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Kurtz MA, Alaniz K, Kurtz PW, Wessinger AC, Moreno-Reyes A, Gilbert JL. Oxide degradation precedes additively manufactured Ti-6Al-4V selective dissolution: An unsupervised machine learning correlation of impedance and dissolution compared to Ti-29Nb-21Zr. J Biomed Mater Res A 2024; 112:1250-1264. [PMID: 37877770 DOI: 10.1002/jbm.a.37632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
Additively manufactured (AM) Ti-6Al-4V devices are implanted with increasing frequency. While registry data report short-term success, a gap persists in our understanding of long-term AM Ti-6Al-4V corrosion behavior. Retrieval studies document β phase selective dissolution on conventionally manufactured Ti-6Al-4V devices. Researchers reproduce this damage in vitro by combining negative potentials (cathodic activation) and inflammatory simulating solutions (H2O2-phosphate buffered saline). In this study, we investigate the effects of these adverse electrochemical conditions on AM Ti-6Al-4V impedance and selective dissolution. We hypothesize that cathodic activation and H2O2 solution will degrade the oxide, promoting corrosion. First, we characterized AM Ti-6Al-4V samples before and after a 48 h -0.4 V hold in 0.1 M H2O2/phosphate buffered saline. Next, we acquired nearfield electrochemical impedance spectroscopy (EIS) data. Finally, we captured micrographs and EIS during dissolution. Throughout, we used AM Ti-29Nb-21Zr as a comparison. After 48 h, AM Ti-6Al-4V selectively dissolved. Ti-29Nb-21Zr visually corroded less. Structural changes at the AM Ti-6Al-4V oxide interface manifested as property changes to the impedance. After dissolution, the log-adjusted constant phase element (CPE) parameter, Q, significantly increased from -4.75 to -3.84 (Scm-2(s)α) (p = .000). The CPE exponent, α, significantly decreased from .90 to .84 (p = .000). Next, we documented a systematic decrease in oxide polarization resistance before pit nucleation and growth. Last, using k-means clustering, we established a structure-property relationship between impedance and the surface's dissolution state. These results suggest that AM Ti-6Al-4V may be susceptible to in vivo crevice corrosion within modular taper junctions.
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Affiliation(s)
- Michael A Kurtz
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Kazzandra Alaniz
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Peter W Kurtz
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Audrey C Wessinger
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Aldo Moreno-Reyes
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Jeremy L Gilbert
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
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2
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Huang Y, Xie H, Yi J, Yang M, Kong X, Chai W. I s pelvic support osteotomy (PSO) suitable for ordinary high-riding hip dysplasia?. INTERNATIONAL ORTHOPAEDICS 2024; 48:1987-1995. [PMID: 38619563 DOI: 10.1007/s00264-024-06177-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE Pelvic support osteotomy (PSO) is regarded to provide pelvic stability and improve abductor function to delay or even avoid total hip arthroplasty (THA) in young patients with high-riding hip dysplasia. However, some of these patients eventually have to undergo THA. Because of the double-angulation deformity of the femur after PSO, subsequent THA is challenging. This study aimed to analyze whether PSO surgery is suitable for high-riding hip dysplasia and summarize orthopaedic strategy during THA for patients with previous PSO. METHODS This case-control study included eight cases of THA for high-riding hip dysplasia patients with previous PSO (study group) and 24 cases of high-riding hip dysplasia patients without any hip surgical therapy (control group) by a 1:3 match (from May 2018 to January 2022). We compared demographics and joint function before and after THA between two groups and recorded all patients' preoperative imaging data, surgical procedures, postoperative imaging data, and complications. The surgical techniques for patients with previous PSO were highlighted. RESULTS There was no statistical difference between the two groups in demographic (p > 0.05). The study group had worse hip Harris score (HHS), range of motion (ROM), visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (p < 0.05) compared with the control group before THA. All patients had concurrent THA and osteotomy at the proximal femur, but the study group experienced longer operation time (p = 0.047) with more blood loss (p = 0.027) and higher complication rate compared with the control group (p = 0.009). At the last follow-up, the study group's HHS, ROM, VAS, and WOMAC were still worse than those in the control group. CONCLUSIONS PSO did not improve the joint function of high-riding hip dysplasia patients but brought challenges to subsequent THA and affected the surgical outcomes. In short, we suggested that PSO is unsuitable for routine high-riding hip dysplasia patients.
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Affiliation(s)
- Yijian Huang
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China
- Graduate School, Chinese PLA Medical School, Beijing, People's Republic of China
| | - Hongbin Xie
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Jiafeng Yi
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Minzhi Yang
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China
- Graduate School, Chinese PLA Medical School, Beijing, People's Republic of China
| | - Xiangpeng Kong
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China.
| | - Wei Chai
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China.
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Ekweariri N, White R, Brown N, Schmitt D. A rare case of taper junction corrosion in semi-constrained total knee arthroplasty. Knee 2024; 48:46-51. [PMID: 38507890 DOI: 10.1016/j.knee.2024.02.010] [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: 06/03/2023] [Revised: 12/19/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
Metallosis is a known yet rare late complication of unicompartmental and total knee arthroplasty (TKA), usually secondary to either metal-backed patellar component failure, mobile-bearing polyethylene dislocation, or catastrophic polyethylene failure and wear through. The majority of literature surrounding metallosis has been published in relation to total hip arthroplasty (THA) metal on metal bearing wear or mechanically assisted crevice corrosion.This case report describes the development of metallosis in a 77-year-old male patient with advanced (Kellgren-Lawrence Grade 4) osteoarthritis with associated valgus deformity, who underwent index TKA with a semiconstrained revision knee system due to intraoperative medial collateral ligament laxity. The taper junction between the titanium alloy stem and cobalt chromium femoral component was the source of diffuse intra-articular metallosis.
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Affiliation(s)
- Nnadozie Ekweariri
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Ryan White
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Nicholas Brown
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Daniel Schmitt
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA
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Scott DF, Eppich K, Mehić E, Gray C, Smith CL, Johnston M. 15-year survivorship of a unique dual-modular femoral stem in primary hip arthroplasty. BMC Musculoskelet Disord 2024; 25:312. [PMID: 38649874 PMCID: PMC11036691 DOI: 10.1186/s12891-024-07422-0] [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: 09/14/2023] [Accepted: 04/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Hip offset, version, and length are interdependent femoral variables which determine stability and leg length. Balancing these competing variables remains a core challenge in hip arthroplasty. The potential benefits of modular femoral stems have been overshadowed by higher rates of failure. The objective of this study was to assess the survivorship of a unique dual-modular femoral stem at an average 15-year follow-up period. METHODS The records of all patients with osteoarthritis who underwent primary total hip arthroplasty with this device between 2004-2009 were reviewed. There were no exclusions for BMI or other factors. We examined the data with Kaplan-Meier survival analysis. The primary endpoint for survival was mechanical failure of the modular neck-body junction. RESULTS The survivorship of this device in 172 subjects was 100% with none experiencing mechanical failure of the modular junction at an average of 15 years. 60 patients died of causes unrelated to their THA and 9 patients were lost to follow-up. There were three early (≤ 12 months) dislocations (1.7%), and seven total dislocations (4.1%). 16 patients underwent reoperations during the follow-up period, none for any complication of the modular junction. Radiographic results showed well-fixed femoral stems in all cases. There were no leg length discrepancies of greater than 10 mm, and 85% were within 5 mm. CONCLUSION There were no mechanical failures of the modular junction in any of the subjects over the average 15-year period, demonstrating that this dual-modular design is not associated with increased failure rates. We achieved a 1.7% early dislocation rate and a 4.1% total dislocation rate without any clinically significant leg length discrepancies.
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Affiliation(s)
- David F Scott
- Elson S. Floyd College of Medicine at Washington State University, 412 E Spokane Falls, Blvd, Spokane, WA, 99202, USA
- Spokane Joint Replacement Center, Inc., Spokane, WA, USA
| | - Kade Eppich
- Elson S. Floyd College of Medicine at Washington State University, 412 E Spokane Falls, Blvd, Spokane, WA, 99202, USA
| | - Edin Mehić
- University of Washington, School of Medicine, Seattle, WA, USA
| | - Celeste Gray
- Spokane Joint Replacement Center, Inc., Spokane, WA, USA
| | - Crystal Lederhos Smith
- Elson S. Floyd College of Medicine at Washington State University, 412 E Spokane Falls, Blvd, Spokane, WA, 99202, USA
| | - Michael Johnston
- Elson S. Floyd College of Medicine at Washington State University, 412 E Spokane Falls, Blvd, Spokane, WA, 99202, USA.
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5
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Bormann T, Kretzer JP, Jaeger S, Lohmann CH. Is taper corrosion in modular revision hip stem junctions associated with patient or implant specific factors? A retrieval analysis. J Mech Behav Biomed Mater 2024; 150:106326. [PMID: 38141361 DOI: 10.1016/j.jmbbm.2023.106326] [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: 09/12/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
Implant modularity within revision total hip arthroplasty (THA) offers multiple implant configurations and allows surgeons a high intraoperative flexibility to restore functionality to the patients joint, even in complex revision cases. However, a rare but devastating complication for patients, clinicians and manufacturers presenting a breakage of the taper junction between the distal stem and the proximal implant part. Aside from implant and patient specific risk factors, corrosion and fretting at the stem junctions have been associated with taper failure. Whether corrosive processes are a precursor of failure or rather an accompaniment of material fatigue is thereby still unclear. Therefore, this study aims to investigate the incidence of taper corrosion in a collection of 17 retrievals from a single type (MRP-Titan, Peter Brehm GmbH) and on the correlation of taper corrosion to implant and patient specific factors. None of the implants was revised for problems related to the taper junction, corrosion or the implant itself. The modular stem junction of all retrievals was visually rated with respect to corrosion, fretting and surface contamination. Additionally, the stability of taper junctions of retrievals where the proximal part with the neck was still assembled to the stem was determined by measuring the loosening moment of the securing screw and the push-out-force for taper dissociation. There was no difference between the mean push-out-force of the retrievals (14 kN ± 1.2 kN) and new reference samples (12.6 kN ± 0.5 kN). Approximately one third of the investigated retrievals showed considerable taper corrosion. The extent of corrosion increased with time in vivo and contamination of the neck piece, while it decreased with the loosening moment of the locking screw. The parameters femoral head offset, neck piece length, lateralized neck pieces, obesity of patients and septic/aseptic revision were not correlated to taper corrosion. Taper corrosion seems to occur regularly in modular taper junctions and is not necessarily connected to taper failure. A correct assembly of the junction and avoiding taper surface contamination during revision surgery is mandatory.
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Affiliation(s)
- Therese Bormann
- Heidelberg University Hospital, Department of Orthopaedics, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - J Philippe Kretzer
- Heidelberg University Hospital, Department of Orthopaedics, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Sebastian Jaeger
- Heidelberg University Hospital, Department of Orthopaedics, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Christoph H Lohmann
- Department of Orthopaedics, University Hospital Magdeburg, Otto-von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
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Houdek MT, Couch CG, Wyles CC, Taunton MJ, Rose PS, Kremers HM, Lewallen DG, Berry DJ. Whole Blood Metal Levels in the Setting of an Oncologic Endoprosthesis: Is There Cause for Concern? Clin Orthop Relat Res 2024; 482:352-358. [PMID: 37603308 PMCID: PMC10776170 DOI: 10.1097/corr.0000000000002805] [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] [Received: 02/21/2023] [Accepted: 07/06/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Massive modular endoprostheses have become a primary means of reconstruction after oncologic resection of a lower extremity tumor. These implants are commonly made with cobalt-chromium alloys that can undergo wear and corrosion, releasing cobalt and chromium ions into the surrounding tissue and blood. However, there are few studies about the blood metal levels in these patients. QUESTION/PURPOSE What is the whole blood cobalt and chromium ion level in patients with massive modular endoprostheses? METHODS We performed a cross-sectional study of our total joints registry to identify patients with a history of an endoprosthetic reconstruction performed at our institution. Patients who were alive at the time of our review in addition to those undergoing an endoprosthetic reconstruction after an oncologic resection were included. Whole blood samples were obtained from 27 (14 male and 13 female) patients with a history of a lower extremity oncologic endoprosthesis. The median time from surgery to blood collection was 8 years (range 6 months to 32 years). Blood samples were collected and stored in metal-free ethylenediaminetetraacetic acid tubes. Samples were analyzed on an inductively coupled plasma mass spectrometer in an International Organization for Standardization seven-class clean room using polytetrafluoroethylene-coated instruments to reduce the risk of metal contamination. The analytical measuring range was 1 to 200 ng/mL for chromium and cobalt. Cobalt and chromium levels were considered elevated when the blood level was ≥ 1 ppb. RESULTS Cobalt levels were elevated in 59% (16 of 27) of patients, and chromium levels were elevated in 26% (seven of 27). In patients with elevated metal ion values, 15 of 17 patients had a reconstruction using a Stryker/Howmedica Global Modular Replacement System implant. CONCLUSION Blood metal levels were elevated in patients who received reconstructions using modular oncology endoprostheses Future work is needed to establish appropriate follow-up routines and determine whether and when systemic complications occur because of elevated metal levels and how to potentially address these elevated levels when complications occur. Prospective and retrospective collaboration between multiple centers and specialty societies will be necessary to address these unknown questions in this potentially vulnerable patient group. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
| | - Cory G. Couch
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Cody C. Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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7
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López RE, Pelayo de Tomás JM, Morales Suárez Varela M, Rodrigo Pérez JL. Comparison of chromium and cobalt serum levels between a modular neck stem and its monoblock counterpart in primary total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3403-3409. [PMID: 37140672 DOI: 10.1007/s00590-023-03567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/27/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND The addition of junctions in modular stems implies a greater susceptibility to corrosion. PURPOSE The aim of this study is to compare serum chromium and cobalt levels after using a bimodular stem and its monoblock counterpart in primary total hip arthroplasty. Postoperative clinical scores were also compared. PATIENTS AND METHODS A prospective cohort study between 2012 and 2015 was designed. One arm of the cohort included patients with the cementless modular neck stem H-Max M® and the other with the cementless monoblock stem counterpart H-Max S®. RESULTS No statistically significant difference was found in chromium value between groups (p = 0.621) at two years postoperative. Cobalt value was higher in the modular group (p = < 0.001). No statistically significant difference was found in clinical postoperative scores except for the Harris Hip Score, with better results at six months in modular group (p = 0.007). CONCLUSIONS Higher serum cobalt level in the modular group has limited the use of modular stems in our daily practice. Advantages of modular stem were not found. LEVEL OF EVIDENCE II.
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Affiliation(s)
- R E López
- Doctor Peset University Hospital, Av. Gaspar Aguilar 90, 46017, Valencia, Spain.
| | - J M Pelayo de Tomás
- Doctor Peset University Hospital, Av. Gaspar Aguilar 90, 46017, Valencia, Spain
- School of Medicine, Valencia University, Av. Blasco Ibañez, 15, 46010, Valencia, Spain
| | - M Morales Suárez Varela
- Unit of Public Health, Hygiene and Enviromental Health, Departament of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, School of Pharmacy, Av. Vicente Andrés Estellés, Burjassot, Valencia, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Av. Monforte De Lemos 3-5, Pavillon 11, Floor 0, 28029, Madrid, Spain
| | - J L Rodrigo Pérez
- Doctor Peset University Hospital, Av. Gaspar Aguilar 90, 46017, Valencia, Spain
- School of Medicine, Valencia University, Av. Blasco Ibañez, 15, 46010, Valencia, Spain
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Castagnini F, Bordini B, Cosentino M, Tassinari E, Guizzardi G, Traina F. Comparison of single taper and dual taper versions of the same stem design in total hip arthroplasty for primary osteoarthritis. J Orthop Traumatol 2023; 24:5. [PMID: 36725766 PMCID: PMC9892395 DOI: 10.1186/s10195-023-00687-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/21/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In total hip arthroplasty (THA), the outcomes of single taper (ST) and dual taper (DT) versions of the same stem design have been scarcely studied. A registry study comparing ST and DT versions of the same stem design was designed, aiming to assess: (1) the survival rates and the hazard ratios for failure; (2) the survival rates and the hazard ratios for failure using stem-focused endpoints. MATERIAL AND METHODS A regional arthroplasty registry was interrogated about stem designs with ST and DT versions in cementless THAs performed for primary osteoarthritis. Only the same cup and ceramic-on-ceramic bearings were included: the DT stems had a titanium-on-titanium modularity. Demographic and implant features were recorded. Survival rates and hazard ratios were evaluated and compared. Stem-focused endpoints were also investigated. RESULTS A total of 5359 THAs were included, with three stem designs. The two versions of every stem showed different demographics and implant-related features: ST versions were preferentially implanted in heavier young men. For each stem, the two versions had similar survival rates at 5 years (p = 0.076; p = 0.319; p = 0.616) and similar adjusted hazard ratios for failures (p = 0.084; p = 0.308; p = 0.729). When stem-focused endpoints were adopted, the ST and DT versions of the three stems achieved similar survival rates (p = 0.710; p = 0.784; p = 0.983) and similar adjusted hazard ratios (p = 0.647; p = 0.858; p = 0.787). Three neck breakages occurred (0.0007% of all the modular implants). CONCLUSIONS ST and DT versions of the same stem design did not show any differences in terms of survival rates and hazard ratios for failures at 5 years. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Francesco Castagnini
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Barbara Bordini
- grid.419038.70000 0001 2154 6641Laboratorio Di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136 Bologna, Italy
| | - Monica Cosentino
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Enrico Tassinari
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Giulia Guizzardi
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Francesco Traina
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy ,grid.6292.f0000 0004 1757 1758DIBINEM, Università Di Bologna, Bologna, Italy
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9
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Kurtz MA, Wessinger AC, Mace A, Moreno-Reyes A, Gilbert JL. Additively manufactured Ti-29Nb-21Zr shows improved oxide polarization resistance versus Ti-6Al-4V in inflammatory simulating solution. J Biomed Mater Res A 2023; 111:1538-1553. [PMID: 37129046 DOI: 10.1002/jbm.a.37552] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
Retrieval studies in the past two decades show severe corrosion of titanium and its alloys in orthopedic implants. This damage is promoted by mechanically assisted crevice corrosion (MACC), particularly within modular titanium-titanium junctions. During MACC, titanium interfaces may be subject to negative potentials and reactive oxygen species (ROS), generated from cathodic activation and/or inflammation. Additive manufacturing (AM) may be able to produce new, corrosion-resistant titanium alloys and admixtures that are less susceptible to these adverse electrochemical events. In this study, we characterize the impedance and corrosion properties of three new AM titanium materials, including Ti-6Al-4V with added 1% nano-yttria stabilized ZrO2 , admixed Ti-29Nb-21Zr, and pre-alloyed Ti-29Nb-21Zr. We aim to elucidate how these materials perform when subjected to high ROS solutions. We include conventionally and additively manufactured Ti-6Al-4V in our study as comparison groups. A 0.1 M H2 O2 phosphate-buffered saline (PBS) solution, simulating inflammatory conditions, significantly increased biomaterial OCP (-0.14 V vs. Ag/AgCl) compared to PBS only (-0.38 V, p = .000). During anodic polarization, Ti-6Al-4V passive current density more than doubled from 1.28 × 10-7 to 3.81 × 10-7 A/cm2 when exposed to 0.1 M H2 O2 . In contrast, Ti-29Nb-21Zr passive current density remained relatively unchanged, slightly increasing from 7.49 × 10-8 in PBS to 9.31 × 10-8 in 0.1 M H2 O2 . Ti-29Nb-21Zr oxide polarization resistance (Rp ) was not affected by 0.1 M H2 O2 , maintaining a high value (1.09 × 106 vs. 1.89 × 106 Ω cm2 ), while Ti-6Al-4V in 0.1 M H2 O2 solution had significantly diminished Rp (4.38 × 106 in PBS vs. 7.24 × 104 Ω cm2 in H2 O2 ). These results indicate that Ti-29Nb-21Zr has improved corrosion resistance in ROS containing solutions when compared with Ti-6Al-4V based biomaterials.
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Affiliation(s)
- Michael A Kurtz
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Audrey C Wessinger
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Annsley Mace
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Aldo Moreno-Reyes
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| | - Jeremy L Gilbert
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
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10
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Castagnini F, Cosentino M, Bordini B, Montalti M, Biondi F, Faldini C, Traina F. Titanium modular stems in total hip arthroplasty due to developmental dysplasia: a registry comparison with single-taper implants. Hip Int 2023; 33:916-924. [PMID: 36127850 PMCID: PMC10486160 DOI: 10.1177/11207000221124115] [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: 09/04/2021] [Accepted: 06/28/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The routine use of proximal femoral modularity was discouraged in total hip arthroplasties (THAs). However, titanium dual-taper (DT) implants may provide some advantages over single-taper (ST) stems in cases of complex deformity. A registry study comparing ST and DT stems in dysplasia was designed, aiming to assess: (1) survival rates at long-term; (2) reasons for revision; (3) the profile of failed implants. METHODS The arthroplasty registry RIPO was investigated for cementless THAs performed for dysplasia since 2000. ST implants were compared to titanium-on-titanium DT stems. Demographics and implant features were collected. Survival rates and reasons for revision were compared. The profile of DT stem failures in dysplasia was defined. RESULTS 6429 implants were included in the study, 3642 ST and 2787 DT. The demographic and implant features of the 2 cohorts were not comparable. The DT cohort achieved higher survival rates at long-term (93.9% vs. 91.6%, p = 0.018). DT implants showed a higher rate of implant breakage (0.6%, p = 0.011) and a lower rate of aseptic loosening (p = 0.005). There were no differences in terms of revisions for dislocation. No metallosis occurred. There were more revisions in DT implants in males <65 years, with a 28-mm head size or smaller. CONCLUSIONS Modularity did not result in lower survival rates in dysplastic patients and may even reduce the rate of aseptic loosening in comparison to ST stems. The rate of implant breakage is not negligible. Younger males are not good candidates for titanium DT stems.
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Affiliation(s)
- Francesco Castagnini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Monica Cosentino
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Montalti
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Biondi
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- First Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- University of Bologna, Italy
| | - Francesco Traina
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- University of Bologna, Italy
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11
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Castagnini F, Bordini B, Lucchini S, Cosentino M, Tassinari E, Traina F. Mid-term outcomes of revision hip arthroplasty due to titanium modular neck failure. Arch Orthop Trauma Surg 2023; 143:5909-5918. [PMID: 36764965 DOI: 10.1007/s00402-023-04805-1] [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: 12/01/2022] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION The current strategy for modular neck failures in total hip arthroplasty (THA) is calibrated on CrCo neck failures. Stem revision is usually required, but the procedure is challenging and achieves modest outcomes (up to 20% of re-revisions at short-term). No study reports revision strategies and outcomes after Ti neck failures. Aims of the study were to evaluate: (1) demographic and implant features of the cohort to be revised, (2) intra-operative findings and surgical revision strategies and (3) clinical and radiological post-revision outcomes. MATERIALS AND METHODS Hospital database was enquired about revisions due to Ti neck failures in primary THAs. Sixty-five revisions were enrolled (all with the same modular system). Neck exchange was attempted as the first-line treatment. Patients were clinically and radiographically evaluated after revision. RESULTS The revision cohort encompassed fatigue neck fractures occurred 4.4 ± 2.6 years after THA: patients < 65 years and/or > 80 kg (98.5%) were predominant. Fifty-three neck exchanges were performed (81.5%). Eleven failures required stem revisions (16.9%), generally due to demanding neck extraction. Six complications occurred after neck exchange (11.3%), among them 2 acute infections requiring surgery (3.8%). Among stem revisions, one aseptic loosening and one neck re-fracture (18.5%) required re-revisions. At a mean follow-up of 7.1 ± 4 years, the neck exchange cohort achieved a mean HHS of 89.1 ± 6.3 (stem revisions: 84.1 ± 10.9). CONCLUSIONS Revisions for Ti neck failures were predominantly performed due to fatigue fractures. In case of failures, neck exchange is a feasible procedure in most of the cases, with good outcomes at 7 years. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Stefano Lucchini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Enrico Tassinari
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- Orthopaedics and Traumatology, DIBINEM University of Bologna, Bologna, Italy
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12
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Zajc J, Fokter SK. Bimodular femoral stems in primary total hip arthroplasty. Expert Rev Med Devices 2023; 20:1051-1064. [PMID: 37753590 DOI: 10.1080/17434440.2023.2264177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION This review critically examines the efficacy of dual-modular stems in primary total hip arthroplasty. Given the variability and non-comparability of certain femoral stem designs and stem-neck couplings, with some even being withdrawn from the market, this review offers an in-depth analysis of predominant implant performances. AREAS COVERED The paper explores a brief historical summary related to dual-modular stems, including the complications associated with their use, diagnostic tools for evaluation, analysis of both recalled and currently available models, as well as alternative therapeutic options. This information is pertinent for both clinical and research domains. EXPERT OPINION While dual-modular systems were initially touted to offer several advantages, the evidence substantiating these benefits has been ambiguous. Further, these systems introduce the risk of alternative complications. In specific cases involving patients with developmental hip dysplasia and certain proximal femoral deformities requiring complex reconstructions, dual-modular systems might be relevant. Nonetheless, the use of long interchangeable necks in patients with a body mass index above 30 kg/m2 is discouraged, and pairing a long varus-oriented neck with an extra-long femoral head should be avoided in all patients.
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Affiliation(s)
- Jan Zajc
- Clinical Department of Orthopedic Surgery, University Medical Center Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Samo K Fokter
- Clinical Department of Orthopedic Surgery, University Medical Center Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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13
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Kurtz MA, Yang R, Elapolu MSR, Wessinger AC, Nelson W, Alaniz K, Rai R, Gilbert JL. Predicting Corrosion Damage in the Human Body Using Artificial Intelligence: In Vitro Progress and Future Applications. Orthop Clin North Am 2023; 54:169-192. [PMID: 36894290 DOI: 10.1016/j.ocl.2022.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Artificial intelligence (AI) is used in the clinic to improve patient care. While the successes illustrate AI's impact, few studies have led to improved clinical outcomes. In this review, we focus on how AI models implemented in nonorthopedic fields of corrosion science may apply to the study of orthopedic alloys. We first define and introduce fundamental AI concepts and models, as well as physiologically relevant corrosion damage modes. We then systematically review the corrosion/AI literature. Finally, we identify several AI models that may be implemented to study fretting, crevice, and pitting corrosion of titanium and cobalt chrome alloys.
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Affiliation(s)
- Michael A Kurtz
- Department of Bioengineering, Clemson University, Clemson, SC, USA; The Clemson University-Medical University of South Carolina Bioengineering Program, 68 President Street, Charleston, SC 29425, USA
| | - Ruoyu Yang
- Department of Automotive Engineering, Clemson University, 4 Research Drive, Greenville, SC 29607, USA
| | - Mohan S R Elapolu
- Department of Automotive Engineering, Clemson University, 4 Research Drive, Greenville, SC 29607, USA
| | - Audrey C Wessinger
- Department of Bioengineering, Clemson University, Clemson, SC, USA; The Clemson University-Medical University of South Carolina Bioengineering Program, 68 President Street, Charleston, SC 29425, USA
| | - William Nelson
- Department of Bioengineering, Clemson University, Clemson, SC, USA; The Clemson University-Medical University of South Carolina Bioengineering Program, 68 President Street, Charleston, SC 29425, USA
| | - Kazzandra Alaniz
- Department of Bioengineering, Clemson University, Clemson, SC, USA; The Clemson University-Medical University of South Carolina Bioengineering Program, 68 President Street, Charleston, SC 29425, USA
| | - Rahul Rai
- Department of Automotive Engineering, Clemson University, 4 Research Drive, Greenville, SC 29607, USA
| | - Jeremy L Gilbert
- Department of Bioengineering, Clemson University, Clemson, SC, USA; The Clemson University-Medical University of South Carolina Bioengineering Program, 68 President Street, Charleston, SC 29425, USA.
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14
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Pomeroy E, Lim J, Vasarhelyi EM, Naudie D, Lanting B, MacDonald SJ, McCalden RW, Howard JL. No Difference In Subsidence Between Modern Monoblock And Modular Titanium Fluted Tapered Femoral Stems. J Arthroplasty 2023:S0883-5403(23)00262-0. [PMID: 36963526 DOI: 10.1016/j.arth.2023.03.034] [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: 11/18/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Subsidence remains a concern when utilizing tapered fluted titanium (TFT) femoral stems and may lead to leg length discrepancy, impingement, instability and failure to obtain osseointegration. This study aims to compare stem subsidence across three modern TFT stems. Our secondary aim was to investigate the influence of bicortical contact or 'scratch fit' on subsidence, as well as the role of intraoperative imaging in maximizing bicortical contact and preventing stem subsidence. METHODS A retrospective review of 271 hip arthroplasties utilizing modern TFT stems at a single institution was performed. Three stem designs were included in the analysis: one monoblock TFT stem (n=91) and two modular TFT stems (n=90; n=90). Patient demographics, Paprosky femoral bone loss classification, bicortical contact, utilization of intra-operative imaging, and stem subsidence (comparison of initial post-operative radiograph to the latest follow up radiograph - minimum three months) were recorded. RESULTS There was no statistically significant difference in overall subsidence (P=0.191) or the incidence of subsidence >5 millimeters between stems (P= 0.126). Subgroup analysis based on femoral bone loss grading showed no difference in subsidence between stems. Increased bicortical contact was associated with reduced subsidence (P=0.004). Intra-operative imaging was used in 46.5% (126 of 271) of cases; this was not correlated with bicortical contact (P=0.673) or subsidence (P=0.521). CONCLUSION All three modern TFT stems were highly successful and associated with low rates of subsidence, regardless of modular or monoblock design. Surgeons should select the stem that they feel is most clinically appropriate.
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Affiliation(s)
- E Pomeroy
- Consultant Orthopaedic Surgeon, Department of Trauma & Orthopaedics, University Hospital Waterford, Waterford, Ireland
| | - Jbt Lim
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, S169608, Republic of Singapore
| | - E M Vasarhelyi
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Ddr Naudie
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - B Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - S J MacDonald
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - R W McCalden
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada.
| | - J L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
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15
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Bischel OE, Suda AJ, Böhm PM, Bormann T, Jäger S, Seeger JB. Breakage of Tapered Junctions of Modular Stems in Revision Total Hip Arthroplasty—High Incidence in a Consecutive Series of a Single Institution. Bioengineering (Basel) 2023; 10:bioengineering10030341. [PMID: 36978732 PMCID: PMC10044894 DOI: 10.3390/bioengineering10030341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Modularity in revision THA (RTHA) has become accepted during the last three decades. Nevertheless, specific risks of modularity of current revision devices such as breakage of taper junctions occur during follow-up. Data reporting failure rates are predominantly given by the manufacturers but independent data acquisition is missing so far. Questions/Purposes: 1. What time-related risk of breakage of taper junction between neck and body of an established modular revision device can be expected in a consecutive single institutional series and a mid-term follow-up? 2. Are there specific factors influencing breakage in this cohort? Materials and Methods: A retrospective analysis was performed of a consecutive series of 89 cases after femoral revision using a tapered modular revision stem. Mean follow-up period was 7.1 (range: 3.0–13.7) years. Breakage of stem as failure criteria of the implant was investigated with a Kaplan–Meier analysis. Results: Breakage of taper junctions occurred in four patients during follow-up showing a time-depending implant survival of 94.2 (95% CI: 88.6–100%) after 13.7 years. Implant survival of stems with lateralized necks of 87.4 (95% CI: 75.6–100%) after 13.7 years was significantly lower compared to the standard offset variant with 100% after 13.5 years (log rank test p = 0.0283). Chi square test also revealed a significantly higher risk of breakage of lateralized necks compared to standard offset pieces (p = 0.0141). Three of four patients were obese with a mean BMI of 37.9 kg/m2. Grade of obesity (grade 1 or higher) had significant influence on risk of breakage. Survival of the implant was significantly lower in obese patients with at least grade 1 obesity compared to patients with a BMI < 30 kg/m2 (82.9 (95% CI: 64.9–100%) after 11.6 years vs. 98.4 (95% CI: 95.3–100%) after 13.7 years; log-rank p = 0.0327). Conclusions: Cumulative risk for failure of taper junctions was high in this consecutive single institutional cohort and may further increase during follow-up. As independent data acquisition in registries is missing, failure rate may be higher than reported data of the manufacturers. The use of lateralized offset necks in obese patients of at least grade 1 obesity showed a significantly higher risk of breakage. The use of monobloc revision devices may be an option, but randomized control trials are currently missing to establish standardized treatment protocols considering individual risks for both monobloc and/or modular implants.
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Affiliation(s)
- Oliver E. Bischel
- Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
- Correspondence:
| | - Arnold J. Suda
- AUVA-Unfallkrankenhaus Salzburg, Dr.-Franz-Rehrl-Platz 5, 5010 Salzburg, Austria
| | - Paul M. Böhm
- General Orthopedics, Neumeyerstr. 46, 90411 Nuremberg, Germany
| | - Therese Bormann
- Department of Orthopedics and Traumatology, University of Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Sebastian Jäger
- Department of Orthopedics and Traumatology, University of Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Jörn B. Seeger
- Kurparkklinik, Kurstr. 41-45, 61231 Bad Nauheim, Germany
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16
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Feyzi M, Fallahnezhad K, Taylor M, Hashemi R. An Overview of the Stability and Fretting Corrosion of Microgrooved Necks in the Taper Junction of Hip Implants. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8396. [PMID: 36499893 PMCID: PMC9735617 DOI: 10.3390/ma15238396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Fretting corrosion at the head-neck interface of modular hip implants, scientifically termed trunnionosis/taperosis, may cause regional inflammation, metallosis, and adverse local tissue reactions. The severity of such a deleterious process depends on various design parameters. In this review, the influence of surface topography (in some cases, called microgrooves/ridges) on the overall performance of the microgrooved head-neck junctions is investigated. The methodologies together with the assumptions and simplifications, as well as the findings from both the experimental observations (retrieval and in vitro) and the numerical approaches used in previous studies, are presented and discussed. The performance of the microgrooved junctions is compared to those with a smooth surface finish in two main categories: stability and integrity; wear, corrosion, and material loss. Existing contradictions and disagreements among the reported results are reported and discussed in order to present a comprehensive picture of the microgrooved junctions. The current research needs and possible future research directions on the microgrooved junctions are also identified and presented.
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17
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Matsushita Y, Otani T, Hayama T, Fujii H, Kawaguchi Y, Saito M. A Modified Modular Stem in Primary Total Hip Arthroplasty for Developmental Dysplasia of the Hip: Average 11-year Follow-Up in Cases With Previously Reported 3-year Clinical Results. J Arthroplasty 2022; 37:1832-1838. [PMID: 35469988 DOI: 10.1016/j.arth.2022.04.022] [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: 02/28/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Modular stems require careful follow-up, especially after any design modification. This study investigated the mid- to long-term outcomes of total hip arthroplasty in patients with developmental dysplasia of the hip using the S-ROM-A stem, a modified S-ROM stem for Asians. METHODS We previously reported short-term outcomes for all 220 dysplastic hips that underwent primary total hip arthroplasty with the S-ROM-A stem. Here, we followed the clinical and radiological outcomes of 201 of the 220 hips (91%) for a mean 11.4 years postoperatively. We also performed multivariate analysis to determine whether large anteversion angle adjustment was associated with increased osteolysis. RESULTS The cumulative survival rate of the stem at 168 months postoperatively was 97.4%. Two hips underwent revision surgery, including 1 due to neck trunnionosis. Characteristic distal stem fracture occurred in 3 hips (1.5%). Most partial radiolucent lines observed around the sleeve early postoperatively disappeared by 7 years, postoperatively. Mild osteolysis occurred relatively frequently (20%), but a multivariate model adjusted for polyethylene type showed no significant association between the occurrence of osteolysis and anteversion adjustment of the modular stem (stem anteversion decreased ≤-20°, P = .829; stem anteversion increased ≥+20°, P = .619). CONCLUSION Partial radiolucent lines early postoperatively do not affect long-term outcomes. The clinical benefits of actively adjusting the stem anteversion angle outweigh the mechanical risks. Mild osteolysis, stem fracture, and trunnionosis were relatively frequent complications. Analysis with longer follow-up and more cases are necessary to clearly determine if these complications are associated with the design modification.
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Affiliation(s)
- Yohei Matsushita
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takuya Otani
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuo Hayama
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Fujii
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiko Kawaguchi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Kurtz MA, Khullar P, Gilbert JL. Cathodic activation and inflammatory species are critical to simulating in vivo Ti-6Al-4V selective dissolution. Acta Biomater 2022; 149:399-409. [PMID: 35842034 DOI: 10.1016/j.actbio.2022.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022]
Abstract
In vivo retrievals of metallic orthopedic implants have shown selective dissolution of Ti-6Al-4V, where the vanadium-rich β phase preferentially corrodes from the surface. This damage, typically observed in crevices, is not directly caused by wear mechanics and the underlying electrochemical mechanism remains poorly understood. Previous studies show that fretting corrosion can cause negative potential drops, resulting in a decrease in surface oxide passivation resistance and the electrochemical generation of reactive oxygen species (ROS) at metallic surfaces. In this study, we combine cathodic activation and hydrogen peroxide to induce selective dissolution in vitro. After a 600 s -1 V hold and 4 h recovery in 20 °C 1 M H2O2 solution, the Ti-6Al-4V β phase was preferentially dissolved. An initial activation threshold of -0.5 V induced a significant increase in β dissolution (p = 0.000). Above this threshold, little selective dissolution occurred. In an Arrhenius-like fashion, decreasing solution concentration to 0.1 M required 72 h to generate β dissolution instead of 4 h at 1 M. Heating 0.1 M solution to body temperature (37 °C) resulted in a decrease in the time needed to replicate a similar level of β dissolution (>90%). Electrochemical impedance shows that both cathodic activation and inflammatory species are necessary to induce selective dissolution, where the combinatorial effect causes a significant drop in oxide passivation resistance from 106 to 102 (p = 0.000). STATEMENT OF SIGNIFICANCE: Though hip arthroplasties are considered a successful procedure, revision rates of 2-4% result in tens of thousands of additional surgeries within the United States, subjecting patients to increased risk of complications. Corrosion is associated with implant failure and retrieval studies show that titanium and its alloys can severely corrode in vivo in ways not yet duplicated in vitro. Here, we reproduce selective dissolution of Ti-6Al-4V β phase simulating key characteristics of in vivo degradation observed in orthopedic retrievals. We establish both cathodically activated corrosion, a relatively unexplored concept, and the presence of inflammatory species as prerequisites, furthering our understanding of this clinically relevant damage mode. We introduce an Arrhenius-based approach to assess the concentration-temperature-time interactions present.
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Affiliation(s)
- Michael A Kurtz
- Department of Bioengineering, Clemson University, Clemson, SC, United States; The Clemson University-Medical University of South Carolina Bioengineering Program, 68 President Street, BE 325, Charleston, SC 29425, United States
| | - Piyush Khullar
- Department of Bioengineering, Clemson University, Clemson, SC, United States; The Clemson University-Medical University of South Carolina Bioengineering Program, 68 President Street, BE 325, Charleston, SC 29425, United States
| | - Jeremy L Gilbert
- Department of Bioengineering, Clemson University, Clemson, SC, United States; The Clemson University-Medical University of South Carolina Bioengineering Program, 68 President Street, BE 325, Charleston, SC 29425, United States.
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Abe T, Otani T, Hayama T, Fujii H, Kawaguchi Y, Saito M. Revision Total Hip Arthroplasty Using the Modular Proximal Stem Modified for Asians: Medium-Term Clinical Results and Perioperative Complications. J Arthroplasty 2022; 37:770-776. [PMID: 34990756 DOI: 10.1016/j.arth.2021.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/22/2021] [Accepted: 12/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to examine the medium-term clinical and radiological outcomes of revision THA using the S-ROM-A stem, a modification of the S-ROM stem intended for Asians. METHODS Femoral reconstruction using the S-ROM-A stem was performed in 126 hips that underwent revision THA. All patients were followed for perioperative complications. In addition, clinical and radiographic outcomes at a mean of 8 (range 5-14) years postoperatively were evaluated in 96 hips of 86 patients (76%). RESULTS The most common perioperative complication was a femoral fracture, occurring in 16 hips (13%), including 11 intraoperative and 5 postoperative fractures. Dislocation occurred in five hips (4.0%), infection in three hips (2.4%), and trunnionosis in two hips (1.6%), including late complications. The total second stem revision was performed in two hips while stem only second revision preserving the bone ingrown sleeve was performed in four hips. With a second revision for aseptic loosening as the endpoint, the 13-year stem survival rate was 100%. Hip function as assessed by the Japanese Orthopedic Association score improved from a mean of 48 points preoperatively to 87 points 8 years postoperatively (P < .05). Radiological evaluation at the final follow-up showed that 95 hips (99%) achieved bone ingrowth fixation and one hip (1%) achieved fibrous stable status. CONCLUSION Revision THA using the S-ROM-A stem resulted in good medium-term outcomes. Although modifications of the stem length and shape may be effective in preventing fractures in Asians with relatively small body sizes, attention should be paid to the occurrence of trunnionosis, which may be associated with the decreased taper size.
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Affiliation(s)
- Toshiomi Abe
- Department of Orthopaedic Surgery, The Jikei University KASHIWA Hospital, Chiba, Japan
| | - Takuya Otani
- Department of Orthopaedic Surgery, The Jikei University DAISAN Hospital, Tokyo, Japan
| | - Tetsuo Hayama
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Fujii
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiko Kawaguchi
- Department of Orthopaedic Surgery, The Jikei University DAISAN Hospital, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Humphrey TJ, Marchwiany D, Bedair HS, Melnic CM. Fracture of a Sivash-Range of Motion Femoral Stem at the Diaphyseal Spline. Cureus 2021; 13:e20660. [PMID: 35103211 PMCID: PMC8784010 DOI: 10.7759/cureus.20660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 11/05/2022] Open
Abstract
We discuss one of the four reported cases involving the fracture of a spline of the Sivash-range of motion (S-ROM) femoral prosthesis. It occurred in a 71-year-old female patient and was fully discovered during stem extraction in revision total hip arthroplasty (THA). The fractured spline was successfully removed using a reverse curette and fluoroscopic guidance. The placement of a new S-ROM femoral prosthesis was successful, and there were no other orthopedic complications.
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21
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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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22
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Griffiths JT, Roumeliotis L, Elson DW, Borton ZM, Cheung S, Stranks GJ. Long Term Performance of an Uncemented, Proximally Hydroxyapatite Coated, Double Tapered, Titanium-Alloy Femoral Stem: Results From 1465 Hips at 10 years Minimum Follow-Up. J Arthroplasty 2021; 36:616-622. [PMID: 32896438 DOI: 10.1016/j.arth.2020.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/14/2020] [Accepted: 08/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We assessed the survivorship of a proximally hydroxyapatite coated, double tapered, titanium-alloy femoral stem in a single center, at an average follow up of 12.5 years (10.1-15.8). The majority of stems were inserted as part of a Metal on Metal (MoM) Total Hip Replacement (THR). METHODS Data was collected prospectively in a local database. A retrospective review was performed of all patients undergoing a primary THR with the prosthesis between 2003 and 2010. Primary outcome was revision of the stem for any cause. Analysis was also performed for stem revision for aseptic loosening, stem revision in the MoM setting and a worst case scenario whereby lost to follow up were presumed to have failed. True stem failure was considered if revision occurred for a stem related complication. RESULTS 1465 stems were included (1310 patients, 155 bilateral). The bearing surface was cobalt chrome on cobalt chrome in 1351 cases (92%). Seven hips were lost to follow up. Thirty-two stems (31 part of a MoM THR) underwent revision for any cause. Kaplan Meier survival analysis demonstrates an overall 97.4% survivorship. Subset analysis demonstrates 100% survivorship for aseptic loosening, 97.3% in the MoM setting and 96.7% for the worst case senario. Of the 32 cases of stem revision, only 13 were classified as 'true' stem failure. CONCLUSION This study represents the largest cohort of this uncemented femoral component with a minimum follow-up longer than 10 years. Our results demonstrate excellent long-term survivorship even in the presence of a challenging MoM environment.
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Affiliation(s)
- Jamie T Griffiths
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom
| | - Leonidas Roumeliotis
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom
| | - David W Elson
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom; Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - Zakk M Borton
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom; Department of Trauma and Orthopaedics, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Simon Cheung
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom; Witterings Medical Centre, Western Sussex Hospitals NHS Foundation Trust, Chichester, United Kingdom
| | - Geoffrey J Stranks
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom
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23
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Feyzi M, Fallahnezhad K, Taylor M, Hashemi R. The mechanics of head-neck taper junctions: What do we know from finite element analysis? J Mech Behav Biomed Mater 2021; 116:104338. [PMID: 33524892 DOI: 10.1016/j.jmbbm.2021.104338] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/16/2020] [Accepted: 01/15/2021] [Indexed: 12/18/2022]
Abstract
Modular hip implants are widely used in hip arthroplasty because of the advantages they can offer such as flexibility in material combinations and geometrical adjustments. The mechanical environment of the modular junction in the body is quite challenging due to the complex and varying off-axial mechanical loads of physical activities applied to a tapered interface of two contacting materials (head and neck) assembled by an impact force intraoperatively. Experimental analogies to the in-vivo condition of the taper junction are complex, expensive and time-consuming to implement; hence, computational simulations have been a preferred approach taken by researchers for studying the mechanics of these modular junctions that can help us understand their failure mechanisms and improve their design and longevity after implantation. This paper provides a clearer insight into the mechanics of the head-neck taper junction through a careful review on the finite element studies of the junction and their findings. The effects of various factors on the mechanical outputs namely: stresses, micromotions, and contact situations are reviewed and discussed. Also, the simulation methodology of the studies in the literature is compared. Research opportunities for future are scrutinised through tabulating data and information that have been carefully retrieved form the reported findings.
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Affiliation(s)
- Mohsen Feyzi
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia
| | - Khosro Fallahnezhad
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia
| | - Mark Taylor
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia
| | - Reza Hashemi
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia.
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24
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Blakeney WG, Lavigne M, Beaulieu Y, Puliero B, Vendittoli PA. Mid-term results of total hip arthroplasty using a novel uncemented short femoral stem with metaphyso-diaphyseal fixation. Hip Int 2021; 31:83-89. [PMID: 31996038 DOI: 10.1177/1120700020903451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Short stems were developed with the promise of providing easier implantation, facilitating revision, reducing thigh pain and proximal stress shielding. The aim of this study is to present the mid-term clinical results of a titanium short stem with modular neck. METHODS This is a prospective case series of 144 THAs performed on a series of 131 patients using the PROFEMUR Preserve Femoral Stem (MicroPort Orthopedics, Arlington, TN, USA). 2 surgeons, operated on the patients using a mini-posterior approach. The primary outcomes evaluated were stem revision for aseptic loosening and all-cause stem revision. Clinical and radiographic outcomes were also assessed. RESULTS Of the 144 THAs, there were 43 males and 101 females, with an average age of 61 (range 22-92) years at surgery. After a mean of 78 (range 53-87) months follow-up, there were 2 (1.5%) femoral implant revisions; 1 for early femoral periprosthetic fracture and 1 for fatigue failure of the modular femoral neck. There were no cases of stem aseptic loosening and radiographic analysis demonstrated no cases of stem migration. The mean UCLA activity, WOMAC and Fogotten Joint scores were respectively 6.1, 10.7 and 86.6. 70% of prosthetic hips were observed as having no restriction and 99.2% of patients were satisfied with their THA. CONCLUSIONS This short modular stem produced satisfactory clinical and radiological results at mid-term, with 98.5% implant survival for any cause of stem revision and no revisions for aseptic loosening. Long-term results are required to further evaluate the stem's promising early results.
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Affiliation(s)
- William G Blakeney
- Department of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Hospital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Martin Lavigne
- Department of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Hospital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Yann Beaulieu
- Department of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Hospital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Benjamin Puliero
- Department of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Hospital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Pascal-André Vendittoli
- Department of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Hospital Maisonneuve-Rosemont, Montreal, Quebec, Canada.,Department of Surgery, University of Montreal, Canada
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25
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Revision Hip Arthroplasty Using a Porous-coated or Taper ZMR Implant: Minimum 10-year Follow-up of Implant Survivorship. J Am Acad Orthop Surg 2021; 29:e41-e50. [PMID: 32796364 DOI: 10.5435/jaaos-d-19-00512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 05/03/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The Zimmer Modular Revision hip (ZMR) system is available in two stem options, a porous-coated cylindrical (PCM) and a taper (TM) stem. Several concerns have been reported regarding modular implants. Specifically, because of early junctional fractures, the ZMR system was redesigned with a wider modular interface. As such, we designed a study assessing long-term ZMR survivorship and functional and radiographic outcomes. METHODS AND MATERIALS A search of our institutional research database was performed. A minimum 10-year follow-up was selected. The following two cohorts were created: PCM and TM stems. The Kaplan-Meier survival analysis was performed, and causes of stem failure requiring revision surgery were collected. Functional outcomes as per the Harris Hip Score and radiographic stem stability were assessed as per the Engh classification. RESULTS A total of 146 patients meeting the inclusion criteria were available for follow-up (PCM = 68, TM = 78). The mean follow-up was 13.4 years clinically and 11.1 years radiographically for the PCM cohort. Similarly, the TM cohort had a follow-up of 11.1 years clinically and 10.5 years radiographically. The Kaplan-Meier survivorships were 87.1% and 87.8% at 15 years for the PCM and TM cohorts, respectively. The most common cause of failure requiring revision surgery overall was aseptic loosening (PCM = 1.4%, TM = 5.6%). The mean postoperative Harris Hip Score was as follows: PCM = 71.2 and TM = 64.7. Engh type I or II stem ingrowth was as follows: PCM = 85% and TM = 68%. DISCUSSION Good survivorship using the ZMR stem system can be expected at up to 15 years. Aseptic loosening remains the most commonly encountered problem for both PCM and TM stems. Previously identified modular junctional weakness seem to have been addressed.
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26
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Picado CHF, Savarese A, Cardamoni VDS, Sugo AT, Garcia FL. Clinical, radiographic, and survivorship analysis of a modular fluted tapered stem in revision hip arthroplasty. J Orthop Surg (Hong Kong) 2020; 28:2309499019891638. [PMID: 31833457 DOI: 10.1177/2309499019891638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Modular fluted tapered stems are one of the most commonly used implants in femoral revision surgery. Due to the relative lack of studies on the Restoration modular fluted tapered stem, we conducted a study to evaluate its short- to mid-term clinical, radiographic, and survival outcomes. METHODS We identified all 45 patients treated with this revision stem at our institution. Five patients did not complete the minimum 2-year follow-up, leaving 40 patients (41 hips) for assessment. Mean follow-up was 5.1 years (range 2-11 years). Clinical outcomes were assessed using the Harris hip score (HHS). Radiographs were evaluated for subsidence and loosening. Kaplan-Meier survival analysis was performed using revision of the stem for any reason as end point. RESULTS The mean HHS improved from 44.6 points preoperatively to 78.4 points at the most recent follow-up (p < 0.0001). Nonprogressive subsidence occurred in 83% of the hips (mean 2.8 mm; range 1-7 mm). One stem (2.4%) showed progressive subsidence (20 mm) and was considered loose. The most common cause for reoperation was dislocation (three hips, 7.3%). The 10-year survivorship with revision of the stem for any reason as the end point was 93.5% (95% CI, 84.9-100%). CONCLUSION There was a significant improvement in the HHS and a low likelihood of revision at short- to mid-term follow-up, adding to the current evidence base for use of this implant in revision surgery. A longer follow-up and a larger number of cases are necessary to fully evaluate its role and performance.
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Affiliation(s)
| | - Aniello Savarese
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto (SP), Brazil
| | | | - Arthur Tomotaka Sugo
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto (SP), Brazil
| | - Flávio Luís Garcia
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto (SP), Brazil
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27
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Kheir MM, Drayer NJ, Chen AF. An Update on Cementless Femoral Fixation in Total Hip Arthroplasty. J Bone Joint Surg Am 2020; 102:1646-1661. [PMID: 32740265 DOI: 10.2106/jbjs.19.01397] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael M Kheir
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicholas J Drayer
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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28
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Baumann AP, Vesnovsky O, Topoleski LDT, Donaldson FE, McMinn NLL, Vignola A, Di Prima M. Specimen-Specific Finite Element Models for Predicting Fretting Wear in Total Hip Arthroplasty Tapers. J Biomech Eng 2020; 142:071002. [PMID: 31913446 DOI: 10.1115/1.4045904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Indexed: 11/08/2022]
Abstract
Products from fretting wear and corrosion in the taper junction of total hip arthroplasty (THA) devices can lead to adverse local tissue reactions. Predicting damage as a function of design parameters would aid in the development of more robust devices. The objectives of this study were to develop an automated method for identifying areas of fretting wear on THA taper junctions, and to assess the predictive ability of a finite element model to simulate fretting wear in THA taper junctions. THA constructs were fatigue loaded, thus inducing damage on the stem taper. An automated imaging and analysis algorithm quantified fretting wear on the taper surfaces. Specimen-specific finite element models were used to calculate fretting work done (FWD) at the taper junction. Simulated FWD was correlated to imaged fretting wear. Results showed that the automated imaging approach identified fretting wear on the taper surface. Additionally, finite element models showed the greatest predictive ability for tapers exhibiting distal contact. Finite element models predicted an average of 30.3% of imaged fretting wear. With additional validation, the imaging and finite element techniques may be useful to manufacturers and regulators in the development and review of new THA devices.
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Affiliation(s)
- Andrew P Baumann
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, 10903 New Hampshire Avenue, Building 62, Room 2110, Silver Spring, MD 20993
| | - Oleg Vesnovsky
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, 10903 New Hampshire Avenue, Building 62, Room 2227, Silver Spring, MD 20993
| | - L D Timmie Topoleski
- Department of Mechanical Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250
| | - Finn E Donaldson
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Product Evaluation and Quality, OHT2: Office of Cardiovascular Devices, 10903 New Hampshire Avenue, Building 66, Room 1253, Silver Spring, MD 20993
| | - Nicole L L McMinn
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Product Evaluation and Quality, OHT6: Office of Orthopedic Devices, 10903 New Hampshire Avenue, Building 66, Room 4435, Silver Spring, MD 20993
| | - Amelia Vignola
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, 10903 New Hampshire Avenue, Building 62, Silver Spring, MD 20993
| | - Matthew Di Prima
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, 10903 New Hampshire Avenue, Building 62, Room 2124, Silver Spring, MD 20993
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29
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Talmo CT, Robbins CE, Siddiqi A, Nandi S, Bono JV, Ward DM. Revision of a dual-modular stem in patients with adverse tissue reaction. Hip Int 2020; 30:452-456. [PMID: 31390922 DOI: 10.1177/1120700019869616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dual-modular femoral components with exchangeable cobalt-chrome neck segments have had higher than expected failure rates due to corrosion and adverse local tissue reaction (ALTR). Complications, survival rates and early clinical outcomes of revision surgery for the treatment of corrosion and ALTR as a result of these implants are underreported. METHODS We identified 44 cases of revision THA for corrosion and ALTR resulting from the same dual modular stem. All revision procedures were performed using a modular tapered fluted titanium stem, ceramic heads and highly cross-linked polyethylene. RESULTS Complications included: dislocation, infection, reoperation, and chronic pain. Mean Harris Hip Score was 84 following revision surgery. CONCLUSIONS Patients undergoing revision surgery for ALTR related to this prosthesis should be aware of the risk of postoperative dislocation and other complications and the potential long-term risk of some chronic pain.
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Affiliation(s)
- Carl T Talmo
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Claire E Robbins
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Ahmed Siddiqi
- Philadelphia College of Osteopathic Medicine, PA, USA
| | - Sumon Nandi
- Department of Orthopaedic Surgery, University of Toledo, OH, USA
| | - James V Bono
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Daniel M Ward
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
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30
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Frandsen J, Duensing I, Anderson L, Gililland J. Disassociation of a Cold-Welded Bimodular Titanium Femoral Stem by Intraoperative Ice Cooling. Arthroplast Today 2020; 6:457-462. [PMID: 32637516 PMCID: PMC7329910 DOI: 10.1016/j.artd.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 11/24/2022] Open
Abstract
Modularity in total hip arthroplasty allows a surgeon to have intraoperative versatility, allowing for fine adjustments of the femoral offset, leg length, and version. However, modularity can be a source of multiple complications. This case report describes a novel intraoperative solution for the problem of cold welding of a neck-stem junction using sterile ice to cryogenically disengage the modular components.
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Affiliation(s)
- Jeff Frandsen
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, UT, USA
| | - Ian Duensing
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, UT, USA
| | - Lucas Anderson
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, UT, USA
| | - Jeremy Gililland
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, UT, USA
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31
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Abdelsamie KR, Elhawary I, Ali H, Ali M, El-Shafie M, Dominic Meek RM. Outcomes of modular femoral revision implants and the effect of component design on subsidence. Bone Joint J 2020; 102-B:709-715. [PMID: 32475233 DOI: 10.1302/0301-620x.102b6.bjj-2019-1366.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS Femoral revision component subsidence has been identified as predicting early failure in revision hip surgery. This comparative cohort study assessed the potential risk factors of subsidence in two commonly used femoral implant designs. METHODS A comparative cohort study was undertaken, analyzing a consecutive series of patients following revision total hip arthroplasties using either a tapered-modular (TM) fluted titanium or a porous-coated cylindrical modular (PCM) titanium femoral component, between April 2006 and May 2018. Clinical and radiological assessment was compared for both treatment cohorts. Risk factors for subsidence were assessed and compared. RESULTS In total, 65 TM and 35 PCM cases were included. At mean follow-up of seven years (1 to 13), subsidence was noted in both cohorts during the initial three months postoperatively (p < 0.001) then implants stabilized. Subsidence noted in 58.7% (38/65 cases) of the TM cohort (mean 2.3 mm, SD 3.5 mm) compared to 48.8% (17/35) of PCM cohort (mean 1.9 mm, SD 2.6 mm; p = 0.344). Subsidence of PCM cohort were significantly associated with extended trochanteric osteotomy (ETO) (p < 0.041). Although the ETO was used less frequently in PCM stem cohort (7/35), subsidence was noted in 85% (6/7) of them. Significant improvement of the final mean Oxford Hip Score (OHS) was reported in both treatment groups (p < 0.001). CONCLUSION Both modular TM and PCM revision femoral components subsided within the femur. TM implants subsided more frequently than PCM components if the femur was intact but with no difference in clinical outcomes. However, if an ETO is performed then a PCM component will subside significantly more and suggests the use of a TM implant may be advisable. Cite this article: Bone Joint J 2020;102-B(6):709-715.
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Affiliation(s)
- Karam R Abdelsamie
- Orthopaedic Department, Minia University, Minia, Egypt.,Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Hesham Ali
- Orthopaedic Department, Minia University, Minia, Egypt
| | - Mohamed Ali
- Orthopaedic Department, Minia University, Minia, Egypt
| | | | - R M Dominic Meek
- Orthopaedic Department, Queen Elizabeth University Hospital, Glasgow, UK
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32
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Grupp TM, Baxmann M, Jansson V, Windhagen H, Heller KD, Morlock MM, Knaebel HP. How to proceed with asymptomatic modular dual taper hip stems in the case of acetabular revision. MATERIALS 2020; 13:ma13051098. [PMID: 32121627 PMCID: PMC7084958 DOI: 10.3390/ma13051098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
How to proceed with a clinically asymptomatic modular Metha® Ti alloy stem with dual taper CoCr neck adapter in case of acetabular revision? To systematically answer this question the status of research and appropriate diagnostic methods in context to clinically symptomatic and asymptomatic dual taper stem-neck couplings has been evaluated based on a systematic literature review. A retrieval analysis of thirteen Metha® modular dual taper CoCr/Ti alloy hip stems has been performed and a rational decision making model as basis for a clinical recommendation was developed. From our observations we propose that in cases of acetabular revision, that for patients with a serum cobalt level of > 4 µg/L and a Co/Cr ratio > 3.6, the revision of the modular dual taper stem may be considered. Prior to acetabular revision surgery a systematic diagnostic evaluation should be executed, using specific tests such as serum metal (Co, Cr) ion analysis, plain antero-posterior and lateral radiographs and cross-sectional imaging modalities (Metal Artefact Reduction Sequence Magnetic Resonance Imaging). For an asymptomatic Metha® dual taper Ti alloy/CoCr stem-neck coupling at the stage of acetabular revision careful clinical decision making according to the proposed model should be followed and overreliance on any single examination should be avoided, considering the complete individual differential diagnosis and patient situation.
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Affiliation(s)
- Thomas M. Grupp
- Aesculap AG Research & Development, 78532 Tuttlingen, Germany;
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern Ludwig Maximilians University Munich, 81377 Munich, Germany;
- Correspondence: ; Tel.: +49-7461-95-2667; Fax: +49-7461-95-382667
| | - Marc Baxmann
- Aesculap AG Research & Development, 78532 Tuttlingen, Germany;
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern Ludwig Maximilians University Munich, 81377 Munich, Germany;
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany;
| | - Karl-Dieter Heller
- Department of Orthopaedic Surgery, Herzogin-Elisabeth-Hospital, 38124 Braunschweig, Germany;
| | - Michael M. Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, 21073 Hamburg, Germany;
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Midterm Outcomes and Frequency of Osteolysis of Total Hip Arthroplasty Using Cementless Modular Stem for Asian Patients. J Arthroplasty 2020; 35:811-817. [PMID: 31685396 DOI: 10.1016/j.arth.2019.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/06/2019] [Accepted: 10/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Modular stems are useful for total hip arthroplasty (THA) in anatomically difficult dysplasia. Here, we present mean 6.8-year outcomes of cementless primary THA using S-ROM-A (modified modular stem for Asian patients) femoral prosthesis in anatomically difficult cases. METHODS Charts of 373 patients (461 hips) undergoing THA (mean age, 58 years) were reviewed for clinical evaluation of modified Merle d'Aubigné-Postel score and Kaplan-Meier survivorship with revision for any reason as the end point. For radiographic analysis, 331 patients (412 hips) followed up for ≥5 years were included. Bearing couples were metal-on-metal (n = 145), metal-on-polyethylene (n = 120), and ceramic-on-polyethylene (n = 147). Radiography and multiplanar computed tomography were performed. RESULTS No postoperative dislocation or deep infection occurred. Mean modified Merle d'Aubigné-Postel score improved significantly (10.9 points preoperatively, 16.7 points at last follow-up; P < .001). Cumulative 5- and 10-year stem survival rates were 100% and 84%, respectively (95% confidence interval, 75%-93%). All stems were classified as bone ingrown fixation. Osteolysis occurred in metal-on-metal (42.8%) and metal-on-polyethylene (15.8%) groups. Mean time to osteolysis was ~3 years, with no significant difference between 3 groups (P = .264). In logistic regression, lower cup inclination angle was significantly associated with osteolysis (odds ratio, 0.914; 95% confidence interval, 0.84-0.99; P = .029). CONCLUSION S-ROM-A femoral prosthesis achieved excellent midterm fixation, and the modular system was useful in primary THA with severe deformity. Bearing couples are potentially associated with adverse reactions to metal debris. S-ROM-A with ceramic-on-polyethylene bearing couples may be an option for anatomically difficult THA.
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Summers S, Nigh E, Sabeh K, Robinson R. Clinical and radiographic outcomes of total hip replacement with a 3-part metaphyseal osseointegrated titanium alloy stem enhanced with low plasticity burnishing: a mean 5-year follow-up study. Arthroplast Today 2019; 5:352-357. [PMID: 31516981 PMCID: PMC6728597 DOI: 10.1016/j.artd.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/26/2019] [Accepted: 07/11/2019] [Indexed: 12/15/2022] Open
Abstract
Background This study evaluates midterm results of a 3-part titanium alloy stem with metaphyseal fixation and a neck-metaphyseal taper junction strengthened with low plasticity burnishing (LPB). Our hypothesis is that this multimodular implant with LPB succeeds in offering the advantages of three-part modularity without junctional failure. Methods Twenty-eight of 32 complex primary (n = 9) and revision (n = 9) total hip arthroplasties were accounted for with minimum 2-year follow-up. Clinical and radiographic data were reviewed at a mean follow-up period of 60 months. One stem, removed for failure to osseointegrate, was submitted for sectioning and taper examination. Results There were no modular junction failures despite body mass indices of 20 to 40 and offsets of 34 to 47 mms. Implant survival was 96.3%, with one removal due to aseptic loosening in a patient with chronic renal failure. Taper analyses of the removed implant showed minimal damage. Preoperative and postoperative Harris Hip Scores and Oxford Hip Scores were 20 to 86 and 16 to 41, respectively. Patient satisfaction was 9.7/10. Radiographs showed stem subsidence >2 mm and radiolucencies around the metaphyseal cone only in the hip requiring implant removal. Conclusions This 3-part titanium alloy modular stem with LPB of the neck-metaphyseal taper junction showed good functional and radiographic results at a mean 5 years without junctional failures. Although this follow-up exceeds previously published reports, longer follow-up will be important to confirm our confidence in the additional strengthening provided by LPB.
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Affiliation(s)
- Spencer Summers
- Department of Orthopaedics and Rehabilitation, University of Miami, Miami, FL, USA
| | - Evan Nigh
- Department of Orthopaedics and Rehabilitation, University of Miami, Miami, FL, USA
| | - Karim Sabeh
- Department of Orthopaedics and Rehabilitation, University of Miami, Miami, FL, USA
| | - Raymond Robinson
- Department of Orthopaedics and Rehabilitation, University of Miami, Miami, FL, USA
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Eltit F, Wang Q, Wang R. Mechanisms of Adverse Local Tissue Reactions to Hip Implants. Front Bioeng Biotechnol 2019; 7:176. [PMID: 31417898 PMCID: PMC6683860 DOI: 10.3389/fbioe.2019.00176] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/08/2019] [Indexed: 12/11/2022] Open
Abstract
Adverse Local Tissue Reactions (ALTRs) are one of the main causes of hip implant failures. Although the metal release from the implants is considered as a main etiology, the mechanisms, and the roles of the released products are topics of ongoing research. The alloys used in the hip implants are considered biocompatible and show negligible corrosion in the body environment under static conditions. However, modularity and its associated mechanically assisted corrosion have been shown to release metal species into the body fluids. ALTRs associated with metal release have been observed in hip implants with metal-on-metal articulation initially, and later with metal-on-polyethylene articulation, the most commonly used design in current hip replacement. The etiological factors in ALTRs have been the topics of many studies. One commonly accepted theory is that the interactions between the metal species and body proteins and cells generate a delayed type IV hypersensitivity reaction leading to ALTRs. However, lymphocyte reactions are not always observed in ALTRS, and the molecular mechanisms have not been clearly demonstrated. A more accepted mechanism is that cell damage generated by metal ions may trigger the secretion of cytokines leading to the inflammatory reactions observed in ALTRs. In this inflammatory environment, some patients would develop hypersensitivity that is associated with poor outcomes. Concerns over ALTRS have brought significant impact to both the clinical selection and development of hip implants. This review is focused on the mechanisms of ALTRs, specifically, the metal release process and the roles of the metal species released in the etiology and pathogenesis of the disease. Hopefully, our presentation and discussion of this biological process from a material perspective could improve our current understanding on the ALTRs and provide useful guidance in developing preventive solutions.
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Affiliation(s)
- Felipe Eltit
- Department of Materials Engineering, University of British Columba, Vancouver, BC, Canada.,School of Biomedical Engineering, University of British Columba, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Qiong Wang
- Department of Materials Engineering, University of British Columba, Vancouver, BC, Canada.,School of Biomedical Engineering, University of British Columba, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Rizhi Wang
- Department of Materials Engineering, University of British Columba, Vancouver, BC, Canada.,School of Biomedical Engineering, University of British Columba, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver, BC, Canada
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Sivan S, Rahman E, Weaver JD, Di Prima M. Comparison of ASTM F2129 and ASTM F746 for Evaluating Crevice Corrosion. JOURNAL OF TESTING AND EVALUATION 2019; 47:2497-2511. [PMID: 37680964 PMCID: PMC10483512 DOI: 10.1520/jte20180585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Crevice corrosion is one of the major mechanisms that drives implant failure in orthopedic devices that have modular interfaces. Despite the prevalence of crevice corrosion in modular interfaces, very little is known with regards to the susceptibility of different material combinations to participate in crevice corrosion. In this study, we compare two electrochemical methods, ASTM F2129, Standard Test Method for Conducting Cyclic Potentiodynamic Polarization Measurements to Determine the Corrosion Susceptibility of Small Implant Devices, and a modified version of ASTM F746, Standard Test Method for Pitting or Crevice Corrosion of Metallic Surgical Implant Materials, in their ability to induce crevice corrosion. Four commonly used metals, 316 stainless steel, commercially pure titanium (Ti grade 2), Ti-6Al-4V (Ti grade 5), and cobalt-chromium-molybdenum per ASTM F1537, Standard Specification for Wrought Cobalt-28Chromium-6Molybdenum Alloys for Surgical Implants (UNSR31537, UNSR31538, and UNSR31539), were used to form crevices with a rod and washer combination. As a control, the metal rod materials were tested alone in the absence of crevices using ASTM F2129 and the modified ASTM F746 method. As another control to determine if crevices formed with polymeric materials would influence crevice corrosion susceptibility, experiments were also conducted with metal rods and polytetrafluorethylene washers. Our results revealed more visible corrosion after ASTM F2129 than ASTM F746. Additionally, ASTM F746 was found to falsely identify crevice corrosion per the critical pitting potential when visual inspection found no evidence of crevice corrosion. Hence, ASTM F2129 was found to be more effective overall at evaluating crevice corrosion compared to ASTM F746.
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Affiliation(s)
- Shiril Sivan
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, USA
| | - Elnaz Rahman
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, USA
| | - Jason D Weaver
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, USA
| | - Matthew Di Prima
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, USA
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Snijders TE, van Erp JHJ, de Gast A. Restoring femoral offset and leg length; the potential of a short curved stem in total hip arthroplasty. J Orthop 2019; 16:396-399. [PMID: 31110402 DOI: 10.1016/j.jor.2019.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/15/2019] [Indexed: 12/23/2022] Open
Abstract
Background Total hip arthroplasty (THA) is a very successful procedure in orthopedics. Still polyethylene wear and gait deficits are limiting the clinical success.It is important to reconstruct leg length (LL) and femoral offset (FO) anatomically in order to have the best possible result of a THA. Gait deficits can arise due to leg length discrepancy as well as changes in the abductor moment arm. In THA, LL and FO are strongly determined by the orientation, size and geometry of the femoral stem. Methods This radio-anatomical study used the data of a prospective cases series of 112 patients who underwent 126 primary THAs and had completed a 1-year follow-up examination. FO and LL were compared between the conventional straight stem in vivo and a computed simulated implantation of a short curved stem, using the pre- and postoperative pelvic radiographs of the same patients. Results In this simulation of the short curved stem statistically significantly restored native FO (p = 0.010) and LL (p = 0.000) better, compared to the conventional straight stem. Conclusions Thus, the short curved stem restores FO and LL better, and could potentially prevent gait deficits.
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Affiliation(s)
- Thom E Snijders
- Clinical Orthopedic Research Center - mN, Diakonessenhuis Zeist, Zeist, the Netherlands
| | - Joost H J van Erp
- Clinical Orthopedic Research Center - mN, Diakonessenhuis Zeist, Zeist, the Netherlands.,Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Arthur de Gast
- Clinical Orthopedic Research Center - mN, Diakonessenhuis Zeist, Zeist, the Netherlands.,Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
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Design, Material, and Seating Load Effects on In Vitro Fretting Corrosion Performance of Modular Head-Neck Tapers. J Arthroplasty 2019; 34:991-1002. [PMID: 30827717 DOI: 10.1016/j.arth.2019.01.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/03/2019] [Accepted: 01/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The short-term corrosion and micromechanical behavior of 32 unique head-neck taper design/material/assembly conditions was tested using an incremental cyclic fretting corrosion (ICFC) test method previously developed. METHODS Seven materials, design, and simulated surgical parameters were evaluated, each being assigned 2 conditions for testing, using a 27-2 (7 factor, quarter factorial) design of experiments test matrix. The factors explored were (1) seating load, (2) head-neck offset, (3) material combination, (4) taper diameter, (5) taper roughness, (6) angular mismatch/engagement, and (7) taper length. Each sample underwent assembly, ICFC testing, pull off. RESULTS Low seating load and high head offset correlated with increased fretting corrosion (P < .05). High head offset also contributed to a lower onset load for fretting current and higher micromotion (P < .05). Head subsidence measured over the ICFC test for samples seated at 100 N was significantly higher than samples seated at 4000 N. Micromotion for 12-mm head offsets was statistically higher than samples with a 1.5-mm head offset. A number of interactive effects were observed. For example, samples seated at 4000 N were less sensitive to head offset than samples seated at 100 N in terms of the resulting fretting current. CONCLUSION Taper locking position, material combination, taper engagement length, taper roughness, and taper dimensions all had weak or no correlation with fretting current and taper micromotion. This test method and experimental design is a versatile means of assessing potential new taper designs in the future.
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Christiner T, Pabbruwe MB, Kop AM, Parry J, Clark G, Collopy D. Taper Corrosion and Adverse Local Tissue Reactions in Patients with a Modular Knee Prosthesis. JB JS Open Access 2018; 3:e0019. [PMID: 30882053 PMCID: PMC6400506 DOI: 10.2106/jbjs.oa.18.00019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Corrosion has been documented in modular knee implants, but it has not been related to negative patient outcomes. We performed an observational retrieval investigation of 13 Stryker Triathlon TS modular knee implants, 3 of which were revised because of osteolysis and adverse local tissue reactions secondary to fretting corrosion at the modular junctions. Methods: Modular surfaces were examined for the presence and severity of corrosion, and factors that may influence the development of corrosion were investigated. Scanning electron microscopy and energy-dispersive x-ray spectroscopy were performed to evaluate implants with severe corrosion, and tissue samples were sent for histopathological analysis. Results: Mild to severe corrosion was present in association with 62% of modular tibial components and 75% of modular femoral components. Although tibial corrosion was less prevalent than femoral corrosion, it occurred earlier and with greater severity. Scanning electron microscopy and energy-dispersive x-ray spectroscopy demonstrated the appearances of fretting and corrosion of the modular junctions. Histopathological analysis of specimens from the 3 patients with adverse local tissue reactions demonstrated severe reactions to metal debris, including 1 reaction that was consistent with an aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). Conclusions: To our knowledge, ALVAL and pseudotumors have not previously been reported secondary to corrosion of modular knee replacements. The threaded taper design and the release of cobalt-chromium ions and/or debris are implicated in the occurrence of the adverse local tissue reactions, osteolysis, and soft-tissue damage that we observed in our investigation. Clinicians should be aware of this possible complication associated with modular knee implants. Clinical Relevance: This article should raise clinician awareness of adverse local tissue reactions secondary to corrosion, potentially resulting in earlier recognition of this complication.
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Affiliation(s)
- Tom Christiner
- Centre for Implant Technology and Retrieval Analysis (CITRA), Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia.,Anatomical Pathology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, Australia
| | - Moreica B Pabbruwe
- Centre for Implant Technology and Retrieval Analysis (CITRA), Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | - Alan M Kop
- Centre for Implant Technology and Retrieval Analysis (CITRA), Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | - Jeremy Parry
- Anatomical Pathology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, Australia
| | - Gavin Clark
- Perth Hip and Knee Clinic, Subiaco, Australia
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Spiegelberg BG, Lanting BA, Howard JL, Teeter MG, Naudie DD. Surface integrity of polyethylene liners following trunnionosis of a dual modular neck total hip implant. Hip Int 2018; 28:629-635. [PMID: 29756511 DOI: 10.1177/1120700018754336] [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: 02/04/2023]
Abstract
BACKGROUND There has been a trend in the evolution of total hip arthroplasty towards increased modularity; with this increase in modularity come some potentially harmful consequences. Modularity at the neck shaft junction has been linked to corrosion, adverse reaction to metal debris and pseudotumour formation. AIM The aim of this retrieval study is to assess whether the surface integrity of the polyethylene (PE) liner is affected by metal wear debris in a single implant design series of THA revised for trunnionosis. METHODS A retrieval analysis of thirty dual-taper modular neck hip prostheses was performed; the mean time from implantation to revision was 2.7 years (1.02-6.2). PE liners were analysed using a scanning electron microscope with an energy dispersive spectrometer to assess for metal particles embedded on the liner surface. Serum metal ion levels and inflammatory markers were also analysed. RESULTS There were small numbers of metal particles present on the PE liners. The mean number of metal particles per liner was four and the particles varied in size from 0.5 µm to 122 µm mean 16 µm. All patients had elevated metal ion levels: cobalt 6.02 µg/l, chromium 1.22 µg/l, titanium 3.11 µg/l. The cobalt:chromium ratio was 7.55:1. Inflammatory markers were also marginally raised (ESR 17; CRP 10). CONCLUSION These results suggest that retention of PE liners may be reasonable when performing isolated revision of the femoral component in cases of failure at the modular neck stem junction, especially when the inner diameter of the liner is already optimised for head size and stability.
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Affiliation(s)
- Ben Gi Spiegelberg
- 1 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Brent A Lanting
- 1 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - James L Howard
- 1 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Matthew G Teeter
- 2 Medical Biophysics and Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Douglas Dr Naudie
- 1 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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Di Laura A, Hothi HS, Henckel J, Kwon YM, Skinner JA, Hart AJ. Retrieval Findings of Recalled Dual-Taper Hips. J Bone Joint Surg Am 2018; 100:1661-1672. [PMID: 30277996 PMCID: PMC6211785 DOI: 10.2106/jbjs.17.00790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The recent high-profile recalls of several dual-taper hip designs pose questions regarding why those designs perform poorly. We aimed to characterize taper damage in 1 recalled design to understand failure mechanisms to inform surgeons on which patients should be considered at risk of revision and when to revise. METHODS High-precision measurement equipment was used to characterize the metal loss from the neck-stem interface of 116 retrieved Rejuvenate femoral stems (Stryker Howmedica Osteonics) revised because of an adverse reaction to metal debris. Head-neck taper surfaces were also investigated, and clinical and laboratory data were examined. RESULTS The neck-stem junction of each implant was moderately to severely corroded and showed a characteristic wear pattern on both male and female taper surfaces. The severity of taper damage was positively correlated with time to revision (coefficient, 0.040 [95% confidence interval (CI), 0.028 to 0.051]; p < 0.0001) and with serum cobalt concentration (coefficient, 0.02 [95% CI, 0.01 to 0.02]; p < 0.0001) and serum chromium concentration (coefficient, 0.04 [95% CI, 0.009 to 0.070]; p = 0.0142). CONCLUSIONS A forensic examination of the retrieved components that failed secondary to an adverse reaction to metal debris showed, in all cases, visible corrosion. Of the implant and patient factors investigated, we did not identify any predictors of corrosion. The severity of damage was found to increase with time; cobalt was significantly elevated over chromium. CLINICAL RELEVANCE Surgeons should scrupulously follow and consider revision for patients with this implant design to avoid extensive tissue excision. Blood metal ion tests may aid in identifying the mechanisms of taper corrosion.
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Affiliation(s)
- Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom,E-mail address for A. Di Laura:
| | - Harry S. Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Young-Min Kwon
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John A. Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Alister J. Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Papaioannou I, Repantis T, Baikousis A, Korovessis P. Late Onset Disassembly of a Modular Neck-stem Component after Cementless Hip Replacement without Dislocation: A Case Report and Review of Literatures. Hip Pelvis 2018; 30:190-195. [PMID: 30202754 PMCID: PMC6123507 DOI: 10.5371/hp.2018.30.3.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/28/2018] [Accepted: 07/06/2018] [Indexed: 11/24/2022] Open
Abstract
Modular femoral prostheses are characterized by a second neck-stem junction. This modularity provides many clinical benefits including hip offset restoration, intraoperative leg length and anteversion adjustment. Although, this extra junction in modular femoral prostheses can contribute to catastrophic consequences like fracture, cold welding, corrosion and fretting of the modularity. However, only few complications related to the modularity itself have been reported in the literature. We report a unique case of neck-stem component dissociation without dislocation of the R-120PC™ Modular Stem (DJO Surgical). Our 71-year-old obese female patient underwent cementless hip replacement 5 years ago. Following radiographic confirmation of neck-stem dissociation open reduction was performed and wiring fixation was applied to secure the neck to the stem. After reduction and fixation, hip joint was stable, and our patient returned to her daily routine 2.5 months postoperatively. The last follow up was at 12 months after surgery with excellent radiographic and clinical evaluation.
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Affiliation(s)
| | - Thomas Repantis
- Department of Orthopedics, General Hospital of Patras, Patras, Greece
| | - Andreas Baikousis
- Department of Orthopedics, General Hospital of Patras, Patras, Greece
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Rueckl K, Boettner F, Bechler U, Baral EC, Wright TM, Sculco PK. Fracture of an S-ROM stem at the sleeve-stem junction. Arthroplast Today 2018; 4:295-299. [PMID: 30186908 PMCID: PMC6123181 DOI: 10.1016/j.artd.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/09/2018] [Accepted: 02/09/2018] [Indexed: 12/02/2022] Open
Abstract
Fracture of a well-ingrown femoral component is a rare and often challenging complication. Modular junctions and sleeve interfaces have been identified as one potential point of weakness with corrosion and fretting being contributing factors to ultimate femoral component fracture. Stem fractures at the sleeve interface were reported occasionally for the proximal ingrowth modular Emperion System (Smith and Nephew, Memphis, TN). However, this failure mechanism has been reported infrequently, often associated with corrosion at the modular junction, for the similarly designed S-ROM system (DePuy Orthopedics Inc., Warsaw, IN). We present the case of a 52-year-old patient, with a body weight of 84 kg (185 lbs) and a body mass index of 30.6 kg/m2, who suffered a fatigue fracture of a 14 × 09 × 130 mm S-ROM stem 42 months after implantation. The present study presents the results of the surface analysis, discusses possible failure mechanisms, provides treatment guidelines, and a review of the literature revealing 15 cases of failure at the level of the stem-sleeve junction. In particular, modifiable risk factors for potential stem failure, including stem diameter, stem offset, and the resulting cantilever bending forces on the proximal sleeve-stem junction, are discussed in detail.
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Affiliation(s)
- Kilian Rueckl
- Hospital for Special Surgery, New York, NY, USA.,Department for Orthopedic Surgery, University of Wuerzburg, Germany
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Ladurner A, Zdravkovic V, Grob K. Femoral Bone Restoration Patterns in Revision Total Hip Arthroplasty Using Distally Fixed Modular Tapered Titanium Stems and an Extended Trochanteric Osteotomy Approach. J Arthroplasty 2018; 33:2210-2217. [PMID: 29599032 DOI: 10.1016/j.arth.2018.02.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Mechanical failure of modular revision stems is a serious complication in revision total hip arthroplasty. The lack of adequate osseous support to the proximal component, especially in cases of an extended trochanteric osteotomy approach, is considered a risk factor for stem failure. In this study, we analyze proximal bone regeneration patterns in patients undergoing revision total hip arthroplasty for aseptic stem loosening through an extended trochanteric osteotomy approach using an uncemented dual modular stem. METHODS Fifty-four patients treated for aseptic stem loosening were radiologically reviewed. The femur was divided according to the Gruen zones. Preoperative bone loss, formation of new cancellous bone, and presence of direct osseous contact to the stem were noted right away for each Gruen zone. The presence of osseous support at the modular junction and the proximal component were examined. RESULTS All patients showed restoration of proximal bone mass at final follow up. New bone formation was first seen in more distally located Gruen zones. Cases with longer proximal components had a trend toward earlier osseous support at the modular junction. Overall, 75% of patients showed osseous support at the modular junction 2 years after surgery. CONCLUSION Restoration of proximal bone occurs in a distal to proximal direction. Shorter proximal components require more time until osseous support to the modular junction is achieved, which may result in a higher risk of mechanical failure. Based on this study, bony support at the modular junction should not be expected in 25% of cases 2 years after surgery.
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Affiliation(s)
- Andreas Ladurner
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Vilijam Zdravkovic
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Karl Grob
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Royhman D, Patel M, Jacobs JJ, Wimmer MA, Hallab NJ, Mathew MT. In vitro simulation of fretting-corrosion in hip implant modular junctions: The influence of pH. Med Eng Phys 2018; 52:1-9. [DOI: 10.1016/j.medengphy.2017.10.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 10/25/2017] [Accepted: 10/29/2017] [Indexed: 11/26/2022]
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Rueckl K, Sculco PK, Berliner J, Cross MB, Koch C, Boettner F. Fracture risk of tapered modular revision stems: a failure analysis. Arthroplast Today 2017; 4:300-305. [PMID: 30186909 PMCID: PMC6123177 DOI: 10.1016/j.artd.2017.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022] Open
Abstract
Fractures of well-ingrown femoral components are a rare and often challenging complication after revision total hip arthroplasty. Prior series have documented catastrophic failure at the modular junction of revision femoral components. However, to the authors' knowledge, there has been only 1 report of a mid-stem fracture of a modular tapered revision stem. The present article reports 2 cases of fatigue fractures (14 months and 10 years after implantation) of a tapered modular revision stem. It presents the results of the fracture surface analysis, discusses the etiology of failure, and presents the authors' recommendations on how to best avoid this complication.
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Affiliation(s)
| | | | | | | | | | - Friedrich Boettner
- Corresponding author. 535 East 70th Street, New York, NY 10021, USA. Tel.: +1 212 774 2127.
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Vierra BM, Blumenthal SR, Amanatullah DF. Modularity in Total Hip Arthroplasty: Benefits, Risks, Mechanisms, Diagnosis, and Management. Orthopedics 2017; 40:355-366. [PMID: 28598491 DOI: 10.3928/01477447-20170606-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 11/07/2016] [Indexed: 02/03/2023]
Abstract
Modular implants are currently widely used in total hip arthroplasty because they give surgeons versatility during the operation, allow for easier revision surgery, and can be adjusted to better fit the anatomy of the specific patient. However, modular implants, specifically those that have metal-on-metal junctions, are susceptible to crevice and fretting corrosion. This can ultimately cause implant failure, inflammation, and adverse local tissue reaction, among other possible side effects. Surgeons should be aware of the possibility of implant corrosion and should follow a set of recommended guidelines to systematically diagnose and treat patients with corroded implants. Ultimately, surgeons will continue to use modular implants because of their widespread benefits. However, more research is needed to determine how to minimize corrosion and the negative side effects that have been associated with modular junctions in total hip arthroplasty. [Orthopedics. 2017; 40(6):355-366.].
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Does a micro-grooved trunnion stem surface finish improve fixation and reduce fretting wear at the taper junction of total hip replacements? A finite element evaluation. J Biomech 2017; 63:47-54. [DOI: 10.1016/j.jbiomech.2017.07.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 07/27/2017] [Accepted: 07/29/2017] [Indexed: 11/30/2022]
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Mueller U, Braun S, Schroeder S, Sonntag R, Kretzer JP. Same Same but Different? 12/14 Stem and Head Tapers in Total Hip Arthroplasty. J Arthroplasty 2017; 32:3191-3199. [PMID: 28552447 DOI: 10.1016/j.arth.2017.04.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/27/2017] [Accepted: 04/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Taper corrosion has been identified to be a major concern in total hip arthroplasty during the past years. So far, the mechanisms that lead to taper corrosion in modular taper junctions are not fully understood. However, it has been shown that corrosion is also influenced by the geometry and topography of the taper, and these parameters vary among the implant manufacturers. The purpose of this study was to investigate the variations of common stem and head tapers regarding design and surface characteristics. METHODS An analysis of selected commercially available 12/14 stem and head tapers was performed. As geometric parameters, the taper angle, the opening taper diameter, and the taper length were measured using a coordinate measuring machine. Several topographic parameters were determined using a tactile roughness measurement instrument. RESULTS Although all investigated tapers are so-called 12/14 tapers, this study showed that the stem and head tapers differ among the manufacturers. The stem tapers were clearly different in both geometry and topography, and the range in variation of the topographic parameter was greater than it was for the geometric parameter. In contrast, the head tapers were different in their geometry, although not in topography. CONCLUSION Ultimately, this study provides an overview on the characteristics and variations of modular hip taper connections, and in addition, a new classification system regarding the surface finish is presented. These findings could be further considered in experimental corrosion or retrieval studies.
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Affiliation(s)
- Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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50
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Di Laura A, Quinn PD, Panagiotopoulou VC, Hothi HS, Henckel J, Powell JJ, Berisha F, Amary F, Mosselmans JFW, Skinner JA, Hart AJ. The Chemical Form of Metal Species Released from Corroded Taper Junctions of Hip Implants: Synchrotron Analysis of Patient Tissue. Sci Rep 2017; 7:10952. [PMID: 28887488 PMCID: PMC5591307 DOI: 10.1038/s41598-017-11225-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/21/2017] [Indexed: 02/08/2023] Open
Abstract
The mechanisms of metal release from the articulation at the head cup bearing and the tapered junctions of orthopaedic hip implants are known to differ and the debris generated varies in size, shape and volume. Significantly less metal is lost from the taper junction between Cobalt-Chromium-Molybdenum (CoCrMo) and Titanium (Ti) components (fretting-corrosion dominant mechanism), when compared to the CoCrMo bearing surfaces (wear-corrosion dominant mechanism). Corrosion particles from the taper junction can lead to Adverse Reactions to Metal Debris (ARMD) similar to those seen with CoCrMo bearings. We used synchrotron methods to understand the modes underlying clinically significant tissue reactions to Co, Cr and Ti by analysing viable peri-prosthetic tissue. Cr was present as Cr2O3 in the corroded group in addition to CrPO4 found in the metal-on-metal (MoM) group. Interestingly, Ti was present as TiO2 in an amorphous rather than rutile or anatase physical form. The metal species were co-localized in the same micron-scale particles as result of corrosion processes and in one cell type, the phagocytes. This work gives new insights into the degradation products from metal devices as well as guidance for toxicological studies in humans.
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Affiliation(s)
- Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
| | - Paul D Quinn
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, United Kingdom
| | - Vasiliki C Panagiotopoulou
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Jonathan J Powell
- Biomineral Research Group, Dept Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Fitim Berisha
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Fernanda Amary
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - J Fred W Mosselmans
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, United Kingdom
| | - John A Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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