; 39:2485-2496. [PMID: 33368644 DOI: 10.1002/jor.24975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 02/04/2023]
Abstract
Anatomical shoulder arthroplasties (ASA) may fail because of micromotion at the modular taper junction causing wear due to fretting. Sufficient taper strength can reduce micromotion and potential reasons for failure. However, there are no normative standards for a safe assembly process performed intraoperatively by the surgeon. The purpose of this study is to determine the effect of common intraoperative assembly strategies and to identify critical influencing factors on taper stability. ASA with standard and stemless humeral component in combination with concentric Al2 O3 heads and eccentric CoCr28Mo6 alloyed humeral heads were tested. Taper angles and surface roughness were determined. Force magnitudes and impact directions were recorded using a sensorized head impactor and a three-dimensional force measuring platform. Subsequently, the axial pull-off forces were measured and taper engagement areas were macroscopically evaluated. In comparison to standard stem tapers that were impacted with an assembly device, stemless tapers were impacted into the artificial bone with significantly lower forces. Taper strength correlates to maximum impact force and was higher for CoCr28Mo6 heads with a mean pull-off ratio of 0.56 than for Al2 O3 heads with 0.37. Interestingly, all tapers showed an asymmetric clamping behavior, due to tilting during impaction. This is caused by the variation of the resulting force vector and further promoted by humeral head eccentricity. Assembly technique markedly influences the force magnitude, impact direction, impulse, and consequently taper strength. The resulting force vector and head eccentricity were identified as potential risk factors for taper malalignment.
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Affiliation(s)
- Maria Herbster
- Institute of Materials and Joining Technology, Otto-von-Guericke University, Magdeburg, Germany
| | - Alexander Berth
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Nicole Märtens
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Marcel Robra
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Florian Welzel
- GFE-Gesellschaft für Fertigungstechnik und Entwicklung Schmalkalden e.V., Schmalkalden, Germany
| | | | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Thorsten Halle
- Institute of Materials and Joining Technology, Otto-von-Guericke University, Magdeburg, Germany
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Joachim Döring
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
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Novel Catalytic Ceramic Conversion Treatment of Ti6Al4V for Improved Tribological and Antibacterial Properties for Biomedical Applications. MATERIALS 2021; 14:ma14216554. [PMID: 34772075 PMCID: PMC8585320 DOI: 10.3390/ma14216554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022]
Abstract
Titanium oxide layers were produced via a novel catalytic ceramic conversion treatment (CCCT, C3T) on Ti-6Al-4V. This CCCT process is carried out by applying thin catalytic films of silver and palladium onto the substrate before an already established traditional ceramic conversion treatment (CCT, C2T) is carried out. The layers were characterised using scanning electron microscopy, X-ray diffraction, transmission electron microscopy; surface micro-hardness and reciprocating tribological performance was assessed; antibacterial performance was also assessed with S. aureus. This CCCT has been shown to increase the oxide thickness from ~5 to ~100 µm, with the production of an aluminium rich layer and agglomerates of silver and palladium oxide surrounded by vanadium oxide at the surface. The wear factor was significantly reduced from ~393 to ~5 m3/N·m, and a significant reduction in the number of colony-forming units per ml of Staphylococcus aureus on the CCCT surfaces was observed. The potential of the novel C3T treatment has been demonstrated by comparing the performance of C3T treated and untreated Ti6Al4V fixation pins through inserting into simulated bone materials.
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Wendler T, Prietzel T, Möbius R, Fischer JP, Roth A, Zajonz D. Quantification of assembly forces during creation of head-neck taper junction considering soft tissue bearing: a biomechanical study. ARTHROPLASTY 2021; 3:20. [PMID: 35236493 PMCID: PMC8796494 DOI: 10.1186/s42836-021-00075-7] [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] [Received: 11/19/2020] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background All current total hip arthroplasty (THA) systems are modular in design. Only during the operation femoral head and stem get connected by a Morse taper junction. The junction is realized by hammer blows from the surgeon. Decisive for the junction strength is the maximum force acting once in the direction of the neck axis, which is mainly influenced by the applied impulse and surrounding soft tissues. This leads to large differences in assembly forces between the surgeries. This study aimed to quantify the assembly forces of different surgeons under influence of surrounding soft tissue. Methods First, a measuring system, consisting of a prosthesis and a hammer, was developed. Both components are equipped with a piezoelectric force sensor. Initially, in situ experiments on human cadavers were carried out using this system in order to determine the actual assembly forces and to characterize the influence of human soft tissues. Afterwards, an in vitro model in the form of an artificial femur (Sawbones Europe AB, Malmo, Sweden) with implanted measuring stem embedded in gelatine was developed. The gelatine mixture was chosen in such a way that assembly forces applied to the model corresponded to those in situ. A study involving 31 surgeons was carried out on the aforementioned in vitro model, in which the assembly forces were determined. Results A model was developed, with the influence of human soft tissues being taken into account. The assembly forces measured on the in vitro model were, on average, 2037.2 N ± 724.9 N, ranging from 822.5 N to 3835.2 N. The comparison among the surgeons showed no significant differences in sex (P = 0.09), work experience (P = 0.71) and number of THAs performed per year (P = 0.69). Conclusions All measured assembly forces were below 4 kN, which is recommended in the literature. This could lead to increased corrosion following fretting in the head-neck interface. In addition, there was a very wide range of assembly forces among the surgeons, although other influencing factors such as different implant sizes or materials were not taken into account. To ensure optimal assembly force, the impaction should be standardized, e.g., by using an appropriate surgical instrument.
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Affiliation(s)
- Toni Wendler
- ZESBO - Centre for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany. .,Institute of Anatomy, Leipzig University, Leipzig, Germany.
| | - Torsten Prietzel
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Zeisigwaldkliniken Bethanien, Chemnitz, Germany
| | - Robert Möbius
- ZESBO - Centre for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany.,Department of Neurosurgery, Leipzig University, Leipzig, Germany
| | - Jean-Pierre Fischer
- ZESBO - Centre for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany.,Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Andreas Roth
- Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Dirk Zajonz
- ZESBO - Centre for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany.,Department of Orthopaedics, Trauma and Reconstructive Surgery, Zeisigwaldkliniken Bethanien, Chemnitz, Germany.,Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
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10
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Stockhausen KE, Riedel C, Belinski AV, Rothe D, Gehrke T, Klebig F, Gebauer M, Amling M, Citak M, Busse B. Variability in stem taper surface topography affects the degree of corrosion and fretting in total hip arthroplasty. Sci Rep 2021; 11:9348. [PMID: 33931680 PMCID: PMC8087796 DOI: 10.1038/s41598-021-88234-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 03/19/2021] [Indexed: 12/29/2022] Open
Abstract
Degradation at the modular head-neck interface in total hip arthroplasty (THA) is predominately expressed in the form of corrosion and fretting, potentially causing peri-prosthetic failure by adverse reactions to metal debris. This retrieval study aimed to quantify variations in stem taper surface topographies and to assess the influence on the formation of corrosion and/or fretting in titanium alloy stem tapers combined with metal and ceramic heads. Four hip stem designs (Alloclassic, CLS, Bicontact and SL-Plus) were characterized using high-resolution 3D microscopy, and corrosion and fretting were rated using the Goldberg scoring scheme. Quantification of the taper surface topographies revealed a high variability in surface characteristics between threaded stem tapers: Alloclassic and CLS tapers feature deeply threaded trapezoid-shaped profiles with thread heights over 65 µm. The sawtooth-shaped Bicontact and triangular SL-Plus taper are characterized by low thread heights below 14 µm. Significantly lower corrosion and fretting scores were observed in lightly threaded compared to deeply threaded tapers in ceramic head combinations. No significant differences in corrosion or fretting scores with thread height were found in pairings with metal heads. Understanding the relationship between stem taper surface topography and the formation of corrosion and fretting could help to improve the performance of modern THAs and lead to longer-lasting clinical results.
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Affiliation(s)
- Kilian Elia Stockhausen
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Christoph Riedel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Alex Victoria Belinski
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany.,Department of Mechanical Engineering, University of California, 6141 Etcheverry Hall, Berkeley, CA, USA
| | - Dorothea Rothe
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Felix Klebig
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Matthias Gebauer
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany. .,Interdisciplinary Competence Center for Interface Research (ICCIR), Martinistr. 52, 20251, Hamburg, Germany. .,Forum Medical Technology Health Hamburg (FMTHH), Butenfeld 34, 22529, Hamburg, Germany.
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11
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Dutta A, Nutt J, Slater G, Ahmed S. Review: Trunnionosis leading to modular femoral head dissociation. J Orthop 2021; 23:199-202. [PMID: 33551613 DOI: 10.1016/j.jor.2021.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/24/2021] [Indexed: 11/18/2022] Open
Abstract
Component dissociation secondary to trunnionosis is rare, and its causes are multifactorial. It is a major complication of total hip replacement, in most cases requiring revision arthroplasty. In this paper, we present a case of taper/head modular interface dissociation in a metal-on-metal total hip replacement. We review the literature of both trunnionosis, as well as a systematic review of modular dissociation of the femoral component in total hip arthroplasty, identifying commonalities with our own case.
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Affiliation(s)
- Agneish Dutta
- Tunbridge Wells Hospital, Royal Tunbridge Wells, United Kingdom
| | - James Nutt
- Tunbridge Wells Hospital, Royal Tunbridge Wells, United Kingdom
| | - Guy Slater
- Tunbridge Wells Hospital, Royal Tunbridge Wells, United Kingdom
| | - Syed Ahmed
- Tunbridge Wells Hospital, Royal Tunbridge Wells, United Kingdom
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12
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Mueller U, Bormann T, Schroeder S, Kretzer JP. Taper junctions in modular hip joint replacements: What affects their stability? J Mech Behav Biomed Mater 2021; 116:104258. [PMID: 33497961 DOI: 10.1016/j.jmbbm.2020.104258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/09/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although taper junctions are beneficial in the reconstruction of hip joints, some clinical concerns like the formation of adverse local tissue reactions have recently emerged. These reactions are associated with wear and corrosion products from the interface of insufficient taper connections regarding strength. Commonly used tapers vary in their geometric and topographical design parameter. Therefore, this study aims to evaluate interactions between design and surgical related parameters to the taper connection strength. METHODS In this study, the effect of the taper contact situation, surface roughness and head material in combination with assembly force on the taper connection strength were assessed using torque-off tests. Furthermore, the type of use in terms of single-use or re-use of the stem taper was investigated. RESULTS The study showed that the impaction force is the predominant factor that determines the taper strength followed by the type of use and the head material. The contact situation seems to slightly influence the determined torque-off moment, whereas the surface topography of the stem taper obviously plays a minor role for the taper connection strength. CONCLUSION Clinical users should be aware that an increased assembly force will strengthen the stability of the taper junction, whereas care should be taken when reusing hip stems with metal heads as this may decrease their connection strength.
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Affiliation(s)
- Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Therese Bormann
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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13
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Bormann T, Mai PT, Gibmeier J, Sonntag R, Müller U, Kretzer JP. Corrosion Behavior of Surface-Treated Metallic Implant Materials. MATERIALS 2020; 13:ma13092011. [PMID: 32344822 PMCID: PMC7254368 DOI: 10.3390/ma13092011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
Abstract
Corrosion of taper connections in total hip arthroplasty remains of concern, as particles and ions generated by corrosive processes can cause clinical problems such as periprosthetic osteolysis or adverse reaction to metallic debris. Mechanical surface treatments that introduce compressive residual stresses (RSs) in metallic materials can lead to a better performance in terms of fretting and fatigue and may lower the susceptibility to corrosion. The study investigates the impact of mechanical surface treatments on the corrosion behavior of metallic biomaterials. Compressive RSs were introduced by deep rolling and microblasting in Ti6Al4V and CoCrMo samples. Polished samples served as reference. Corrosion behavior was characterized by repeated anodic polarization. Residual stresses of up to about −900 MPa were introduced by deep rolling with a reach in depth of approximately 500 µm. Microblasting led to compressive RSs up to approximately −800 and −600 MPa for Ti6Al4V and CoCrMo, respectively, in the immediate vicinity of the surface. For Ti6Al4V, microblasting resulted in decreased corrosion resistance with lower breakdown potentials and/or increased passive current densities in comparison to the polished and deep-rolled samples. The corrosion behavior of CoCrMo on the other hand was not affected by the mechanical surface treatments.
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Affiliation(s)
- Therese Bormann
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
- Correspondence:
| | - Phuong Thao Mai
- Institute for Applied Materials, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Jens Gibmeier
- Institute for Applied Materials, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Ulrike Müller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - J. Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
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14
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Rieker CB, Wahl P. What the Surgeon Can Do to Reduce the Risk of Trunnionosis in Hip Arthroplasty: Recommendations from the Literature. MATERIALS 2020; 13:ma13081950. [PMID: 32326259 PMCID: PMC7215371 DOI: 10.3390/ma13081950] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/24/2023]
Abstract
Trunnionosis, defined as wear and corrosion at the head–neck taper connection, is a cause of failure in hip arthroplasty. Trunnionosis is linked to a synergistic combination of factors related to the prosthesis, the patient, and the surgeon. This review presents analytical models that allow for the quantification of the impact of these factors, with the aim of providing practical recommendations to help surgeons minimize the occurrence of this failure mode. A tighter fit reduces micromotion and, consequently, fretting of the taper connection. The paramount parameters controlling the fixation force are the coefficient of friction and the impaction force. The influence of the head diameter, as well as of the diameter and angle of the taper, is comparatively small, but varus alignment of the taper and heads with longer necks are unfavourable under physiologic loads. The trunnion should be rinsed, cleaned, and dried carefully, while avoiding any contamination of the bore—the female counterpart within the head—prior to assembly. Biological debris, and even residual water, might critically reduce the fixation of the taper connection between the head and the neck. The impaction force applied to the components should correspond to at least two strong blows with a 500 g hammer, striking the head with an ad hoc impactor aligned with the axis of the taper. These strong blows should correspond to a minimum impaction force of 4000 N.
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Affiliation(s)
- Claude B. Rieker
- Scientific Affairs, Zimmer Biomet EMEA (Europa, Middle East and Africa), Sulzerallee 8, 8404 Winterthur, Switzerland
- Correspondence:
| | - Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland;
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15
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Abstract
Objectives Taper junctions between modular hip arthroplasty femoral heads and stems fail by wear or corrosion which can be caused by relative motion at their interface. Increasing the assembly force can reduce relative motion and corrosion but may also damage surrounding tissues. The purpose of this study was to determine the effects of increasing the impaction energy and the stiffness of the impactor tool on the stability of the taper junction and on the forces transmitted through the patient’s surrounding tissues. Methods A commercially available impaction tool was modified to assemble components in the laboratory using impactor tips with varying stiffness at different applied energy levels. Springs were mounted below the modular components to represent the patient. The pull-off force of the head from the stem was measured to assess stability, and the displacement of the springs was measured to assess the force transmitted to the patient’s tissues. Results The pull-off force of the head increased as the stiffness of the impactor tip increased but without increasing the force transmitted through the springs (patient). Increasing the impaction energy increased the pull-off force but also increased the force transmitted through the springs. Conclusions To limit wear and corrosion, manufacturers should maximize the stiffness of the impactor tool but without damaging the surface of the head. This strategy will maximize the stability of the head on the stem for a given applied energy, without influencing the force transmitted through the patient’s tissues. Current impactor designs already appear to approach this limit. Increasing the applied energy (which is dependent on the mass of the hammer and square of the contact speed) increases the stability of the modular connection but proportionally increases the force transmitted through the patient’s tissues, as well as to the surface of the head, and should be restricted to safe levels. Cite this article: A. Krull, M. M. Morlock, N. E. Bishop. Maximizing the fixation strength of modular components by impaction without tissue damage. Bone Joint Res 2018;7:196–204. DOI: 10.1302/2046-3758.72.BJR-2017-0078.R2.
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Affiliation(s)
- A Krull
- Institute of Biomechanics, TUHH - Hamburg University of Technology, Denickestrasse 15, 21073 Hamburg, Germany
| | - M M Morlock
- Institute of Biomechanics, TUHH - Hamburg University of Technology, Denickestrasse 15, 21073 Hamburg, Germany
| | - N E Bishop
- Faculty of Life Sciences, HAW Hamburg University of Applied Sciences, Ulmenliet 20, 21033 Hamburg, Germany
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16
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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: 50] [Impact Index Per Article: 8.3] [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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17
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Whitehouse MR. Head-stem trunnion dissociation due to corrosion in total hip arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:363. [PMID: 28936457 DOI: 10.21037/atm.2017.06.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michael R Whitehouse
- Musculoskeletal Research Unit, School of Clinical Sciences, Southmead Hospital, Bristol BS10 5NB, UK.,Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
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