1
|
Pagani NR, Coden GS, Ramsden DM, Zink TM, Ward DM, Bono JV, Talmo CT. Failure Following Revision Total Hip Arthroplasty After Cobalt-Chrome Femoral Heads are Placed on a Retained Femoral Stem. J Arthroplasty 2024:S0883-5403(24)00437-6. [PMID: 38754707 DOI: 10.1016/j.arth.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Failure due to trunnionosis with adverse local tissue reaction (ALTR) has been reported with cobalt-chrome (CoCr) heads in total hip arthroplasty (THA); however, there are limited data on the use of these heads in the revision setting. The purpose of this study was to analyze the outcomes of patients who underwent revision THA with a retained femoral component and received a CoCr femoral head on a used trunnion. METHODS In this retrospective review, we identified all patients who underwent revision THA with a retained femoral component and received a CoCr femoral head between February 2006 and March 2014. Demographic factors, implant details, and postoperative complications, including the need for repeat revisions, were recorded. In total, 107 patients were included (mean age 67 years, 74.0% women). Of the 107 patients, 24 (22.4%) required repeat revisions. RESULTS Patients who required repeat revision were younger than those who did not (mean age: 62.9 versus 69, P = .03). The most common indications for repeat revision were instability (8 of 24, 33.3%), ALTR (5 of 24, 20.8%), and infection (4 of 18, 16.7%). Evidence of ALTR or metallosis was identified at the time of reoperation in 10 of the 24 patients who underwent re-revision (41.7%). CONCLUSIONS The placement of a new CoCr femoral head on a used trunnion during revision THA with a retained femoral component carries a significant risk of complication (22.4%) and should be avoided when possible.
Collapse
Affiliation(s)
- Nicholas R Pagani
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Gloria S Coden
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - David M Ramsden
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Thomas M Zink
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Daniel M Ward
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - James V Bono
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Carl T Talmo
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| |
Collapse
|
2
|
Bruggink C, Gerards R, Nijs A. Gross trunnion failure in an elderly obese patient presenting 10 years after total hip arthroplasty with a cobalt chromium femoral head: A case report. Int J Surg Case Rep 2024; 118:109525. [PMID: 38555830 PMCID: PMC10987315 DOI: 10.1016/j.ijscr.2024.109525] [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: 01/10/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Trunnionosis of total hip prosthesis is defined as corrosion at the head-neck taper junction combined with local tissue reaction. Trunnionosis is a rare complication of total hip arthroplasty (THA) that is often missed in diagnosis. Severe trunnionosis can result in head-neck dissociation, which is called gross trunnion failure (GTF). CASE PRESENTATION We describe a case of GTF in a 70-year-old male patient 10 years after right total hip arthroplasty with a cobalt chromium (CoCr) femoral head and a titanium alloy stem. A revision of the stem, cup and femoral head was performed. Six months after surgery, the patient is recovering well and walking. DISCUSSION Trunnionosis is associated with hip prostheses with a CoCr femoral head and a titanium alloy stem. Metal Artefact Reduction Sequence (MARS) and serum cobalt and chromium levels are diagnostic tools that can be useful when trunnionosis is suspected. CONCLUSION Trunnionosis remains hard to diagnose in an early stage when gross trunnion failure is not present. This case of a 70-year-old patient with gross trunnion failure 10 years after right total hip arthroplasty supports the literature suggesting that a CoCr femoral head, a high body mass index (BMI), and a longer implantation time are risk factors for developing trunnionosis. When conventional X ray and C-reactive protein are inconclusive, serum cobalt and chromium levels should be determined. When serum cobalt and chromium levels are elevated, a MARS MRI should be performed to confirm trunnionosis.
Collapse
Affiliation(s)
- Chiara Bruggink
- Department of Orthopedic Surgery, Amphia Hospital, Breda, Netherlands.
| | - Rogier Gerards
- Department of Orthopedic Surgery, Amphia Hospital, Breda, Netherlands.
| | - Anouk Nijs
- Foundation for Orthopedic Research, Care and Education, Amphia Hospital, Breda, Netherlands
| |
Collapse
|
3
|
Zitsch BP, Cahoy KM, Urban ND, Buckner BC, Garvin KL. Highly Cross-Linked Polyethylene in Patients 50 Years of Age and Younger: A 20-year Follow-Up Analysis. J Arthroplasty 2024:S0883-5403(24)00267-5. [PMID: 38548239 DOI: 10.1016/j.arth.2024.03.051] [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: 12/04/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) has been an excellent bearing for total hip arthroplasty (THA) due to improved wear characteristics compared to conventional materials. Patients 50 years of age or younger are at high risk for wear-related complications of their THA, and few studies have followed these patients who have HXPLE into the third decade. METHODS In a retrospective review of 88 consecutive THAs performed in 77 patients aged 50 years and younger (mean 41; range, 20 to 50), in which HXLPE was utilized, they were evaluated for their clinical and radiographic results at an average of 20-year follow-up (range, 18 to 24). The current study reports on longer-term follow-up from our previously published series at shorter follow-up times. Patients were categorized by femoral head material: cobalt chrome (n = 14), ceramic (n = 30), and oxidized zirconium (n = 22) and by femoral head size: 26 mm (n = 12), 28 mm (n = 46), and 32 mm (n = 8). Harris Hip Scores were collected preoperatively and at the most recent follow-up. Radiographs were evaluated for linear and volumetric wear, radiolucent lines, and osteolysis. RESULTS Mean Harris Hip Scores improved from 47.1 (standard deviation [SD] 8.8) preoperatively to 92.0 (SD 7.7) (P < .0001) at 20-year follow-up. There was one hip that was revised for recurrent instability, and no hip demonstrated radiographic evidence of loosening or osteolysis. The mean polyethylene linear wear rate was 0.017 (SD 0.012) mm/y, and the mean polyethylene volumetric wear rate was 3.15 (SD 2.8) mm3/year, with no significant differences based on articulation type or head size. CONCLUSIONS Total hip arthroplasty with HXLPE in patients ≤ 50 years of age continues to demonstrate excellent long-term clinical and radiographic outcomes with low wear characteristics at 20-year follow-up, regardless of femoral head material or size.
Collapse
Affiliation(s)
- Bradford P Zitsch
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kevin M Cahoy
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nathanael D Urban
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Brandt C Buckner
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kevin L Garvin
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| |
Collapse
|
4
|
Bunyoz KI, Tsikandylakis G, Mortensen K, Gromov K, Mohaddes M, Malchau H, Troelsen A. The size of the femoral head does not influence metal ion levels after metal-on-polyethylene total hip arthroplasty: a five-year report from a randomized controlled trial. Bone Joint J 2024; 106-B:31-37. [PMID: 38423094 DOI: 10.1302/0301-620x.106b3.bjj-2023-0795.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Aims In metal-on-polyethylene (MoP) total hip arthroplasty (THA), large metal femoral heads have been used to increase stability and reduce the risk of dislocation. The increased size of the femoral head can, however, lead to increased taper corrosion, with the release of metal ions and adverse reactions. The aim of this study was to investigate the relationship between the size of the femoral head and the levels of metal ions in the blood in these patients. Methods A total of 96 patients were enrolled at two centres and randomized to undergo MoP THA using either a 32 mm metal head or a femoral head of between 36 mm and 44 mm in size, being the largest possible to fit the thinnest available polyethylene insert. The levels of metal ions and patient-reported outcome measures (Oxford Hip Score, University of California, Los Angeles Activity Scale) were recorded at two and five years postoperatively. Results At five years, the median levels of chromium, cobalt, and titanium were 0.5 μg/l (interquartile range (IQR) 0.50 to 0.62), 0.24 μg/l (IQR 0.18 to 0.30), and 1.16 μg/l (IQR 1.0 to 1.68) for the 32 mm group, and 0.5 μg/l (IQR 0.5 to 0.54), 0.23 μg/l (IQR 0.17 to 0.39), and 1.30 μg/l (IQR 1 to 2.05) for the 36 mm to 44 mm group, with no significant difference between the groups (p = 0.825, p = 1.000, p = 0.558). There were increased levels of metal ions at two years postoperatively in seven patients in the 32 mm group, compared with four in the 36 mm to 44 mm group, and at five years postoperatively in six patients in the 32 mm group, compared with seven in the 36 mm to 44 mm group. There was no significant difference in either the OHS (p = 0.665) or UCLA (p = 0.831) scores between patients with or without an increased level of metal ions. Conclusion In patients who underwent MoP THA, we found no differences in the levels of metal ions five years postoperatively between those with a femoral head of 32 mm and those with a femoral head of between 36 mm and 44 mm, and no corrosion-related revisions. As taper corrosion can start after five years, there remains a need for longer-term studies investigating the relationship between the size of the femoral head size and corrosion in patients undergoing MoP THA.
Collapse
Affiliation(s)
- Kristine I Bunyoz
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Georgios Tsikandylakis
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Mortensen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maziar Mohaddes
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Malchau
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Harris Orthopaedic Laboratory, Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Kobayashi F, Oe K, Sogawa S, Nakamura T, Saito T. Trunnionosis in Metal-on-Polyethylene Total Hip Arthroplasty With Periprosthetic Infection: A Case Report. Cureus 2023; 15:e49401. [PMID: 38149154 PMCID: PMC10750139 DOI: 10.7759/cureus.49401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
A 67-year-old man who underwent right hemiarthroplasty and left total hip arthroplasty (THA) experienced left hip pain two years previously. No previous diagnosis was made at other hospitals. Radiography revealed left hip trunnionosis because of stem-neck shortening, with periprosthetic joint infection (PJI) spreading to both hips. Bilateral revision THA was performed, but the treatment was difficult due to the delayed diagnosis, necessitating the extraction of the well-fixed stem for PJI. Trunnionosis is caused by implant-related, surgical, and patient factors, and early diagnosis is important because of its association with PJI. Furthermore, even implants with few reports of trunnionosis can lead to this complication. Surgeons should always consider that performing THA using a large-diameter head predisposes the patient to trunnionosis.
Collapse
Affiliation(s)
- Fumito Kobayashi
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, JPN
| | - Kenichi Oe
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, JPN
| | - Shohei Sogawa
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, JPN
| | - Tomohisa Nakamura
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, JPN
| | - Takanori Saito
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, JPN
| |
Collapse
|
7
|
Taheriazam A, Baghbani S, Amiri S, Jahanshahi F. Trunnionosis in metal-on-polyethylene total hip arthroplasties: Report two cases. Int J Surg Case Rep 2023; 109:108623. [PMID: 37542879 PMCID: PMC10428132 DOI: 10.1016/j.ijscr.2023.108623] [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: 03/11/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Several studies have discussed trunnionosis in metal-on-metal total hip arthroplasties. However, trunnionosis in metal-on-polyethylene total hip arthroplasties has been less frequently discussed. CASE PRESENTATION In this study, trunnionosis in two male patients undergoing metal-on-polyethylene total hip arthroplasty, which was done to treat femoral head osteonecrosis were reported and discussed adequately. CLINICAL DISCUSSION Total hip arthroplasties (THA) were done for the treatment of femoral head osteonecrosis in these cases. In the first case, trunnionosis occurred one year after the revision of the primary THA, and in the second case occurred ten years after the primary THA. Both of these cases were presented with reduced range of motion. After surgery, the symptoms were resolved, and the patients remained complication-free until the last follow-up. CONCLUSION This report raises awareness regarding the importance of trunnionosis as a serious complication of modular total hip arthroplasty.
Collapse
Affiliation(s)
- Afshin Taheriazam
- Department of Orthopaedics, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Salar Baghbani
- Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Amiri
- Assistant Professor of Orthopaedic Surgery, Shohadaye Haftom-e-Tir Hospital, School of Medicine, Iran University of Sciences, Tehran, Iran
| | - Fatemeh Jahanshahi
- Research Committee Member, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
8
|
Bunyoz KI, Tsikandylakis G, Mortensen K, Gromov K, Mohaddes M, Malchau H, Troelsen A. No difference in whole-blood metal ions between 32-mm and 36- to 44-mm femoral heads in metal-on-polyethylene total hip arthroplasty: a 2-year report from a randomised control trial. Hip Int 2023; 33:184-192. [PMID: 34102902 DOI: 10.1177/11207000211022623] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To investigate the effect of femoral head size on blood metal-ion levels caused by taper corrosion in metal-on-polyethylene total hip arthroplasty, comparing 36- to 44-mm heads with 32-mm heads. METHODS In a randomised, controlled, single-blinded trial, 96 patients were allocated to receive either a 32-mm metal head or the largest possible metal head (36-44 mm) that could be accommodated in the thinnest available vitamin E, cross-linked polyethylene insert. Blood metal ion levels were collected at 1- and 2-year follow-ups. RESULTS At 1-year, metal-ion levels did not differ between the groups. The median (interquartile range) blood-ion levels for the 32-mm versus the 36- to 44-mm group were 0.11 µg/L (0.08-0.15) versus 0.12 µg/L (0.08-0.22), p = 0.546, for cobalt, 0.50 µg/L (0.50-0.59) versus 0.50 µg/L (0.50-1.20), p = 0.059, for chromium and 1.58 µg/L (1.38-2.05) versus 1.48 µg/L (1.14-1.87), p = 0.385, for titanium. At 2 years, there was no difference either and the corresponding values were 0.15 µg/L (0.12-0.24) versus 0.18 µg/L (0.12-0.28), p = 0.682 for cobalt, 0.50 µg/L (0.50-0.50) versus 0.50 µg/L (0.50-0.57), p = 0.554, for chromium and 1.54 µg/L (1.16-1.87) versus 1.42 µg/L (1.01-1.72), p = 0.207 for titanium. CONCLUSIONS The use of the largest possible metal head (36-44 mm) compared to a 32-mm head in metal-on-polyethylene bearings does not appear to elevate blood metal-ion levels up to 2 years postoperatively. As taper corrosion is probably time-dependent, longer-term reports are needed to evaluate the association between large metal heads and blood metal ion levels.Trial registration: ClinicalTrials.gov (reg. ID NCT0231 6704).
Collapse
Affiliation(s)
- Kristine I Bunyoz
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Georgios Tsikandylakis
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Kristian Mortensen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maziar Mohaddes
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Henrik Malchau
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Harris Orthopaedic Laboratory, Department of Orthopaedics, Massachusetts General Hospital, Boston, USA
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| |
Collapse
|
9
|
Ishii S, Homma Y, Matsukawa T, Baba T, Kaneko K, Ishijima M. Reply to letter to editor: Blood cobalt ion level in patients with different sizes of cobalt/chrome femoral head with Accolade TMZF stem. INTERNATIONAL ORTHOPAEDICS 2023; 47:97-98. [PMID: 36383224 DOI: 10.1007/s00264-022-05635-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Seiya Ishii
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Yasuhiro Homma
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Takehisa Matsukawa
- Department of Epidemiology and Environmental Health, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.,Department of Forensic Medicine, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Tomonori Baba
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| |
Collapse
|
10
|
Ishii S, Homma Y, Matsukawa T, Baba T, Kaneko K, Ishijima M. Blood cobalt ion level in patients with different sizes of cobalt/chrome femoral head with the Accolade TMZF stem. INTERNATIONAL ORTHOPAEDICS 2022; 46:2205-2212. [PMID: 35840813 DOI: 10.1007/s00264-022-05502-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Corrosion of stem-cobalt/chromium (Co/Cr) head interface and subsequent systemic Co ion complication have been a clinical concern after total hip arthroplasty (THA). The aim of this study is to investigate correlation between type of femoral head and blood Co ion level. METHODS One hundred four patients with THA using accolade TMZF and Co/Cr femoral head (32-mm; 55 cases, 36-mm; 20 cases, dual mobility system (DM) with 22.2 or 28-mm inner head; 29 cases) participated in this study, and blood Co ion concentration test was performed in patients a minimum of four years after THA. RESULTS DM group was significantly older than 32-mm and 36-mm group (DM: 73.9 ± 4.6, 32-mm: 63.3 ± 8.5, 36-mm: 66.8 ± 10.5). The median (interquartile range) blood Co concentration of each group was 32-mm group 0.26 µg/L (0.69), 36-mm group; 0.21 µg/L (0.30); and DM group 0.21 µg/L (0.13). There was a significant difference of Co concentration between DM and 32-mm group (p = 0.023). Abnormal values of the blood Co concentration (> 1 µg/L) were observed in the 32-mm group; 12 cases (21.8%), 36-mm group; 2 cases (10.0%); and DM group; 0 case (0%) (p = 0.018). CONCLUSIONS Co blood concentration differed among the different sizes of Co/Cr femoral head. THA using DM is a safe option with low risk of complication from cobalt ion if it is used for elderly patients.
Collapse
Affiliation(s)
- Seiya Ishii
- Department of Orthopaedic Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Takehisa Matsukawa
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Forensic Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| |
Collapse
|
11
|
Abdel Hamid OI, Attia ME, Hirshon JM, El-Shinawi M, El-Hussaini M, El-Setouhy M. Psychiatric Disorders and Genotoxicity Following Primary Metal on Polyethylene Total Hip Arthroplasty and Their Correlation to Cobalt/Chromium Levels. Drug Healthc Patient Saf 2022; 14:97-111. [PMID: 35880007 PMCID: PMC9308046 DOI: 10.2147/dhps.s360643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Hip arthroplasty (HA) using implantable metal components is among the commonest orthopedic interventions. However, it can be followed by several complications following corrosion and the release of metal ions. Several studies proved that damaged genomic DNA may contribute to the pathophysiology of mental disorders. Aim The current work aims to evaluate the psychiatric disorders in metal on polyethylene hip arthroplasty (MOP-HA) patients and its correlation to cobalt/chromium (Co/Cr) levels and genotoxicity. Methods The work was a longitudinal follow-up study including 34 adults with unilateral primary MOP-HA meeting the inclusion and exclusion criteria. Preoperatively, 6, 12-months-postoperatively, patients were examined for cognitive impairment using mini-mental-state-examination (MMSE), depression using major-depressive-inventory (MDI), and blood samples were collected for estimation of Co/Cr, detection of genotoxicity by single-cell-gel-electrophoresis (comet assay) and serum 8-hydroxy-2'-deoxyguanosine (8-OHdG). Results Cognitive impairment was reported in 18.5% and 14.8% at 6-months, and 12-months postoperative, respectively. Depressive disorder was recorded in 22.2% at 6-months and 14.8% at 12-months postoperative. The marginal homogeneity tests proved a non-significant difference. There was a non-significant difference in preoperative, 6-months, 12-months postoperative MMSE, and MDI scores. There were significantly increased Co/Cr levels at 6-months postoperative. The levels decreased at 12-months postoperative, however, still significantly higher than preoperative values. There was a significant increase in serum 8-OHdG and the levels were positively correlated to cobalt levels at both 6 and 12-months-postoperative. There was a non-significant difference among preoperative, 6-months, and 12-months postoperative comet assay measurements. Conclusion From previous findings, we can conclude that will-functioning MOP hip arthroplasty can induce increased ion levels and positively correlated increase in biochemical markers of genotoxicity (8-OHdG).
Collapse
Affiliation(s)
- Omaima I Abdel Hamid
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed E Attia
- Orthopedics Departments, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Jon M Hirshon
- Department of Emergency Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Mohamed El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Galala University, Galala City, Suez, Egypt
| | - Moustafa El-Hussaini
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maged El-Setouhy
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Family and Community Medicine, Faculty of Medince, Jazan University, Jazan, Kingdom of Saudi Arabia
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Gazendam A, Ekhtiari S, Wood TJ. Intermediate to Long-Term Outcomes and Causes of Aseptic Failure of an At-Risk Femoral Stem. J Bone Joint Surg Am 2022; 104:896-901. [PMID: 35188899 DOI: 10.2106/jbjs.21.00397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Accolade TMZF is a tapered-wedge cementless metaphyseal-coated femoral stem that was widely utilized from 2002 to 2012. In recent years, there have been reports of early catastrophic failure of this implant. The purposes of the present study were to establish the long-term survival of this stem and to analyze patients who underwent aseptic revision to understand the causes and risk factors for failure. METHODS We retrospectively reviewed the records of all patients who had undergone primary total hip arthroplasty with use of an Accolade TMZF stem at a high-volume arthroplasty center. The causes and timing of revision surgery were documented. Survivorship analysis was performed with use of Kaplan-Meier curves to determine the overall and aseptic survival rates at the time of the latest follow-up. Patient and implant factors commonly associated with aseptic failure were extracted, and a Cox proportional hazards model was used. RESULTS A consecutive series of 2,609 patients who had undergone unilateral primary total hip arthroplasty with use of an Accolade TMZF femoral stem were included. The mean time from the primary procedure was 11.3 years (range, 0 days to 19.4 years). The cumulative survival rate was 95.5% ± 0.1% at the time of the latest follow-up. One hundred and seven patients underwent revision surgery, with aseptic loosening of the femoral component being the most common cause of aseptic failure in this cohort (33 of 2,609; 1.3%). Smaller femoral size and larger femoral head offset were independent risk factors for aseptic failure. CONCLUSIONS To our knowledge, this is the largest series representing the longest follow-up of this tapered-wedge cementless femoral implant. Despite early concerns, the Accolade TMZF stem had excellent survivorship in this cohort. Trunnionosis as the cause for revision surgery was rare. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Aaron Gazendam
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Seper Ekhtiari
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Thomas J Wood
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Juravinski Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | |
Collapse
|
14
|
Pruitt BP, Mears SC, Apple AE, Stambough JB, Barnes CL, Stronach BM. Catastrophic Trunnion Failure in an Anatomic Titanium Alloy Stem. Geriatr Orthop Surg Rehabil 2022; 13:21514593221142726. [DOI: 10.1177/21514593221142726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Certain titanium alloy stems have been shown to be susceptible to failure at the neck with catastrophic trunnion failure. Failure has been particularly noted in the single wedge Accolade 1 stem design. Other stems also used this alloy including the anatomic designed Citation stem. Methods This case series details 3 catastrophic failures of the TMZF version of the Citation femoral stem. Results Each of these failures appear to be attributed to cyclical wear of the TMZF trunnion against the cobalt chromium femoral head. Wear resulted in ultimate implant failure and significant metal debris in the joint capsule at the time of revision surgery. Discussion While surgeons are aware of the risk of catastrophic failure for the Accolade 1 stem, failure may similarly happen in the TMZF Citation stem. Surgeons should monitor these implants with care and discuss the potential for trunnion failure with their patients.
Collapse
Affiliation(s)
- Benjamin P. Pruitt
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Andrew E. Apple
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jeffrey B. Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C. Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin M. Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
15
|
Ishii S, Homma Y, Matsukawa T, Baba T, Kubota A, Yokoyama K, Kaneko K, Ishijima M. Horror of three synergistic factors in THA: high mechanical stress, dissimilar metals, low elasticity stem: a case report. ARTHROPLASTY 2021; 3:39. [PMID: 35236468 PMCID: PMC8796415 DOI: 10.1186/s42836-021-00091-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023] Open
Abstract
Background A large-diameter femoral head is effective in preventing dislocation after total hip arthroplasty. However, although rare, catastrophic stem tribocorrosion may occur at the head-stem junction. Case presentation A 70-year-old woman underwent revision surgery 7.5 years after total hip arthroplasty because of catastrophic stem corrosion with dissociation of the metal head (cobalt/chromium) and stem (TiMo12Zr6Fe2). Abnormal levels of cobalt were found in the intra-articular fluid, capsule, hip muscle, and blood. Revision surgery was performed via the direct anterior approach. The well-fixed femoral stem was explanted, and a cemented stainless stem with stainless head was implanted. Three months after the revision surgery, the cobalt concentration in the blood had decreased to normal. Conclusions Stem dissociation in the present case might have been caused by synergistic combination of a 36-mm-diameter femoral head and long neck length offset with high frictional torque, a cobalt-chromium head with a high risk of galvanic corrosion, and a TMZF (TiMo12Zr6Fe2) alloy stem with a low Young’s modulus of elasticity. The combination of these factors must be avoided.
Collapse
|
16
|
Polster V, Fischer S, Steffens J, Morlock MM, Kaddick C. Experimental validation of the abrasive wear stage of the gross taper failure mechanism in total hip arthroplasty. Med Eng Phys 2021; 95:25-29. [PMID: 34479689 DOI: 10.1016/j.medengphy.2021.07.003] [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: 02/16/2021] [Revised: 04/30/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Gross taper failure (GTF) is a rare but catastrophic failure mode of the head-stem-taper junction of hip prostheses, facilitated by massive material loss. GTF is a two stage process initiated by corrosion leading to head bottoming out, followed by abrasive wear due to the head rotating on the stem. The purpose of this study was to reproduce the clinical failure patterns and to determine the material loss during simulated gait. METHODS Six cobalt-chromium alloy heads (36 mm, 12/14 taper) with three different head lengths (short / medium / extra long) were combined with stem taper replicas made from titanium alloy sized to achieve bottoming out. A hip simulator was used to simulate gait loading after (ISO 14242-1 for 2 million cycles). RESULTS Wear patterns from in-vitro testing match the clinical failure patterns. Stem taper wear increased linearly with time (p< 0.001). After two million cycles the material loss of short / medium / extra long heads was (M+-STD) 1168±242 mg / 400±23 mg / 94±12 mg on the stem side and 46±36 mg / 46±24 mg / 70±8 mg on the head side. Stem taper wear decreased with increasing head length (p=0.01), whereas clinical failures are mostly seen for long and extra long heads.
Collapse
Affiliation(s)
- Valerie Polster
- Institute of Biomechanics, Hamburg University of Technology,Denickestraße 15, Hamburg 21073, Germany.
| | - Sarah Fischer
- Institute of Biomechanics, Hamburg University of Technology,Denickestraße 15, Hamburg 21073, Germany
| | | | - Michael M Morlock
- Institute of Biomechanics, Hamburg University of Technology,Denickestraße 15, Hamburg 21073, Germany
| | | |
Collapse
|
17
|
Pagani NR, LeRoy TE, Menendez ME, Stoker GE, Lococo DV, Nairus JG. Gross Trunnion Failure of a Type 1 Taper After Metal-on-Polyethylene Total Hip Arthroplasty: A Report of 2 Cases. JBJS Case Connect 2021; 11:01709767-202106000-00133. [PMID: 34166254 DOI: 10.2106/jbjs.cc.21.00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CASE We describe 2 cases of gross trunnion failure (GTF) in males with Centers for Disease Control and Prevention Class 3 obesity 10 years after metal-on-polyethylene total hip arthroplasty (THA) with a titanium-alloy femoral stem and Type 1 taper. One patient received a large diameter cobalt-chromium femoral head, whereas the other received a smaller diameter head, both with high-offset femoral stems. CONCLUSION This is the first report of GTF involving the Echo Bi-Metric femoral stem after metal-on-polyethylene THA, and surgeons should consider the potential complication of GTF when using this specific femoral stem with metal heads in obese male patients.
Collapse
Affiliation(s)
- Nicholas R Pagani
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
» The true incidence of pseudotumors in association with total joint arthroplasty is underestimated. » Pseudotumors occur with metal-on-metal, metal-on-polyethylene, and metal-on-ceramic articulations. » Metal ion levels should not be the only factor in decision-making regarding revision surgery. » Revision surgery is only indicated in symptomatic patients with clinical and radiographic findings and elevated metal ion levels. » Revision to a non-metal articulation is strongly suggested.
Collapse
|
19
|
Kim K, Lee J, Yoo JJ, Kim HJ. Gross Trunnion Failure in the Bipolar Hemiarthroplasty; Raising Concern about Short Trunnion: A Case Report. Hip Pelvis 2021; 33:40-44. [PMID: 33748025 PMCID: PMC7952271 DOI: 10.5371/hp.2021.33.1.40] [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: 10/29/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022] Open
Abstract
There have been some reports of gross trunnion failure (GTF) in total hip arthroplasty. Here, we report a case of GTF 19 years after bipolar hemiarthroplasty using a 28-mm head with a 14/16 taper bore. Compared to other GTF reports, the current case had some unusual aspects: bipolar hemiarthroplasty, 28-mm head, relatively late-onset, and no apparent findings of metallosis though a severe one was evident. A Computed tomography scout view provided valuable information in evaluating polyethylene, metal head, and neck inside the bipolar cup. The current report suggests a need for concerned regarding short trunnion length which may be associated with GTF.
Collapse
Affiliation(s)
- Kangbaek Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Junpyo Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
20
|
Tutuncu MN, Karaismailoglu B, Sahin E, Karaismailoglu TN. Early Disassembly of Femoral Head and Neck Components After Total Hip Arthroplasty Revision. Cureus 2021; 13:e13177. [PMID: 33717722 PMCID: PMC7943054 DOI: 10.7759/cureus.13177] [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: 11/22/2022] Open
Abstract
Modular femoral and acetabular components are frequently used in hip arthroplasty. Although the use of modular components offers many advantages, the increased number of components leads to a high risk of disassembly. Disassociation of the femoral head and neck is a rarely reported complication in the literature. This case report depicts a patient with non-traumatic early disassociation of the femoral head and neck components following total hip revision arthroplasty. Femoral head-neck disassembly in early postoperative period may occur due to manufacturing error or insufficient impaction. If sufficient impaction is thought to be achieved, manufacturing errors should be kept in mind as potential underlying reasons for femoral head-neck dissociation.
Collapse
Affiliation(s)
| | | | - Erdem Sahin
- Orthopaedics and Traumatology, Kars Harakani State Hospital, Kars, TUR
| | | |
Collapse
|
21
|
Homma Y, Morikawa T, Ishii S, Baba T, Kaneko K. Bowing-head sign: rare but detectable in pre-catastrophic hip implant failure. Arch Orthop Trauma Surg 2020; 140:2085-2089. [PMID: 32940804 DOI: 10.1007/s00402-020-03609-x] [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: 06/22/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022]
Abstract
Recently, catastrophic failure (i.e., dissociation between the metal femoral head and stem due to stem neck deformation) after total hip arthroplasty (THA) has been reported. Early detection of this complication is very important, because it is accompanied by an increased cobalt concentration in the body, which might influence systemic conditions such as heart failure and immune system diseases. However, early detection of stem neck deformation is considered as difficult. In most cases in the literatures, the diagnosis was made at the time of acute dissociation. We report a case of early detection of stem neck deformation with the 'Bowing-head sign' before acute dissociation. The patient is a 71-year old woman complained of a clicking sensation in the right hip during regular follow-up after THA with a 32-mm cobalt/chromium head with polyethylene insert for osteoarthritis performed 7 years previously. The plain radiograph showed that the angle between the metal femoral head and the axis of the stem neck was not perpendicular ('Bowing-head sign'). Dynamic evaluation under fluoroscopy showed movement of the stem neck in the metal femoral head with hip abduction and adduction. Laboratory data showed abnormal serum cobalt (6.3 μg/L, normal < 1 μg/L) and chromium (3.8 μg/L, normal < 5 μg/L) levels. Considering those radiographic findings, deformation of the stem neck due to trunnionosis was diagnosed, and elective revision surgery was performed without any complications. Plain radiographs after THA should be assessed with attention to this complication, 'Bowing-head sign' must not be overlooked.
Collapse
Affiliation(s)
- Yasuhiro Homma
- Department of Orthopedic Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Takahiro Morikawa
- Department of Orthopedic Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Seiya Ishii
- Department of Orthopedic Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomonori Baba
- Department of Orthopedic Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| |
Collapse
|
22
|
Morlock MM, Hube R, Wassilew G, Prange F, Huber G, Perka C. Taper corrosion: a complication of total hip arthroplasty. EFORT Open Rev 2020; 5:776-784. [PMID: 33312704 PMCID: PMC7722945 DOI: 10.1302/2058-5241.5.200013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The focus on taper corrosion in modular hip arthroplasty increased around 2007 as a result of clinical problems with large-head metal-on-metal (MoM) bearings on standard stems. Corrosion problems with bi-modular primary hip stems focused attention on this issue even more. Factors increasing the risk of taper corrosion were identified in laboratory and retrieval studies: stiffness of the stem neck, taper diameter and design, head diameter, offset, assembly force, head and stem material and loading. The high variability of the occurrence of corrosion in the clinical application highlights its multi-factorial nature, identifying the implantation procedure and patient-related factors as important additional factors for taper corrosion. Discontinuing the use of MoM has reduced the revisions due to metal-related pathologies dramatically from 49.7% (MoM > 32 mm), over 9.2% (MoM ⩽ 32 mm) to 0.8% (excluding all MoM). Further reduction can be achieved by omitting less stiff Ti-alloys and large metal heads (36 mm and above) against polyethylene (PE). Standardized taper assembly of smaller and ceramic heads will reduce the clinical occurrence of taper corrosion even further. If 36 mm heads are clinically indicated, only ceramic heads should be used. Taper-related problems will not comprise a major clinical problem anymore if the mentioned factors are respected.
Cite this article: EFORT Open Rev 2020;5:776-784. DOI: 10.1302/2058-5241.5.200013
Collapse
Affiliation(s)
| | | | - Georgi Wassilew
- Department for Orthopaedics and Orthopaedic Surgery, University of Greifswald, Greifswald, Germany
| | - Felix Prange
- TUHH Hamburg University of Technology, Hamburg, Germany
| | - Gerd Huber
- TUHH Hamburg University of Technology, Hamburg, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Orthopedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
23
|
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.
Collapse
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;
| |
Collapse
|