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Sacher SE, Baral EC, Wright TM, Bauer TW, Li Q, Padgett DE, Potter HG, Koff MF. Association of Total Hip Arthroplasty Flexural Rigidity With Magnetic Resonance Imaging and Histological Findings. J Arthroplasty 2024; 39:2116-2123.e1. [PMID: 38428693 DOI: 10.1016/j.arth.2024.02.072] [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: 12/11/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Modular connections in total hip arthroplasty (THA) offer surgical advantages, but can contribute to implant fretting and corrosion due to micromotion at the head-stem interface. Previous studies implicated lower flexural rigidity as a key contributing factor to THA corrosion and fretting, but none associated flexural rigidity with direct histological evaluation or magnetic resonance imaging (MRI) outcomes. The purpose of this study was to determine how implant flexural rigidity is associated with MRI imaging metrics and histopathological outcomes in patients who have a failed THA. METHODS Patients requiring revision THA surgery underwent preoperative MRIs with 3-dimensional multispectral imaging techniques to suppress metal artifacts. The MRI images were graded for adverse local tissue reactions. For each hip, trunnion flexural rigidity was measured from the retrieved femoral stem, and a periprosthetic tissue sample was retrieved and evaluated using semiquantitative histology. Generalized linear models and analyses of variance were used to assess associations between flexural rigidity and MRI and histology outcomes. RESULTS A total of 106 THA stems were retrieved (46 women and 60 men, age: 68 years (range, 60 to 73 years). After adjustment for length of implantation, flexural rigidity was negatively correlated with histologic aseptic lymphocyte-dominant vasculitis-associated lesion severity (β = -26.27, P = .018), Fujishiro lymphocyte grading (β = -13.4, P = .039), perivascular lymphocyte layers (β = -17.8, P = .022), the grade of tissue organization (β = -22.5, P = .009), the presence of diffuse synovitis (β = -66.5, P = .003), and the presence of lymphoid aggregates (β = -75.9, P = .022). No association was found between MRI metrics and flexural rigidity. CONCLUSIONS Among these implants, decreased trunnion stiffness was associated with increased histologic features of adverse host-mediated soft tissue reactions.
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Affiliation(s)
- Sara E Sacher
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Elexis C Baral
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Timothy M Wright
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Thomas W Bauer
- Hospital for Special Surgery, Department of Pathology and Laboratory Medicine, New York, New York
| | - Qian Li
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Douglas E Padgett
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Hollis G Potter
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Matthew F Koff
- Hospital for Special Surgery, Department of Radiology, New York, New York
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Spece H, Ouellette ES, Klein GR, Mont MA, Kurtz SM. Are Corrosion and Material Loss a Threat for Titanium-Titanium Tapers in Total Hip Arthroplasty Modular Acetabular Components? J Arthroplasty 2024; 39:1602-1608. [PMID: 38070717 DOI: 10.1016/j.arth.2023.12.001] [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: 07/26/2023] [Revised: 11/09/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Extensive research has reported on fretting corrosion and material loss for a variety of metal taper interfaces in orthopedic devices. For modular acetabular shell-liner constructs, the interfaces studied thus far have consisted of mixed-metal pairings, and the risk of fretting corrosion and material loss for the all-titanium (Ti) shell-liner taper junction in one ceramic-on-ceramic (COC) design remains poorly understood. We asked: do Ti shell-liner taper interfaces in COC total hip arthroplasty devices show in vivo evidence of (1) fretting and/or corrosion, and (2) quantifiable potential material loss? METHODS We examined 22 shell-liner pairs and 22 single liners from retrieved COC components. The taper interface surfaces were assessed for fretting corrosion using a semiquantitative scoring method and imaged with scanning electron microscopy. A subcohort of components was measured with a coordinate measuring machine, and volumetric material loss and maximum wear depth were calculated. RESULTS Fretting corrosion at the taper interfaces was minimal to mild for 95% of liners and 100% of shells. Imaging revealed fretting marks within a band of corrosion on some implants and evidence of corrosion not in the proximity of mechanical damage. Estimated material loss ranged from 0.2 to 1.3 mm3 for liners, and 0.5 to 1.1 mm3 for shells. Maximum wear depth for all components was 0.03 mm or less. CONCLUSIONS Our results indicate that, compared to other taper junctions in total joint arthroplasty, the risk of corrosion and material loss may be minimal for Ti shell-liner interfaces.
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Affiliation(s)
- Hannah Spece
- Implant Research Core, School of Biomedical Science, Engineering, and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | | | - Gregg R Klein
- Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, New Jersey
| | - Michael A Mont
- Department of Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Steven M Kurtz
- Implant Research Core, School of Biomedical Science, Engineering, and Health Systems, Drexel University, Philadelphia, Pennsylvania
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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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Mathew MT, Cheng KY, Sun Y, Barao VAR. The Progress in Tribocorrosion Research (2010-21): Focused on the Orthopedics and Dental Implants. JOURNAL OF BIO- AND TRIBO-CORROSION 2023; 9:48. [PMID: 38525435 PMCID: PMC10959289 DOI: 10.1007/s40735-023-00767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/20/2023] [Accepted: 05/05/2023] [Indexed: 03/26/2024]
Abstract
Tribocorrosion is an integration of two areas-tribology and corrosion. It can be defined as the material degradation caused by the combined effect of corrosion and tribological process at the material interfaces. Significant development has occurred in the field of tribocorrosion over the past years. This development is due to its applications in various fields, such as aerospace, marine, biomedical, and space. Focusing on biomedical applications, tribocorrosion finds its applications in the implants used in cardiovascular, spine, orthopedics, trauma, and dental areas. It was reported that around 7.2 million Americans are living with joint implants. Implant surgery is a traumatic and expensive procedure. Tribocorrosion can affect the lifespan of the implants, thus leading to implant failure and a potential cause of revision surgery. Hence, it is essential to understand how tribocorrosion works, its interaction with the implants, and what procedures can be implemented to protect materials from tribocorrosion. This paper discusses how tribocorrosion research has evolved over the past 11 years (2010-2021). This is a comprehensive overview of tribocorrosion research in biomedical applications.
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Affiliation(s)
- Mathew T. Mathew
- Department of Biomedical Science, UIC College of Medicine, Rockford, IL 61107, USA
- Department of Biomedical Engineering, UIC, Chicago, IL 60612, USA
- Department of Restorative Dentistry, College of Dentistry, UIC, Chicago, IL 60612, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kai-yuan Cheng
- Department of Biomedical Science, UIC College of Medicine, Rockford, IL 61107, USA
| | - Yani Sun
- Department of Biomedical Science, UIC College of Medicine, Rockford, IL 61107, USA
| | - Valentim A. R. Barao
- Departament of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo 13414-903, Brazil
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Trunnions and Modularity in Total Hip Arthroplasty: A Historical Review With Current Clinical Implications. J Am Acad Orthop Surg 2023; 31:189-197. [PMID: 36728328 DOI: 10.5435/jaaos-d-22-00498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/27/2022] [Indexed: 02/03/2023] Open
Abstract
Trunnion in total hip arthroplasty refers to the interface between the neck of a femoral stem and the femoral head. Clinical complications arising from damage to this junction, whether it be due to mechanical wear, corrosion, or a combination, are referred to as mechanically assisted crevice corrosion (MACC), also commonly known as trunnionosis. With the use of modular hip prostheses, which help customize offset and leg length to an individual patient's anatomy, the incidence of MACC and revision due to MACC has increased in recent years. Although the cause of MACC is multifactorial, with patient factors and technique factors contributing to this condition, taper design and geometry, metallurgical properties of implants, and size mismatch of the bearing couple are some of the implant factors that have also been implicated in this clinical phenomenon. Understanding the history of taper design and geometry, the track record of older implants, and the rationale behind the development of current prostheses can help surgeons choose the right implants for their patients and accurately assess the pros and cons of new implants being introduced to the market each year.
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Selecting a Press-fit Stem for Total Hip Arthroplasty: The Rationale and Evolution of the Modern Femoral Prosthesis. J Am Acad Orthop Surg 2022; 30:e1279-e1290. [PMID: 35962989 DOI: 10.5435/jaaos-d-22-00074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Noncemented press-fit femoral stems predominate in total hip arthroplasty for all age groups with generally excellent long-term survivorship. The 2021 American Joint Replacement Registry reports that 96% of all elective primary total hip arthroplasties used noncemented femoral implant fixation. 1 Today, there are many styles of press-fit stems, each with supposed benefits, based on a range of design philosophies. Design aspects to consider when selecting a stem are numerous, including stem geometry, stem length, collared or collarless, material properties, and surface structure. Although most stem designs demonstrate excellent results, the differences in stem designs are intimately linked to additional factors such as ease of use/implantation, percentage of surface osseointegration, overall bone removal versus bone stock preservation, subsequent femoral stress shielding, and consideration of complexity of later revision. A surgeon with a broad understanding and appreciation of femoral stem designs should be prepared to select between the multitude of options to best serve individual patients.
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Taper corrosion in total hip arthroplasty – How to assess and which design features are crucial? J Mech Behav Biomed Mater 2022; 133:105307. [DOI: 10.1016/j.jmbbm.2022.105307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022]
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McCarty CP, Park SH, Ho NC, Sangiorgio SN, Ebramzadeh E. Taper Material Loss in Total Hip Replacements: Is It Affected by Joint Friction? J Bone Joint Surg Am 2022; 104:796-804. [PMID: 35167500 DOI: 10.2106/jbjs.21.00579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metal debris and corrosion products generated from the taper junctions of modular joint replacements have been recognized as contributors to failure. Therefore, understanding the factors associated with increased taper wear and corrosion is fundamental to improving implant performance. METHODS A cohort of 85 large-diameter metal-on-metal heads and cups retrieved at revision surgery, after 10 to 96 months of service, was evaluated. First, metrology was conducted to quantify head taper material loss and implant articular surface wear. Then, joint frictional moments for each retrieved head-and-cup pair were measured during 10 cycles of simulated physiological gait in a biomechanical model. Taper material loss was evaluated for correlations with frictional moments, articular wear, head diameter, head-cup clearance, and time in vivo. RESULTS Peak resultant frictional moments ranged from 9.1 to 26.3 Nm, averaging 17.3 ± 2.7 Nm. Fretting and corrosion damage during in vivo service resulted in material loss from the head tapers ranging between 0.04 and 25.57 mm3, compared with combined head and cup articular wear of 0.80 to 351.75 mm3 in this cohort. Taper material loss was not correlated with higher frictional moments (R = -0.20 to 0.11, p = 0.07 to 0.81). Higher frictional moments from axial rotation were correlated with higher head and cup wear (R = 0.33, p < 0.01). The correlation between taper material loss and head diameter was weak and did not reach statistical significance (R = 0.20, p = 0.07). Taper material loss was not correlated with nominal head-cup clearance (R = 0.06, p = 0.6). Finally, taper material loss increased significantly over time (R = 0.34, p < 0.01). CONCLUSIONS Despite serious concerns regarding trunnionosis, volumes of head taper wear were generally lower than those of articular surface wear. There was no statistical correlation between taper wear and frictional moments. Therefore, the results suggest that high friction in metal-on-metal implants does not contribute to higher material loss at the head taper, despite high bending moments. CLINICAL RELEVANCE The amount of metal debris and corrosion products from taper junctions of the joint arthroplasties, widely recognized as an insidious cause of failure, was not correlated with joint frictional moments. Multiple factors affect taper wear: implant design, material, size, surface finish, and patient weight and activity level. However, in the present cohort, high friction of metal-on-metal total hip replacements likely did not contribute to increased volume of material loss at taper interfaces, despite increased moments at the locations of taper material loss.
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Affiliation(s)
- Colin P McCarty
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, California
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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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Brusalis CM, Thacher RR, Baral E, Wright TM, Gulotta LV, Dines DM, Warren RF, Fu MC, Taylor SA. Tribocorrosion is Common, but Mild in Modular Humeral Components in Shoulder Arthroplasty: An Implant Retrieval Analysis. JSES Int 2022; 6:401-405. [PMID: 35572421 PMCID: PMC9091787 DOI: 10.1016/j.jseint.2022.01.009] [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] [Indexed: 11/22/2022] Open
Abstract
Background Wear and corrosion at the junctions of modular implants are increasingly recognized issues in the design of hip and knee arthroplasty prostheses, yet less is known about their significance in shoulder arthroplasty. Methods A query of paired total shoulder implant specimens (eg, humeral head and stem components from the same patient) was performed using an institutional implant retrieval registry. Implants were examined under a stereomicroscope and evaluated for evidence of fretting and corrosion using the modified Goldberg scoring system. Available electronic medical records of included specimens were reviewed to report relevant clinical characteristics and identify potential associations with the presence of tribocorrosion. Results Eighty-three paired total shoulder implant specimens, explanted at a single institution between 2013 and 2020, were analyzed. Corrosion was identified in 52% (43/83) of humeral head components and 40% (33/83) of humeral stem components. Fretting was identified in 29% (24/83) of humeral head components and 28% (23/83) of humeral stem components. Of the 56 paired implants for which clinical data were available, the duration of implantation (DOI) was less than 2 years in 29% of paired implants and greater than 5 years in 36% of implants. The presence of corrosion or fretting was not associated with DOI, a male humeral head taper, or periprosthetic infection as the indication for revision. Conclusion Mild tribocorrosion was present in more than half of the retrieved humeral implant specimens. However, trunnionosis did not manifest as a clinical cause of revision surgery in our study.
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Shang X, Fang Y. Comparison of Ceramic-on-Ceramic vs. Ceramic-on-Polyethylene for Primary Total Hip Arthroplasty: A Meta-Analysis of 15 Randomized Trials. Front Surg 2022; 8:751121. [PMID: 34977138 PMCID: PMC8716688 DOI: 10.3389/fsurg.2021.751121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: This meta-analysis aimed to compare ceramic-on-ceramic (COC) components and ceramic-on-polyethylene (COP) components during total hip arthroplasty (THA). Settings: A meta-analysis of randomized controlled trials (RCTs) comparing COC and COP during primary THA was conducted. Electronic searches were current to March 2021. Participants: Trials were included for meta-analysis if they compared at least the bearing surfaces of COC and COP for patients undergoing primary THA and if they reported the outcomes of THA after a certain period of follow-up and only RCTs in English were included. Primary and Secondary Outcome Measures: The primary endpoints consist of audible noise, prosthesis fracture, and revision. Secondary endpoints include dislocation, deep infection, osteolysis, and prosthesis loosening. Extracted data were statistically analyzed with the Stata11.0. Results: A total of 15 RCTs containing 2,702 patients (2,813 hips) were included in this study. The audible noise [odds ratio (OR) = 5.919; 95% CI: 2.043, 17.146; p ≤ 0.001] and prosthesis fracture (OR = 35.768; 95% CI: 8.957, 142.836; p = 0.001) were significantly higher in the COC group. Hip function, revision rate, dislocation rate, deep infection rate, osteolysis rate, and prosthesis loosening rate were comparable between these two groups, while the wear rate was higher in the COP group. Conclusion: This study indicated comparable outcomes of COC and COP bearing surfaces in primary THA; high-quality RCTs with a long-term follow-up are still urgently needed to provide more evidence on the optimal bearing surfaces in primary THA.
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Affiliation(s)
- Xiaobin Shang
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Fang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Trebše R, Valič M, Savarin D, Milošev I, Levašič V. Survival rate of total hip replacements with matched and with mixed components with 10.7 years mean follow-up. Hip Int 2022; 32:32-38. [PMID: 33213223 DOI: 10.1177/1120700020972710] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mixing and matching components from different manufacturers in total hip arthroplasty is a frequently used off-label praxis. The clinical consequences of this procedure have not been studied in detail. METHODS 860 patients with matched and 1067 patients with mixed primary total hip replacement (THR) components carried out between 1 January 2002 and 31 December 2004, were selected from our Institution registry. The analysis endpoint was set at 1 January 2016. THRs with poorly performing components were excluded from study groups. Kaplan-Meier survival curves for both groups were calculated and compared using the Log-Rank test and the demographic data using the chi-square test. Correlations between demographic data and revisions were calculated using bivariate correlation. RESULTS 28 revisions were carried out in the matched group and 67 in the mixed group. The 14-year overall survival probability was significantly better in the former (96.0%) than in the mixed group (92.7%) (p = 0.002). Survival, free of aseptic and septic failures, was statistically, significantly higher in the matched group (p = 0.026 and p = 0.007, respectively).The survival of the mixed subgroup with heads and stems from the same manufacturer did not differ statistically from that of the matched group (p = 0.079). CONCLUSIONS In contrast to the results listed in the National Joint Registry and the New Zealand Joint Registry, the survival probability in our study was, statistically, significantly higher in total hip replacements using components of the same manufacturer. Importantly, mixing and matching the components of different manufacturers led to similar survival providing the head and the stem were from the same manufacturer.
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Affiliation(s)
- Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia
| | - Matej Valič
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
| | | | - Ingrid Milošev
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia.,Jožef Stefan Institute, Ljubljana, Slovenia
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Gómez Taborda Y, Gómez Botero M, Castaño-González JG, Bermúdez-Castañeda A. Assessment of physical, chemical, and tribochemical properties of biomedical alloys used in explanted modular hip prostheses. Proc Inst Mech Eng H 2021; 236:9544119211061928. [PMID: 34931555 DOI: 10.1177/09544119211061928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During their service life, modular interfaces experience tribological, and corrosion phenomena that lead to deterioration, which in turn can cause a revision procedure to remove the failed prosthesis. To achieve a clearer understanding of the surface performance of those biomedical alloys and the role of the surface properties in the mechanical and chemical performance, samples were taken from retrieval implants made of Ti6Al4V and Co28Cr6Mo alloys. Polarization resistance and pin-on-disk tests were performed on these samples. Physical properties such as contact angle, roughness, microhardness, and Young's modulus were determined. A correlation between surface energy and evolution of the tribological contact was observed for both biomedical alloys. In tribocorrosion tests, titanium particles seem to remain in the surface, unlike what is observed in CoCr alloys. These metallic or oxidized particles could cause necrosis or adverse tissue reactions.
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Affiliation(s)
- Yesenia Gómez Taborda
- Centro de Investigación, Innovación y Desarrollo de Materiales - CIDEMAT, Universidad de Antioquia, Medellín, Colombia
| | - Maryory Gómez Botero
- Centro de Investigación, Innovación y Desarrollo de Materiales - CIDEMAT, Universidad de Antioquia, Medellín, Colombia
| | | | - Angela Bermúdez-Castañeda
- Diseño Sostenible en Ingeniería Mecánica - DSIM, Escuela Colombiana de Ingeniería Julio Garavito, Bogotá, Colombia
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Tucker K, Günther KP, Kjaersgaard-Andersen P, Lützner J, Kretzer JP, Nelissen RGHH, Lange T, Zagra L. EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty. EFORT Open Rev 2021; 6:982-1005. [PMID: 34909220 PMCID: PMC8631244 DOI: 10.1302/2058-5241.6.210080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended. Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced). Within the EFORT ‘Implant and Patient Safety Initiative’, evidence- and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty. Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately. Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake. Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results. Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures.
Cite this article: EFORT Open Rev 2021;6:982-1005. DOI: 10.1302/2058-5241.6.210080
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Affiliation(s)
- Keith Tucker
- Orthopaedic Data Evaluation Panel (ODEP), Norwich, UK
| | - Klaus-Peter Günther
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | | | - Jörg Lützner
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Toni Lange
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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Hemmerling KJ, Weitzler L, Bauer TW, Padgett DE, Wright TM. Fretting and corrosion of metal liners from modular dual mobility constructs : a retrieval analysis. Bone Joint J 2021; 103-B:1238-1246. [PMID: 34192940 DOI: 10.1302/0301-620x.103b7.bjj-2020-0221.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Dual mobility implants in total hip arthroplasty are designed to increase the functional head size, thus decreasing the potential for dislocation. Modular dual mobility (MDM) implants incorporate a metal liner (e.g. cobalt-chromium alloy) in a metal shell (e.g. titanium alloy), raising concern for mechanically assisted crevice corrosion at the modular liner-shell connection. We sought to examine fretting and corrosion on MDM liners, to analyze the corrosion products, and to examine histologically the periprosthetic tissues. METHODS A total of 60 retrieved liners were subjectively scored for fretting and corrosion. The corrosion products from the three most severely corroded implants were removed from the implant surface, imaged using scanning electron microscopy, and analyzed using Fourier-transform infrared spectroscopy. RESULTS Fretting was present on 88% (53/60) of the retrieved liners, and corrosion was present on 97% (58/60). Fretting was most often found on the lip of the taper at the transition between the lip and the dome regions. Macrophages and particles reflecting an innate inflammatory reaction to corrosion debris were noted in six of the 48 cases for which periprosthetic tissues were examined, and all were associated with retrieved components that had high corrosion scores. CONCLUSION Our results show that corrosion occurs at the interface between MDM liners and shells and that it can be associated with reactions in the local tissues, suggesting continued concern that this problem may become clinically important with longer-term use of these implants. Cite this article: Bone Joint J 2021;103-B(7):1238-1246.
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Affiliation(s)
| | - Lydia Weitzler
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
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McAleese T, Feeley I, Hughes A, Sheehan E, Merghani K, Niall D. Bilateral Mechanically-Assisted Crevice Corrosion Resulting in Femoral Stem-Head Dissociation in Metal-on-Polyethylene Total Hip Arthroplasty. Arthroplast Today 2021; 8:35-39. [PMID: 33718553 PMCID: PMC7921711 DOI: 10.1016/j.artd.2020.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022] Open
Abstract
There are emerging reports of complications related to corrosion in modular femoral components. We report a unique case describing an 83-year-old man with bilateral mechanically-assisted crevice corrosion in hip replacements performed 10 years previously, by the same surgeon using the same size 3 Accolade TMZF stem and same 44-mm CoCr LFIT V40 head (Stryker Orthopedics, Mahwah NJ). Our patient presented with complete femoral stem-head complex dissociation of his right hip and elevated serum cobalt and chromium levels. He subsequently underwent right hip revision arthroplasty while his contralateral hip is monitored closely as an outpatient. This case helps to define the poorly understood mechanisms and component design factors implicated in this emerging issue. We also hope to provoke discussions about guidelines for monitoring and revising failing metal-on-polyethylene arthroplasty systems.
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Affiliation(s)
- Timothy McAleese
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
- Corresponding author. Tullamore Hospital, Arden Road, Tullamore, Co Offaly, Ireland.
| | - Iain Feeley
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
| | - Andrew Hughes
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
| | - Eoin Sheehan
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
- Medical School, University of Limerick, Limerick, Ireland
| | - Khalid Merghani
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
- Medical School, University of Limerick, Limerick, Ireland
| | - Dorothy Niall
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
- Medical School, University of Limerick, Limerick, Ireland
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A Crevice Corrosion Model for Biomedical Trunnion Geometries and Surfaces Feature. MATERIALS 2021; 14:ma14041005. [PMID: 33672713 PMCID: PMC7924358 DOI: 10.3390/ma14041005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
Modular hip joint implants were introduced in arthroplasty medical procedures because they facilitate the tailoring of patients' anatomy, the use of different materials in one single configuration, as well as medical revision. However, in certain cases, such prostheses may undergo deterioration at the head-neck junctions with negative clinical consequences. Crevice-corrosion is commonly invoked as one of the degradation mechanisms acting at those junctions despite biomedical alloys such as Ti6Al4V and CoCr being considered generally resistant to this form of corrosion. To verify the occurrence of crevice corrosion in modular hip joint junctions, laboratory crevice-corrosion tests were conducted in this work under hip joint-relevant conditions, i.e., using similar convergent crevice geometries, materials (Ti6Al4V and CoCr alloys vs. ceramic), surface finish, NaCl solution pHs (5.6 and 2.3), and electrochemical conditions. A theoretical model was also developed to describe crevice-corrosion considering relevant geometrical and electrochemical parameters. To verify the model, a FeCr alloy, known to be sensitive to this phenomenon, was subjected to the crevice-corrosion test in sulfuric acid. The experiments and the model predictions clearly showed that, in principle, crevice corrosion of Ti6Al4V or CoCr is not supposed to occur in typical crevices formed at the stem-neck junction of hip implants.
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Liu S, Hall DJ, Della Valle CJ, Walsh MJ, Jacobs JJ, Pourzal R. Simultaneous Characterization of Implant Wear and Tribocorrosion Debris within Its Corresponding Tissue Response Using Infrared Chemical Imaging. ACTA ACUST UNITED AC 2021; 26. [PMID: 33829077 DOI: 10.1016/j.biotri.2021.100163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Biotribology is one of the key branches in the field of artificial joint development. Wear and corrosion are among fundamental processes which cause material loss in a joint biotribological system; the characteristics of wear and corrosion debris are central to determining the in vivo bioreactivity. Much effort has been made elucidating the debris-induced tissue responses. However, due to the complexity of the biological environment of the artificial joint, as well as a lack of effective imaging tools, there is still very little understanding of the size, composition, and concentration of the particles needed to trigger adverse local tissue reactions, including periprosthetic osteolysis. Fourier transform infrared spectroscopic imaging (FTIR-I) provides fast biochemical composition analysis in the direct context of underlying physiological conditions with micron-level spatial resolution, and minimal additional sample preparation in conjunction with the standard histopathological analysis workflow. In this study, we have demonstrated that FTIR-I can be utilized to accurately identify fine polyethylene debris accumulation in macrophages that is not achievable using conventional or polarized light microscope with histological staining. Further, a major tribocorrosion product, chromium phosphate, can be characterized within its histological milieu, while simultaneously identifying the involved immune cell such as macrophages and lymphocytes. In addition, we have shown the different spectral features of particle-laden macrophages through image clustering analysis. The presence of particle composition variance inside macrophages could shed light on debris evolution after detachment from the implant surface. The success of applying FTIR-I in the characterization of prosthetic debris within their biological context may very well open a new avenue of research in the orthopedics community.
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Affiliation(s)
- Songyun Liu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States.,Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Deborah J Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Craig J Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Michael J Walsh
- Material Sciences and Biomedical Engineering Department, University of Wisconsin-Eau Claire, Eau Claire, WI, United States
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
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Mueller U, Bormann T, Schroeder S, Kretzer JP. Taper junctions in modular hip joint replacements: What affects their stability? J Mech Behav Biomed Mater 2021; 116:104258. [PMID: 33497961 DOI: 10.1016/j.jmbbm.2020.104258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/09/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although taper junctions are beneficial in the reconstruction of hip joints, some clinical concerns like the formation of adverse local tissue reactions have recently emerged. These reactions are associated with wear and corrosion products from the interface of insufficient taper connections regarding strength. Commonly used tapers vary in their geometric and topographical design parameter. Therefore, this study aims to evaluate interactions between design and surgical related parameters to the taper connection strength. METHODS In this study, the effect of the taper contact situation, surface roughness and head material in combination with assembly force on the taper connection strength were assessed using torque-off tests. Furthermore, the type of use in terms of single-use or re-use of the stem taper was investigated. RESULTS The study showed that the impaction force is the predominant factor that determines the taper strength followed by the type of use and the head material. The contact situation seems to slightly influence the determined torque-off moment, whereas the surface topography of the stem taper obviously plays a minor role for the taper connection strength. CONCLUSION Clinical users should be aware that an increased assembly force will strengthen the stability of the taper junction, whereas care should be taken when reusing hip stems with metal heads as this may decrease their connection strength.
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Affiliation(s)
- Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Therese Bormann
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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20
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Head-Neck Taper Corrosion in Metal-on-Polyethylene Total Hip Arthroplasty: Risk Factors, Clinical Evaluation, and Treatment of Adverse Local Tissue Reactions. J Am Acad Orthop Surg 2020; 28:907-913. [PMID: 32694319 DOI: 10.5435/jaaos-d-20-00475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Adverse local tissue reaction (ALTR) associated with mechanically assisted crevice corrosion of metal-on-polyethylene (MoP) head-neck modular total hip arthroplasty (THA), similarly observed in the metal-on-metal bearing, is a growing concern in MoP THA patients. Given the complex pathogenesis as well as variable clinical presentation, the diagnosis can be challenging. This article focuses on providing surgeons with an evidence-based update on (1) implant, surgical, and patient risk factors associated with ALTRs; (2) clinical systematic evaluation; and (3) surgical management options for ALTRs in MoP THA patients based on the currently available evidence.
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21
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Ihekweazu UN, Lyman S, Chiu YF, Vaynberg I, Westrich G. Modern trunnion designs do not affect clinically significant patient-reported outcomes. Hip Int 2020; 30:752-760. [PMID: 31296068 DOI: 10.1177/1120700019864317] [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
INTRODUCTION Trunnion geometry is known to vary between hip systems. Trunnionosis and the impact of trunnion design on total hip arthroplasty (THA) survival, has gained attention as a failure mechanism. We sought to report the differences in patient-reported outcome measures (PROMs) between the most commonly utilised modern THA trunnions. METHODS We reviewed primary unilateral THA patients from May 2007 to October 2011. The most frequently used stems were included. LEAS, HOOS subdomains, and SF-12 were obtained pre and post operatively while satisfaction was measured at 2 years after THA. Trunnions were grouped by taper geometry and manufacturer. The 2-year change in PROMs for each trunnion was compared to the pooled 2-year change in HOOS for all other trunnions. RESULTS 3950 THA patients were studied. 6 trunnion designs were evaluated from 5 manufacturers. The range in differences between the 2-year change in individual PROMs were as follows: HOOS pain (0.6-2.4), HOOS symptoms (0-3.8), HOOS ADL (0.4-4), and HOOS QOL (0.5-3.6). None of the differences in the 2-year change in PROMs reached a minimal clinically important change (MCIC), which we previously determined to be a minimum of 9 points for all HOOS domains. CONCLUSION All of the trunnions designs utilised in our study cohort demonstrated excellent clinical results. Small differences were well below the known MCIC; and were not clinically relevant. The findings of this study should prompt further investigations into the long-term impact of trunnion design on clinical patient-reported outcomes.
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Affiliation(s)
- Ugonna N Ihekweazu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NY, USA
| | - Stephen Lyman
- Biostatistics Core, Hospital for Special Surgery, NY, USA
| | - Yu-Fen Chiu
- Biostatistics Core, Hospital for Special Surgery, NY, USA
| | - Idelle Vaynberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NY, USA
| | - Geoffrey Westrich
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NY, USA
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22
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Chalmers BP, Dubin J, Westrich GH. Modular Dual-Mobility Liner Malseating: A Radiographic Analysis. Arthroplast Today 2020; 6:699-703. [PMID: 32923553 PMCID: PMC7475050 DOI: 10.1016/j.artd.2020.07.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 01/23/2023] Open
Abstract
Background With dislocation as a leading cause for revision after total hip arthroplasty (THA), modular dual-mobility (MDM) constructs are more commonly used at present in an attempt to decrease postoperative instability. With modularity, there is potential for additional complications, including malseating of the liner. The goal of this study was to perform a radiographic analysis on the incidence of MDM liner malseating. Methods We retrospectively identified 305 patients (305 THAs) who underwent primary THA with an MDM liner from a single manufacturer inserted by a single surgeon. One hundred fifty-six (51%) patients were male. The mean age was 68 years, and the mean body mass index was 31 kg/m2. Only patients with both anteroposterior and cross-table lateral radiographs at a minimum of 6 weeks postoperatively were included. Dislocations and reoperations were determined at 1 year after the procedure. All MDM liners were routinely tested intraoperatively with a "4-quadrant test" to assess for proper seating. Results Four (4/305, 1.3%) MDM liners were noted to be radiographically malseated at early follow-up with three (3/147, 2.0%) occurring in a thinner two dimentional (2D) ongrowth shell and only one (1/158, 0.6%) observed in a thicker three dimentional (3D) additively manufactured shell. They were inferiorly prominent by a median of 1.2 mm, best seen on the cross-table lateral radiograph. In patients with at least 1-year follow-up, no MDM liners dissociated and no patients sustained a dislocation. Five (1.6%) patients required reoperation unrelated to the acetabular or MDM construct. Conclusions Surgeons should be aware that malseating of dual-mobility liners may occur. However, with utilization of a consistent surgical technique to test for seating of the liner, the radiographic incidence of MDM liner malseating was low at 1%. Although there were no short-term clinical implications of liner malseating, long-term follow-up is needed.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jeremy Dubin
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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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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What Is the Risk of THA Revision for ARMD in Patients with Non-metal-on-metal Bearings? A Study from the Australian National Joint Replacement Registry. Clin Orthop Relat Res 2020; 478:1244-1253. [PMID: 32345846 PMCID: PMC7319380 DOI: 10.1097/corr.0000000000001277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are increasing reports of corrosion between the femoral head and trunnion in primary conventional THA, resulting in metal particulate release often termed trunnionosis. There may be heightened awareness of this condition because of severe soft-tissue reactions initially thought to be solely attributable to prostheses with a metal-on-metal (MoM) bearing surface. It is unclear what percentage of revisions for THA with non-MoM bearing surfaces can be attributed to trunnionosis and to what extent adverse reaction to metal debris (ARMD) seen with MoM bearings may also be seen with other bearing surfaces in THA. QUESTIONS/PURPOSES We analyzed data from a large national registry to ask: (1) What is the revision risk for the indication of ARMD in patients with conventional THA and modern non-MoM bearing surfaces such as metal or ceramic-on-cross-linked polyethylene (XLPE) or ceramic-on-ceramic? (2) What prosthesis factors are associated with an increased risk of such revision? (3) What is the relative revision risk for ARMD in THAs with large-head MoM bearings, small-head MoM bearings, and non-MoM modern bearing surfaces? METHODS The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) longitudinally maintains data on all primary and revision joint arthroplasties, with nearly 100% capture. The study population included all THAs using modern bearing surfaces (defined as metal or ceramic heads-on-XLPE and ceramic-on-ceramic bearing couples) revised because of ARMD between September 1999 and December 2018. Prostheses with modular necks were excluded. The cumulative percent revision (CPR) because of ARMD was determined. The study group consisted of 350,027 THAs with a modern bearing surface, 15,184 THAs with a large-head MoM bearing (≥ 36 mm), and 5474 THAs with a small head MoM bearing (≤ 32 mm). The patients in the group who received the modern bearing surfaces were slightly older than the patients in the groups who received the large- and small-head bearing surfaces, with a mean age 68 years (SD 12) versus a mean age 63 years (SD 12), and a mean age 62 years (SD 11), respectively. There was a higher proportion of women in the modern bearing surface group; 55% (193,312 of 350,027), compared with 43% (6497 of 15,184) in the large-head MoM group and 50% (2716 of 5474) in the small-head MoM group. The outcome measure was the CPR, which was defined using Kaplan-Meier estimates of survivorship to describe the time to the first revision for ARMD at 17 years. Hazard ratios (HR) from Cox proportional hazards models, adjusting for age and sex, were performed to compare the revision rates among groups. The registry defines a revision as a reoperation of a previous hip arthroplasty in which one or more of the prosthetic components is replaced or removed, or one or more components is added. RESULTS The CPR for ARMD for patients with a modern bearing surface at 17 years was 0.1% (95% confidence interval 0.0 to 0.1). After controlling for age and sex, we found that cobalt chrome heads, two specific prostheses (Accolade® I and M/L Taper), and head sizes ≥ 36 mm were associated with an increased risk of revision for ARMD. Metal-on-XLPE had a higher risk of revision for ARMD than ceramic-on-ceramic or ceramic-on-XLPE (HR 3.4 [95% CI 1.9 to 6.0]; p < 0.001). The Accolade 1 and the M/L Taper stems had a higher risk of revision than all other stems (HR, 8.3 [95% CI 4.7 to 14.7]; p < 0.001 and HR 14.4 [95% CI 6.0 to 34.6]; p < 0.001, respectively). Femoral stems with head sizes ≥ 36 mm had a higher rate of revision for ARMD than stems with head sizes ≤ 32 mm (HR 3.2 [95% CI 1.9 to 5.3]; p < 0.001).Large-head MoM bearings had a greater increase in revision for ARMD compared with modern bearing surfaces. The CPR for patients with a large-head MoM bearing at 17 years for ARMD was 15.5% (95% CI 14.5 to 16.6) and it was 0.1% for modern bearing surfaces (HR 340 [95% CI 264.2 to 438.0]; p < 0.001). Modern bearing surfaces likewise had a lower HR for revision for ARMD than did THAs with small-head MoM bearings, which had a 0.9% (95% CI 0.7 to 1.4) CPR compared with modern bearings from 0 to 9 years (HR 10.5 [95% CI 6.2 to 17.7]; p < 0.001). CONCLUSIONS The revision risk for ARMD with modern bearing surfaces in THA is low. The Accolade 1 and the M/L Taper stem have a higher risk of revision for ARMD and cobalt-chrome heads, and head sizes ≥ 36 mm have a higher rate of revision than ≤ 32 mm head sizes. ARMD is a rare failure mode for THA with non-MoM bearings, but in patients presenting with unexplained pain with no other obvious cause, this diagnosis should be considered and investigated further. LEVEL OF EVIDENCE Level III, therapeutic study.
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Freccero DM, McAlpine KJ, Smith EL. Taper fretting corrosion with Stryker Anato stem after hip replacement. Arthroplast Today 2020; 6:210-213. [PMID: 32577464 PMCID: PMC7303489 DOI: 10.1016/j.artd.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 11/27/2022] Open
Abstract
We report a case of head-neck taper fretting corrosion in a patient who had a total hip replacement with a noncemented Stryker Anato femoral stem and a V40 metal head with a Stryker Tritanium hemispherical socket with a highly cross-linked polyethylene liner (metal on polyethylene) (Stryker, Mahwah, NJ, USA). A 57-year-old man presented with early-onset hip pain after right total hip arthroplasty. Workup was negative for infection. Metal artifact reduction sequence MRI revealed an encapsulated fluid mass. Metal ion cobalt level was elevated at 6 ppb. The patient underwent right revision total hip arthroplasty with excellent results at 1-year follow-up.
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26
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Rieker CB, Wahl P. What the Surgeon Can Do to Reduce the Risk of Trunnionosis in Hip Arthroplasty: Recommendations from the Literature. MATERIALS 2020; 13:ma13081950. [PMID: 32326259 PMCID: PMC7215371 DOI: 10.3390/ma13081950] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/24/2023]
Abstract
Trunnionosis, defined as wear and corrosion at the head–neck taper connection, is a cause of failure in hip arthroplasty. Trunnionosis is linked to a synergistic combination of factors related to the prosthesis, the patient, and the surgeon. This review presents analytical models that allow for the quantification of the impact of these factors, with the aim of providing practical recommendations to help surgeons minimize the occurrence of this failure mode. A tighter fit reduces micromotion and, consequently, fretting of the taper connection. The paramount parameters controlling the fixation force are the coefficient of friction and the impaction force. The influence of the head diameter, as well as of the diameter and angle of the taper, is comparatively small, but varus alignment of the taper and heads with longer necks are unfavourable under physiologic loads. The trunnion should be rinsed, cleaned, and dried carefully, while avoiding any contamination of the bore—the female counterpart within the head—prior to assembly. Biological debris, and even residual water, might critically reduce the fixation of the taper connection between the head and the neck. The impaction force applied to the components should correspond to at least two strong blows with a 500 g hammer, striking the head with an ad hoc impactor aligned with the axis of the taper. These strong blows should correspond to a minimum impaction force of 4000 N.
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Affiliation(s)
- Claude B. Rieker
- Scientific Affairs, Zimmer Biomet EMEA (Europa, Middle East and Africa), Sulzerallee 8, 8404 Winterthur, Switzerland
- Correspondence:
| | - Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland;
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Taper Design, Head Material, and Manufacturer Affect the Onset of Fretting Under Simulated Corrosion Conditions. J Arthroplasty 2020; 35:1117-1122. [PMID: 31836326 DOI: 10.1016/j.arth.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We investigated the effect of taper design, head material, and manufacturer on simulated mechanically assisted crevice corrosion (MACC). METHODS Six pristine C-taper stems coupled with alumina-zirconia or cobalt-chromium (CoCr) heads were tested in a mechanical/electrochemical setup to measure average fretting currents and fretting current onset loads. Outcomes were compared with previous data from V40 tapers from the same manufacturer and 12/14 tapers from another manufacturer. RESULTS Within a single manufacturer, differences in average fretting current between V40 and C-taper designs were dependent on head material. Only with V40 tapers did CoCr heads show higher average fretting currents than ceramic heads. Between manufacturers, differences were found between similar taper designs, as 12/14 taper couples showed higher average fretting currents than C-taper couples, regardless of head material. CONCLUSION Taper design, head material, and factors inherent to different manufacturers influence fretting current in simulated MACC. Unlike clinical and retrieval studies, this experimental design allows for investigations of factors affecting MACC in a controlled environment. Taper design, independent of manufacturer, contributes to the observed differences in average fretting current between head materials. In some taper designs, head composition, specifically ceramic, should not be considered alone to reduce risk of corrosion.
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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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Diagnosis of the failed total hip replacement. J Clin Orthop Trauma 2020; 11:2-8. [PMID: 32001976 PMCID: PMC6985031 DOI: 10.1016/j.jcot.2019.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/28/2019] [Indexed: 12/27/2022] Open
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Goodman SB, Gallo J, Gibon E, Takagi M. Diagnosis and management of implant debris-associated inflammation. Expert Rev Med Devices 2020; 17:41-56. [PMID: 31810395 PMCID: PMC7254884 DOI: 10.1080/17434440.2020.1702024] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
Introduction: Total joint replacement is one of the most common, safe, and efficacious operations in all of surgery. However, one major long-standing and unresolved issue is the adverse biological reaction to byproducts of wear from the bearing surfaces and modular articulations. These inflammatory reactions are mediated by the innate and adaptive immune systems.Areas covered: We review the etiology and pathophysiology of implant debris-associated inflammation, the clinical presentation and detailed work-up of these cases, and the principles and outcomes of non-operative and operative management. Furthermore, we suggest future strategies for prevention and novel treatments of implant-related adverse biological reactions.Expert opinion: The generation of byproducts from joint replacements is inevitable, due to repetitive loading of the implants. A clear understanding of the relevant biological principles, clinical presentations, investigative measures and treatments for implant-associated inflammatory reactions and periprosthetic osteolysis will help identify and treat patients with this issue earlier and more effectively. Although progressive implant-associated osteolysis is currently a condition that is treated surgically, with further research, it is hoped that non-operative biological interventions could prolong the lifetime of joint replacements that are otherwise functional and still salvageable.
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Affiliation(s)
- Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Jiri Gallo
- Department of Orthopaedics, Palacký University Olomouc, Olomouc, Czech Republic
| | - Emmanuel Gibon
- Department of Orthopaedic Surgery, University of Florida, Gainesville, FL, USA
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
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Is There Material Loss at the Conical Junctions of Modular Components for Total Knee Arthroplasty? J Arthroplasty 2019; 34:2479-2486. [PMID: 31227303 DOI: 10.1016/j.arth.2019.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/01/2019] [Accepted: 05/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Clinical concern exists regarding fretting corrosion and material loss from taper junctions in orthopedic devices, with previous research focusing on the modular components from total hip arthroplasty. Comparatively little has been published regarding the fretting corrosion and material loss in modular knee devices. The purpose of this study is to evaluate fretting corrosion damage and quantify material loss for conical total knee arthroplasty taper interfaces. METHODS Stem tapers of 166 retrieved modular knee devices were evaluated for fretting corrosion using a semiquantitative scoring method. High precision profilometry was then used to determine volumetric material loss and maximum wear depth for a subset of 37 components (implanted for 0.25-18.76 years). Scanning electron microscopy and energy-dispersive X-ray spectroscopy were used to characterize the observed damage. RESULTS Mild to severe fretting corrosion was observed on the majority of tapers, with 23% receiving a maximum visually determined damage score of 4. The median rate of volumetric material loss was 0.11 mm3/y (range 0.00-0.76) for femoral components (both cone and bore taper surfaces combined) and 0.01 mm3 (range 0.00-8.10) for tibial components. Greater rates of material loss were associated with mixed metal pairings. There was a strong correlation between visual fretting corrosion score and calculated material loss (ρ = 0.68, P < .001). Scanning electron microscopy revealed varying degrees of scratching, wear, fretting corrosion, and instances of cracking with morphology not consistent with fretting corrosion, wear, or fatigue. CONCLUSION Although visual evidence of fretting corrosion damage was prevalent and correlated with taper material loss, the measured volumetric material loss was low compared with prior reports from total hip arthroplasty.
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Gascoyne T, Flynn B, Turgeon T, Burnell C. Mid-term progressive loosening of hydroxyapatite-coated femoral stems paired with a metal-on-metal bearing. J Orthop Surg Res 2019; 14:225. [PMID: 31324195 PMCID: PMC6642514 DOI: 10.1186/s13018-019-1271-1] [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: 04/02/2019] [Accepted: 07/08/2019] [Indexed: 12/27/2022] Open
Abstract
Background Several hydroxyapatite (HA)-coated femoral stems from a single manufacturer were identified to have aseptically loosened at mid-term follow-up despite prior radiographic appearance of osseointegration. Possible causes and associated risk factors for stem loosening were explored through radiographic review and implant retrieval analysis. Methods Forty-six retrieved hip stems (Corail, DePuy-Synthes) were identified and grouped by bearing type: metal-on-metal (MoM), metal-on-polyethylene, and ceramic-on-ceramic. Stem lucency was graded on post-operative radiographs up to the time of revision. Stems were examined for stripping of the HA coating, taper corrosion, and bearing wear in metal-on-metal cases. Patient demographics, implant design features, and perioperative data were collected from electronic databases and patient charts. Results Aseptic loosening occurred in 37% of cases examined. MoM bearings were associated with 7.25 times greater risk of loosening compared to other bearing types. Stem radiolucency was more prevalent for MoM cases and, although not statistically significant, demonstrated progressive lucency. Taper corrosion appeared more severe for MoM cases and correlated with proximal stem radiolucency. Removal of the HA coating from the stems was associated with both taper corrosion and MoM bearing wear. Length of implantation was a confounding factor for the MoM cases. Conclusion This study has demonstrated a high risk of mid-term loosening of previously osseointegrated HA-coated femoral stems when paired with a MoM bearing. The mechanism of loosening appears progressive in nature and related to the MoM bearing, possibly interacting with the HA coating. If such loosening is recognized early, rapid revision may allow for retention of the femoral stem.
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Affiliation(s)
- Trevor Gascoyne
- Orthopaedic Innovation Centre, 320-1155 Concordia Avenue, Winnipeg, R2K2M9, Manitoba, Canada
| | - Bryan Flynn
- Concordia Joint Replacement Group, 310-1155 Concordia Avenue, Winnipeg, Manitoba, R2K 2M9, Canada
| | - Thomas Turgeon
- Concordia Joint Replacement Group, 310-1155 Concordia Avenue, Winnipeg, Manitoba, R2K 2M9, Canada.,Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Colin Burnell
- Concordia Joint Replacement Group, 310-1155 Concordia Avenue, Winnipeg, Manitoba, R2K 2M9, Canada. .,Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
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Chalmers BP, Mangold DG, Hanssen AD, Pagnano MW, Trousdale RT, Abdel MP. Uniformly low serum cobalt levels after modular dual-mobility total hip arthroplasties with ceramic heads: a prospective study in high-risk patients. Bone Joint J 2019; 101-B:57-61. [PMID: 31146553 DOI: 10.1302/0301-620x.101b6.bjj-2018-1403.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Modular dual-mobility constructs reduce the risk of dislocation after revision total hip arthroplasty (THA). However, questions about metal ions from the cobalt-chromium (CoCr) liner persist, and are particularly germane to patients being revised for adverse local tissue reactions (ALTR) to metal. We determined the early- to mid-term serum Co and Cr levels after modular dual-mobility components were used in revision and complex primary THAs, and specifically included patients revised for ALTR. PATIENTS AND METHODS Serum Co and Cr levels were measured prospectively in 24 patients with a modular dual-mobility construct and a ceramic femoral head. Patients with CoCr heads or contralateral THAs with CoCr heads were excluded. The mean age was 63 years (35 to 83), with 13 patients (54%) being female. The mean follow-up was four years (2 to 7). Indications for modular dual-mobility were prosthetic joint infection treated with two-stage exchange and subsequent reimplantation (n = 8), ALTR revision (n = 7), complex primary THA (n = 7), recurrent instability (n = 1), and periprosthetic femoral fracture (n = 1). The mean preoperative Co and Cr in patients revised for an ALTR were 29.7 μg/l (2 to 146) and 21.5 μg/l (1 to 113), respectively. RESULTS Mean Co and Cr levels were 0.30 μg/l and 0.76 μg/l, respectively, at the most recent follow-up. No patient had a Co level ≥ 1 μg/l. Only one patient had a Cr level ≥ 1 μg/l. That patient's Cr level was 12 μg/l at 57 months after revision THA for ALTR (and decreased ten-fold from a preoperative Cr of 113 μg/l). CONCLUSION At a mean of four years, no patient with a modular dual-mobility construct and ceramic femoral head had elevated Co levels, including seven patients revised specifically for ALTR. While further studies are required, we support the selective use of a modular dual-mobility construct in revision and complex primary THAs for patients at high risk for instability. Cite this article: Bone Joint J 2019;101-B(6 Supple B):57-61.
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Affiliation(s)
- B P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - D G Mangold
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - R T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Haschke H, Konow T, Huber G, Morlock MM. Influence of flexural rigidity on micromotion at the head-stem taper interface of modular hip prostheses. Med Eng Phys 2019; 68:1-10. [PMID: 30981609 DOI: 10.1016/j.medengphy.2019.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 12/17/2022]
Abstract
Fretting corrosion as one reason for failure of modular hip prostheses has been associated with micromotion at the head taper junction. Historically the taper diameter was reduced to improve the range of motion of the hip joint. In combination with other developments, this was accompanied by increased observations of taper fretting, possibly due to the reduced flexural rigidity of smaller tapers. The aim of the study was to investigate how the flexural rigidity of tapers influences the amount of micromotion at the head taper junction. Three different stem and two different taper designs were manufactured. Experimental testing was performed using three different activity levels with peak loads representing walking, stair climbing and stumbling. The relative motion at the head-stem taper was measured in six degrees of freedom. Micromotion was obtained by subtraction of the elastic deformation derived from monoblock and finite element analysis. Less rigid tapers lead to increased micromotion between the head and stem, enlarging the risk of fretting corrosion. The influence of the stem design on micromotion is secondary to taper design. Manufacturers should consider stiffer taper designs to reduce micromotion within the head taper junction.
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Affiliation(s)
- Henning Haschke
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg Germany.
| | - Tobias Konow
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg Germany
| | - Gerd Huber
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg Germany
| | - Michael M Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg Germany
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Hampton C, Weitzler L, Baral E, Wright TM, Bostrom MPG. Do oxidized zirconium heads decrease tribocorrosion in total hip arthroplasty? A study of retrieved components. Bone Joint J 2019; 101-B:386-389. [PMID: 30929492 DOI: 10.1302/0301-620x.101b4.bjj-2018-1316.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS The aim of this study was to evaluate fretting and corrosion in retrieved oxidized zirconium (OxZr; OXINIUM, Smith & Nephew, Memphis, Tennessee) femoral heads and compare the results with those from a matched cohort of cobalt-chromium (CoCr) femoral heads. PATIENTS AND METHODS A total of 28 OxZr femoral heads were retrieved during revision total hip arthroplasty (THA) and matched to 28 retrieved CoCr heads according to patient demographics. The mean age at index was 56 years (46 to 83) in the OxZr group and 70 years (46 to 92) in the CoCr group. Fretting and corrosion scores of the female taper of the heads were measured according to the modified Goldberg scoring method. RESULTS The OxZr-retrieved femoral heads showed significantly lower mean corrosion scores than the CoCr heads (1.3 (1 to 2.75) vs 2.1 (1 to 4); p < 0.01). Mean fretting scores were also significantly lower in the OxZr cohort when compared with the CoCr cohort (1.3 (1 to 2) vs 1.5 (1 to 2.25); p = 0.02). OxZr heads had more damage in the proximal region compared with the distal region of the head. Location had no impact on damage of CoCr heads. A trend towards increased corrosion in large heads was seen only in the CoCr heads, although this was not statistically significant. CONCLUSION Retrieval analysis of OxZr femoral heads showed a decreased amount of fretting and corrosion compared with CoCr femoral heads. OxZr seems to be effective at reducing taper damage. Cite this article: Bone Joint J 2019;101-B:386-389.
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Affiliation(s)
- C Hampton
- Hospital for Special Surgery, New York, New York, USA
| | - L Weitzler
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - E Baral
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - T M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - M P G Bostrom
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Thangaraj R, Kuiper J, Perkins RD. Low failure rate at short term for 40 mm heads and second generation triple annealed HCLPE liners in hybrid hip replacements. J Clin Orthop Trauma 2019; 10:350-357. [PMID: 30828207 PMCID: PMC6383141 DOI: 10.1016/j.jcot.2017.12.008] [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: 10/24/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION 40 mm large diameter heads offer the advantages of lesser dislocation rates and better stability while highly cross linked polyethylene have lower wear rates than ultra high molecular weight polyethylene. Studies of the survivorship of 40 mm heads in hybrid hip replacements with Exeter stem and second generation highly cross linked polyethylene are limited. The purpose of the study is to report the short term of survivorship of the large diameter heads (40 mm) with Exeter stem with the secondary aim being the survival analysis of the thinnest second generation highly cross linked polyethylene. METHODS Retrospective case series of survivorship of patients with hybrid hip replacements of Exeter stems with 40 mm heads articulating with second generation triple annealed highly cross linked polyethylene liner on a uncemented acetabular shell was performed. As a subset, survival of thinnest second generation highly cross linked polyethylene survival (3.8 mm) at short term was assessed. Survival of the implants was confirmed from the hospital records and National joint registry as of 2015. Revision for any cause was taken as end point. RESULTS 324 hybrid hip replacements with 40 mm heads had been performed for primary hip osteoarthritis. Of the 324 hip replacements, 154 hip replacements had thinnest second generation highly cross linked polyethylene (3.8 mm). Two patients had revision of components, one for periprosthetic fracture and one for deep infection. Mean age of the patients was 70.5 years (range 42-88 years, median 71, SD 8.3 years). None of the patients had revision due to trunion wear or loosening of components. The overall 5-year implant survival probability of hips with 40 mm heads was 99.4% (95% CI 98 to 100%) while the subset group of hip replacements with thinnest second generation highly cross linked polyethylene (3.8 mm) had 5-year implant survival probability of 99.3% (95% CI 97.1 to 100%). CONCLUSION Short term survivorship does not show significant evidence of early failure or higher rate of revision in our series of hybrid hip replacements with large diameter heads and second generation triple annealed highly cross linked polyethylene. Dislocation rate at the short term is none. Results from this series have to be carefully interpreted due to the relatively short follow up but so far results are encouraging. Long term follow up is required to conclude whether there is early or higher rate of failure. It is our intention to follow up this cohort and further publish our results at longer term.
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Affiliation(s)
- Rajkumar Thangaraj
- Princess Royal Hospital, Telford, United Kingdom,Corresponding author at: Department of Orthopaedics, Princess Royal Hospital, Apley Castle, Telford, TF1 6TF, United Kingdom.
| | - Jan Kuiper
- ISTM, Keele University, Keele, ST5 5BG, United Kingdom,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
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Abstract
BACKGROUND MRI is predictive of adverse local tissue reactions (ALTRs) after THA but how MRI directly relates to implant surface wear, fretting, and trunnion corrosion at different articulations between implant components remains unclear. MRI generates high-contrast images to display soft tissues around arthroplasty and may provide a surgeon the means to distinguish and differentiate host-related synovial patterns as a response to either polyethylene wear or metal wear and corrosion products. QUESTIONS/PURPOSES The purposes of this study were (1) to correlate findings from MRI in patients who have undergone THA with direct assessment of implant wear, corrosion, and fretting from retrieved components; and (2) to distinguish the unique synovial responses on MRI in patients who have undergone THA based on bearing materials. METHODS In this prospective study, patients undergoing THA (181 patients, 187 hips) with metal-on-metal (MoM), hip resurfacing (HRA), metal-on-polyethylene (MoP), ceramic-on-polyethylene, ceramic-on-ceramic, or modular neck designs having revision surgery (between October 2013 and June 2017) underwent preoperative MRI. A single reader blinded to the bearing surface made an assessment of the synovial response (Gwet's AC1, 0.65-0.97); these data were compared with semiquantitative histology of tissue samples by a single reader (Gwet's AC1, 0.92) and semiquantitative wear, corrosion, and fretting analysis of retrieved components using Goldberg scoring (Gwet's AC1, 0.60-0.79). Direct noncontact measurements of implant wear were also made. Correlations and analyses of variance were used to assess associations between metrics and differences by implant type, respectively. RESULTS Correlations were found between MRI synovial thickness with severity of fretting and corrosion damage of the female head-neck trunnion of femoral stems in modular designs (ρ = 0.26 [95% confidence interval {CI}, 0.12-0.39]; p = 0.015, n = 185) and ALTR grade and volumetric wear in MoM bearings (ρ = 0.93 [95% CI, 0.72-0.98]; p < 0.001, n = 10). MRI synovial thickness was highest in patients identified with aseptic lymphocyte-dominated vasculitis-associated lesions and diffuse tissue necrosis. On MRI, MoP hips demonstrated a distinct polymeric synovial response, whereas HRA, MoM, and modular hips more commonly demonstrated ALTR. Hips classified as having a polymeric synovial response on MRI had a greater number of particles present in tissue samples. CONCLUSIONS In this study, we demonstrated that MRI of THA can distinguish synovial responses that reflect the bearing type of the implanted THA and correlate to direct measurements of implant wear, corrosion, and fretting and histologic assessment of wear particles in periprosthetic tissues. MRI provides a means of direct, noninvasive visualization of the host-generated synovial response. Patients presenting with painful arthroplasties may be evaluated for the cause of their discomfort, specifically highlighting any concerning synovial reactions that would warrant more prompt surgical intervention. Future studies would benefit from a prospective evaluation of different implants to assess the natural longitudinal history of arthroplasty complications, including the development and prevalence of ALTR across bearing constructs. LEVEL OF EVIDENCE Level III, diagnostic study.
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Kim YH, Park JW, Kim JS. There Is No Significant Difference in Fretting and Corrosion at the Trunnion of Metal and Ceramic Heads. Orthopedics 2019; 42:e99-e103. [PMID: 30540877 DOI: 10.3928/01477447-20181206-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 07/30/2018] [Indexed: 02/03/2023]
Abstract
No study has compared the prevalence of fretting and corrosion at the trunnion of cobalt-chrome (Co-Cr) and zirconia ceramic heads in the same patients. The authors sought to compare the prevalence of fretting and corrosion at the trunnion after total hip arthroplasty with a 32-mm Co-Cr or a 32-mm zirconia ceramic head-on-polyethylene bearing. Isolated revision of the ace-tabular components was performed in 78 patients (156 hips) for polyethylene wear and osteolysis of the acetabulum. Seventy-eight Co-Cr head-titanium alloy stem pairs were compared with 78 zirconia ceramic head-titanium alloy stem pairs in the same patients. Using a visual scoring technique, the 156 head-stem pairs were analyzed for the prevalence of fretting and/or corrosion at the trunnion of the stem and the prevalence of metal transfer to the inner taper of the femoral head. Mean patient age was 48 years, and there were 65 men and 13 women. There was no trunnionosis in either group. Prevalence of fretting (81% vs 83%) and corrosion (4% vs 3%) at the trunnion was not significantly different (P=.518 vs .612, respectively) between the 2 groups. The median fretting scores (1.4±1.1 vs 1.2±1.4 points) and corrosion scores (1.2±0.8 vs 1.3±0.9 points) at the trunnion were not significantly different (P=.893 vs .781, respectively) between the 2 groups. Prevalence of metal transfer to the inner taper of the femoral head (8% vs 10%) and the median metal transfer scores (1.2±0.9 vs 1.4±1.1 points) were not significantly different (P=.213 vs .729, respectively) between the 2 groups. [Orthopedics. 2019; 42(1):e99-e103.].
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Sultan AA, Cantrell WA, Khlopas A, Berger RJ, Sodhi N, Molloy RM, Krebs VE, Mont MA. Evidence-Based Management of Trunnionosis in Metal-on-Polyethylene Total Hip Arthroplasty: A Systematic Review. J Arthroplasty 2018; 33:3343-3353. [PMID: 29929829 DOI: 10.1016/j.arth.2018.05.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 02/01/2023] Open
Abstract
Multiple recent reports have indicated a rising awareness of trunnionosis-related implant failures, accounting for up to 3% of all total hip arthroplasty revisions. Moreover, aseptic loosening and osteolysis from local release of metal debris can be the presenting manifestations, and thus the true incidence of trunnionosis is thought to be underreported. Furthermore, the relatively unclear and multifactorial pathogenesis and the widely variable clinical presentations pose a diagnostic challenge. A consensus regarding the ideal intervention and its timing is also lacking. Because of the relative paucity of reports regarding the diagnosis and management of trunnionosis, we conducted this evidence-based review to evaluate the (1) incidence, (2) pathogenesis, (3) diagnosis, and (4) treatment of trunnionosis in metal-on-polyethylene total hip arthroplasty. We then propose an algorithm for the diagnostic work-up and management of this condition.
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Affiliation(s)
- Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Ryan J Berger
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York City, NY
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH; Department of Orthopaedic Surgery, Lenox Hill Hospital, New York City, NY
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Abstract
BACKGROUND Our understanding of fretting and corrosion at head-neck junctions in modular THAs in vivo is based largely on the analysis of retrieved implants removed for various diagnoses. Little is known about the condition of head-neck tapers in well-functioning THAs. QUESTIONS/PURPOSES Regarding a cohort of well-functioning autopsy-retrieved modular THAs, we asked: (1) Does trunnion geometry or femoral head material affect the pull-off force of the femoral head? (2) Is there a relationship between trunnion damage and length of implantation time, head diameter, and neck length? (3) Does visual damage scoring accurately determine the presence or absence of corrosion on cobalt-chrome trunnions? METHODS Sixty-six femoral stems and engaged femoral heads were retrieved at autopsy from 53 patients at Anderson Orthopaedic Research Institute from 1998 to 2014. Ten stems were excluded for low stem design group size or insufficient head-stem clearance for pull-off testing, leaving a cohort of 56 THAs with a median implantation time of 10 years (range, 1-24 years). The femoral stems included three cobalt-chrome (CoCr) designs from a single manufacturer with either a 12/14 or 14/16 trunnion design (N = 36 and 20, respectively) mated with alumina or CoCr heads (N = 13 and 43, respectively). The force required to pull off the femoral heads was measured using a uniaxial load frame according to ASTM F2009-00. Mating surfaces were visually examined to assess the presence and severity of fretting and corrosion using a modified Goldberg scoring system. Three 12/14 trunnions of similar implantation lengths and varied damage scores were selected for imaging with a scanning electron microscope (SEM) and energy dispersive x-ray analysis (EDAX) to confirm the absence or presence of corrosion damage. RESULTS No difference was seen in pull-off force between groups based on trunnion geometry and head material (median [range], alumina-12/14: 3127 [2320-6992] N, alumina-14/16: 2670 [1095-7919] N, CoCr-12/14: 2255 [1332-5939] N, CoCr-14/16: 2812 [1655-4246] N; p = 0.132). A positive correlation was found between damage score and length of implantation (ρ = 0.543, p < 0.001). However, no correlation between damage score and either head diameter or neck length was found (ρ = -0.012, p = 0.930 and ρ < 0.001, p = 0.995, respectively). In all, 39 of 56 specimens demonstrated no fretting or corrosion, and 16 specimens had mild damage scores. One specimen demonstrated severe corrosion without visual evidence of fretting. The presence of intergranular corrosion on this trunnion was determined by SEM imaging and EDAX. The absence of corrosion products on two trunnions with no observed damage was confirmed. CONCLUSIONS This study found little evidence of fretting and corrosion in a cohort of well-functioning CoCr-CoCr and alumina-CoCr head-neck couples. Further studies are necessary to characterize fretting and corrosion at head-neck junctions of well-functioning implants of other designs and manufacturers. CLINICAL RELEVANCE The results from this study suggest that patients with well-functioning THAs using polyethylene bearing surfaces with alumina or CoCr heads appear to be at low risk for trunnion corrosion for the specific CoCr alloy stems and trunnion geometries analyzed here.
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Molecular pathology of adverse local tissue reaction caused by metal-on-metal implants defined by RNA-seq. Genomics 2018; 111:1404-1411. [PMID: 30248488 DOI: 10.1016/j.ygeno.2018.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 12/18/2022]
Abstract
Total hip arthroplasty (THA) alleviates hip pain and improves joint function. Current implant design permits long-term survivorship of THAs, but certain metal-on-metal (MoM) articulations can portend catastrophic failure due to adverse local tissue reactions (ALTR). Here, we identified biological and molecular differences between periacetabular synovial tissues of patients with MoM THA failure undergoing revision THA compared to patients undergoing primary THA for routine osteoarthritis (OA). Analysis of tissue biopsies by RNA-sequencing (RNA-seq) revealed that MoM patient samples exhibit significantly increased expression of immune response genes but decreased expression of genes related to extracellular matrix (ECM) remodeling. Thus, interplay between local tissue inflammation and ECM degradation may account for the pathology and compromised clinical outcomes in select patients with MoM implants. We conclude that adverse responses of host tissues to implant materials result in transcriptomic modifications in patients with MoM implants that permit consideration of strategies that could mitigate ECM damage.
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Lanting B, Naudie DDR, McCalden RW. Clinical Impact of Trunnion Wear After Total Hip Arthroplasty. JBJS Rev 2018; 4:01874474-201608000-00003. [PMID: 27603271 DOI: 10.2106/jbjs.rvw.15.00096] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Trunnionosis, characterized by corrosion and fretting of the taper, is a well-known entity commonly demonstrated in retrieval specimens. While there have been a number of recent reports regarding the potential for adverse local tissue reactions related to trunnionosis, it remains a relatively infrequent cause for failure of total hip replacement implants. A number of factors, including both biomechanical and bioelectrochemical factors, have a known impact on the development and severity of trunnionosis. Furthermore, specific implant design and material-related factors have been shown to influence the risk of trunnionosis leading to adverse local tissue reactions. Retention of a well-fixed femoral stem, in spite of corrosion of the male taper junction, is acceptable in the majority of cases. A ceramic head, often in combination with a titanium adaptor sleeve, is the most common replacement reported in the current literature to treat trunnionosis. In patients with modular-neck total hip replacements, revision of the femoral stem is likely required if corrosion at the modular neck-stem junction is encountered.
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Affiliation(s)
- Brent Lanting
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.,Joint Replacement Institute, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - Douglas D R Naudie
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.,Joint Replacement Institute, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - Richard W McCalden
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.,Joint Replacement Institute, London Health Sciences Center, University Hospital, London, Ontario, Canada
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43
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Goodman SB, Mihalko WM, Anderson PA, Sale K, Bozic KJ. Introduction of New Technologies in Orthopaedic Surgery. JBJS Rev 2018; 4:01874474-201605000-00005. [PMID: 27490218 DOI: 10.2106/jbjs.rvw.o.00067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The introduction of new devices, biologics, and combination products to the orthopaedic marketplace is increasing rapidly. The majority of these new technologies obtain clearance to market by demonstrating substantial equivalence to a predicate (previously approved device) according to the U.S. Food and Drug Administration (FDA) 510(k) process. Surgeons play a critical role in the introduction of new technologies to patients and must take a leadership role in promoting safe, efficacious, appropriate, and cost-effective care, especially for operative procedures. Surgeons should monitor and document their patients' clinical outcomes and adverse events when using new technology, to ensure that the new technology is performing as desired.
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Affiliation(s)
- Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - William M Mihalko
- Department of Orthopaedic Surgery & Biomedical Engineering, Campbell Clinic, Memphis, Tennessee
| | - Paul A Anderson
- Department of Orthopaedic Surgery, University of Wisconsin, Madison, Wisconsin
| | - Katherine Sale
- Department of Research and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas
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Benelli G, Maritato M, Cerulli Mariani P, Sasso F. Revision of ASR hip arthroplasty: analysis of two hundred and ninety six recalled patients at seven years. INTERNATIONAL ORTHOPAEDICS 2018; 43:97-101. [PMID: 30194652 DOI: 10.1007/s00264-018-4128-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/21/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of this study is to present an algorithm for the evaluation of both symptomatic and asymptomatic patients. METHODS From November 2004 to May 2010, there were performed 296 operations: 245 total hip arthroplasty and 51 resurfacing arthroplasty with the ASR DePuy system. In April 2010, there was the first Medical Device Alert regarding all MoM hip replacements in the UK and in August 2010, DePuy recall started worldwide. In March 2012, we started our recall. All patients were invited to undergo clinical investigation, X-ray evaluations, and blood chrome and cobalt level determination. For a short period of time, there were performed second level exams and subsequently, we carried out MARS MRI hip study to all symptomatic patients and there was evidence of ALVAL lesions. RESULTS To the patients with ALVAL lesions were proposed surgical hip revision while the others frequent follow-up controls. One hundred patients underwent hip surgical revision. CONCLUSIONS We recommend constant MoM THA patients monitoring and early revision if necessary.
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Affiliation(s)
- Giovanni Benelli
- Orthopaedic and Traumatology Department, Santo Stefano Hospital, Azienda USL Toscana Centro, Prato, Italy
| | - Merildo Maritato
- Orthopaedic and Traumatology Department, Santo Stefano Hospital, Azienda USL Toscana Centro, Prato, Italy
| | - Pierpaolo Cerulli Mariani
- Orthopaedic and Traumatology Department, Santo Stefano Hospital, Azienda USL Toscana Centro, Prato, Italy.
| | - Francesco Sasso
- Orthopaedic and Traumatology Department, Santo Stefano Hospital, Azienda USL Toscana Centro, Prato, Italy
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Bhalekar RM, Smith SL, Joyce TJ. Wear at the taper‐trunnion junction of contemporary ceramic‐on‐ceramic hips shown in a multistation hip simulator. J Biomed Mater Res B Appl Biomater 2018; 107:1199-1209. [DOI: 10.1002/jbm.b.34213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/04/2018] [Accepted: 07/21/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Rohan M. Bhalekar
- School of EngineeringNewcastle University Newcastle upon Tyne NE1 7RU England
| | - Simon L. Smith
- School of EngineeringNewcastle University Newcastle upon Tyne NE1 7RU England
| | - Thomas J. Joyce
- School of EngineeringNewcastle University Newcastle upon Tyne NE1 7RU England
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Abstract
BACKGROUND This study investigates if the placement of femoral heads (trials and actual implants) using varying impaction forces causes physical compromise to the trunnion. METHODS Trunnion and head taper wear patterns were evaluated after impaction and removal of new femoral stem trunnions and ceramic heads at various impaction loads (2 kN, 4 kN, or 6 kN, n = 6/group). In addition, trunnion wear patterns were measured after plastic trials were hand-placed on new trunnions and underwent range of motion testing in a Hip Simulator (n = 5). RESULTS There was no significant difference in trunnion or head surface deviation, taper angle, or surface roughness in any groups preimpaction and postimpaction and removal. There was no significant surface trunnion damage from assembly and range of motion testing of the plastic femoral head trial. CONCLUSIONS The use of femoral head trials and the concurrent impaction and removal of a new femoral head were not associated with significant trunnion surface damage for the impaction loads observed in this study.
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47
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Teeter MG, MacLean CJ, Somerville LE, Howard JL, McCalden RW, Lanting BA, Vasarhelyi EM. Wear performance of cobalt chromium, ceramic, and oxidized zirconium on highly crosslinked polyethylene at mid-term follow-up. J Orthop 2018; 15:620-623. [PMID: 29881207 DOI: 10.1016/j.jor.2018.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022] Open
Abstract
Patients with THA using a ceramic head and using an OxZr head were each matched to patients with a CoCr head. Mean implantation time was 5 years. There was no difference in steady state wear rate between the ceramic (0.066 ± 0.050 mm/year) and CoCr match groups (0.052 ± 0.041 mm/year), or between the OxZr (0.022 ± 0.029 mm/year) and CoCr match groups (0.048 ± 0.071 mm/year). Follow-up into the second decade will be necessary before any changes in THA wear rate from using ceramic or OxZr bearings may be appreciated clinically with available imaging techniques.
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Affiliation(s)
- Matthew G Teeter
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada.,Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Colin J MacLean
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Lyndsay E Somerville
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - James L Howard
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Richard W McCalden
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Brent A Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Edward M Vasarhelyi
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
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48
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Gascoyne TC, Turgeon TR, Burnell CD. Retrieval Analysis of Large-Head Modular Metal-on-Metal Hip Replacements of a Single Design. J Arthroplasty 2018; 33:1945-1952. [PMID: 29402714 DOI: 10.1016/j.arth.2017.12.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/23/2017] [Accepted: 12/31/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are limited publications examining modular metal-on-metal (MoM) total hip implants in which a comprehensive analysis of retrieved components is performed. This study examines 24 retrieved modular MoM implants from a single manufacturer and compares retrieval analytics; bearing surface damage, wear, and modular taper corrosion against patient, surgical and implant characteristics to elucidate significant associations. METHODS Clinical, patient, and surgical data were collected including age, body mass index, blood metal ion levels, and cup inclination. Damage assessment was performed visually in addition to surface profilometry. Acetabular liners and femoral heads were measured for volumetric wear. Femoral head taper bores were similarly measured for material removal due to corrosion and fretting. RESULTS Patients with MoM-related reasons for revision showed significantly higher levels of blood metal ion levels. Bearing wear was strongly associated with blood metal ion levels and was significantly increased in cups placed more vertically. Younger patients tended to have higher body mass indices as well as poorer cup placement. CONCLUSION This work details a broad range of analyses on a series of modular MoM total hip implants from a single manufacturer of which there are few published studies. Acetabular cup inclination angle was deemed a primary cause of revision surgery through increased MoM wear, high metal ion levels in the blood, and subsequent adverse local tissue reactions. Heavy patients can increase the surgical difficulty which was shown to be related to poor cup placement in this cohort.
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Affiliation(s)
| | - Thomas R Turgeon
- Concordia Joint Replacement Group, Winnipeg, Manitoba, Canada; Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Colin D Burnell
- Concordia Joint Replacement Group, Winnipeg, Manitoba, Canada; Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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de Steiger R, Peng A, Lewis P, Graves S. What Is the Long-term Survival for Primary THA With Small-head Metal-on-metal Bearings? Clin Orthop Relat Res 2018; 476:1231-1237. [PMID: 29432270 PMCID: PMC6263567 DOI: 10.1007/s11999.0000000000000209] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large-head metal-on-metal (MoM) bearing hip replacements have been shown to have a much higher rate of revision than other bearing surfaces. However, small-head (≤ 32 mm) MoM bearing surfaces have been in use for many years with several reports of satisfactory mid- to long-term survivorship. It is unclear whether the long-term survival of small-head MoM devices will continue to be satisfactory or whether the same concerns seen with the large-head MoM devices will ultimately become more prevalent. QUESTIONS/PURPOSES We analyzed a large national registry to ask: (1) What is the 15-year Kaplan-Meier survivorship of primary conventional THA using small-head (≤ 32 mm) MoM bearing surfaces compared with large-head MoM bearing surfaces in primary THA? (2) Is there an increased rate of revision for adverse reaction to metal debris (ARMD) in this group of patients over time? METHODS The Australian Orthopaedic Association National Joint Replacement Registry longitudinally maintains data on all primary and revision joint arthroplasties with nearly 100% capture. We analyzed all conventional primary THAs performed from Registry inception in September 1999 until December 31, 2015, in patients with a diagnosis of osteoarthritis and using MoM bearing surfaces ≤ 32 mm in diameter, defined as small-head MoM. The study group included 4838 primary THA with ≤ 32-mm MoM bearing surfaces. There were 2506 (51.8%) male patients and the median age of patients undergoing THA with a small-head MoM bearing surface was 64 years (range, 20-92 years of age). The outcome measure was the cumulative percent revision defined as the time to first revision using Kaplan-Meier estimates of survivorship at 15 years; reasons for revision and type of revision were also examined. We specifically investigated whether there was an increased risk of revision for ARMD in this MoM group compared with all other bearing surfaces. We compared these results with large-head MoM THAs (femoral head size > 32 mm). RESULTS The cumulative percent revision for small-head MoM designs at 15 years was 8.5% (95% confidence interval [CI], 7.3-9.9). The cumulative percent revision for large-head MoM at 14 years was 27.4% (95% CI, 24.8-30.2). Prostheses with a large-head MoM articulation have a higher rate of revision than small-head MoM bearing surfaces (hazard ratio after 6 years, 5.14; 95% CI, 4.1-6.5; p < 0.001). Over time, there was a gradual increase in the diagnosis of ARMD for small-head MoM and the cumulative incidence of revision for ARMD was 0.8% at 15 years. CONCLUSIONS Despite survival that is substantially greater than that of large-head MoM THAs, there has been a marked decrease in the use of small-head MoM designs in our registry. Although the reasons for this are likely multifactorial, the increasing incidence of revisions for ARMD among small-head MoM THAs is concerning. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Richard de Steiger
- R. de Steiger, Department of Surgery, Epworth Healthcare, University of Melbourne, Richmond, Victoria, Australia A. Peng, South Australian Health and Medical Research Institute, Adelaide, Australia P. Lewis, S. Graves, Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, Australia This work was performed at the Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
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50
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Rowan FE, Wach A, Wright TM, Padgett DE. The onset of fretting at the head-stem connection in hip arthroplasty is affected by head material and trunnion design under simulated corrosion conditions. J Orthop Res 2018; 36:1630-1636. [PMID: 29319895 DOI: 10.1002/jor.23813] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/11/2017] [Indexed: 02/04/2023]
Abstract
Mechanically assisted crevice corrosion (MACC) is a mechanism for trunnion damage in total hip arthroplasties (THAs). Retrieval studies have shown reduced MACC-related damage for ceramic heads compared with cobalt-chromium (CoCr) heads. We propose that ceramic heads demonstrate fretting at higher cyclic compressive loads than CoCr heads on titanium alloy trunnions in a simulated corrosion model. A closed electrochemical chamber was used to measure fretting current onset loads for two modern titanium alloy trunnions (Zimmer 12/14 and Stryker V-40) in which trunnion failure has been reported. Ceramic and CoCr alloy 36 + 0 mm heads were impacted on each trunnion and cyclically loaded at 3 Hz with increasing magnitude from 100 to 3,400 N for 540 cycles. Onset load was the cyclic compressive load at which the slope of the average fretting current increased significantly. A CoCr head with V40 trunnion demonstrated the lowest onset load (1,400 N), while the V40 trunnion with a ceramic head showed the highest onset load (2,200 N). Significant differences occurred in average fretting current between head materials for V40 trunnions (p < 0.001) at loads over 2,000 N. CoCr-12/14 and ceramic-12/14 couples demonstrated similar onset loads (2,000 N). All head-trunnion combinations showed cyclical fretting response to loading at 100 N. Head material composition was observed to increase fretting at the taper junction but the effect was taper geometry dependent. Using ceramic heads may reduce the phenomena of trunnion fretting and corrosion but the effect of both trunnion geometry and metallurgy warrants further investigation. Statement of clinical significance: Trunnion corrosion may occur with titanium alloy stems regardless of the head material used. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1630-1636, 2018.
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Affiliation(s)
- Fiachra E Rowan
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, 10021, New York
| | - Amanda Wach
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, 10021, New York
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