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Dolinar D, Kocjančič B, Avsec K, Šetina Batič B, Kocijan A, Godec M, Sedlaček M, Debeljak M, Grant JT, Zupanc T, Jenko M. Characterization of Micro-Threaded Stem Taper Surfaces of Cementless Hip Endoprostheses. MATERIALS (BASEL, SWITZERLAND) 2024; 17:2751. [PMID: 38894016 PMCID: PMC11173811 DOI: 10.3390/ma17112751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
We investigated micro-threaded stem taper surface and its impact on premature failures, aseptic loosening, and infection in cementless hip endoprostheses. Our study focused on the fretting, and crevice corrosion of micro-threaded tapers, as well as the characterization of the microstructure and surface properties of two new and three retrieved Zweymüller stem tapers. The retrieved samples were selected and examined based on the head-stem taper interface being the sole source of modularity with a metallic component, specifically between the Ti alloy taper stem and the ceramic head. To determine the surface chemistry and microstructures of both new and retrieved hip endoprostheses stem taper titanium alloy, scanning -electron microscopy (SEM) was employed for morphological and microstructural analyses. Energy dispersive spectroscopy (EDS) was utilized for characterizing chemical element distribution, and electron backscattered diffraction (EBSD) was used for phase analysis. The roughness of the micro-threated stem tapers from different manufacturers was investigated using an optical profilometer, with standard roughness parameters Ra (average surface roughness) and Rz (mean peak to valley height of the roughness profile) being measured. Electrochemical studies revealed no fretting corrosion in retrieved stem tapers with ceramic heads. Consequently, three retrieved tapers and two new ones for comparison underwent potentiodynamic measurements in Hank's solution to determine the corrosion rate of new and retrieved stem taper surfaces. The results showed a low corrosion rate for both new and prematurely failed retrieved samples due to aseptic loosening. However, the corrosion rate was higher in infected and low-grade infected tapers. In conclusion, our study suggests that using ceramic heads reduces taper corrosion and subsequently decreases the incidence of premature failures in total hip arthroplasty.
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Affiliation(s)
- Drago Dolinar
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
- Orthopaedic Surgery Chair, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Boštjan Kocjančič
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
- Orthopaedic Surgery Chair, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Klemen Avsec
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
- Orthopaedic Surgery Chair, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Barbara Šetina Batič
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Aleksandra Kocijan
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Matjaž Godec
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Marko Sedlaček
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Mojca Debeljak
- University Rehabilitation Institute Republic of Slovenia, Linhartova 51, 1000 Ljubljana, Slovenia;
| | - John T. Grant
- Research Institute, University of Dayton, Dayton, OH 45469, USA;
| | - Timon Zupanc
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
| | - Monika Jenko
- MD-RI Institute for Materials Research in Medicine, Bohoričeva 5, 1000 Ljubljana, Slovenia
- MD Medicina, Sanatorium, Bohoričeva 5a, 1000 Ljubljana, Slovenia
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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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Fischer A, Telouk P, Beckmann C, Heermant S, Wittrock A, Debus J, Wimmer MA. Performance of Austenitic High-Nitrogen Steels under Gross Slip Fretting Corrosion in Bovine Serum. J Funct Biomater 2024; 15:110. [PMID: 38667567 PMCID: PMC11051106 DOI: 10.3390/jfb15040110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Modular artificial hip joints are a clinical standard today. However, the release of wear products from the head-taper interface, which includes wear particles in the nm size range, as well as metal ions, have raised concerns. Depending on the loading of such taper joints, a wide variety of different mechanisms have been found by retrieval analyses. From these, this paper concentrates on analyzing the contribution of gross slip fretting corrosion at ultra-mild wear rates using a bovine calf serum solution (BCS) as the lubricant. The parameters were chosen based on biomechanical considerations, producing wear rates of some ng/m wear path. In parallel, the evolution of tribomaterial (third bodies) was analyzed as to its constituents and generation rates. It has already been shown earlier that, by an advantageous combination of wear mechanisms and submechanisms, certain constituents of the tribomaterial remain inside the contact area and act like extreme-pressure lubricant additives. For the known wear and corrosion resistance of austenitic high-nitrogen steels (AHNSs), which outperform CoCrMo alloys even under inflammatory conditions, we hypothesized that such steels will generate ultra-mild wear rates under gross slip fretting. While testing AHNSs against commercially available biomedical-grade materials of CoCrMo and TiAlV alloys, as well as zirconia-toughened alumina (ZTA) and against itself, it was found that AHNSs in combination with a Ti6Al4V alloy generated the smallest wear rate under gross slip fretting corrosion. This paper then discusses the wear behavior on the basis of ex situ analyses of the worn surfaces as to the acting wear mechanisms and submechanisms, as well as to the tribological reaction products.
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Affiliation(s)
- Alfons Fischer
- Max Planck Institute for Sustainable Materials, Microstructure Physics and Alloy Design, 40237 Duesseldorf, Germany
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Philipe Telouk
- Laboratoire de Géologie, Université de Lyon, 69342 Lyon, France;
| | - Christian Beckmann
- Department of Physics, TU Dortmund University, 44227 Dortmund, Germany; (C.B.); (S.H.); (A.W.); (J.D.)
| | - Saskia Heermant
- Department of Physics, TU Dortmund University, 44227 Dortmund, Germany; (C.B.); (S.H.); (A.W.); (J.D.)
| | - Adrian Wittrock
- Department of Physics, TU Dortmund University, 44227 Dortmund, Germany; (C.B.); (S.H.); (A.W.); (J.D.)
| | - Jörg Debus
- Department of Physics, TU Dortmund University, 44227 Dortmund, Germany; (C.B.); (S.H.); (A.W.); (J.D.)
| | - Markus A. Wimmer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA;
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Matar HE, van Duren BH, Bloch BV, Berber R, James PJ, Manktelow ARJ. Lower Risk of Revision With 32- and 36-Millimeter Femoral Heads Compared With 28-mm Heads in Primary Total Hip Arthroplasty: A Comparative Single-Center Study (10,104 Hips). J Arthroplasty 2024; 39:991-996. [PMID: 38661490 DOI: 10.1016/j.arth.2023.10.042] [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: 03/08/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND We aimed to compare the clinical outcomes of different head sizes (28-, 32-, and 36- millimeter) in primary total hip arthroplasty (THA) at mean 6 years follow-up (range, 1 to 17.5 years). METHODS This was a retrospective consecutive study of primary THA at our institution (2003 to 2019). Demographic and surgical data were collected. The primary outcome measures were all-cause revision, revision for dislocation, and all-cause revision excluding dislocation. Continuous descriptive statistics used means, median values, ranges, and 95% confidence intervals, where appropriate. Kaplan-Meier survival curves were used to estimate time to revision. Cox proportional hazard regression analyses were used to compare revision rates between the femoral head size groups. Adjustments were made for age at surgery, sex, primary diagnosis, American Society of Anesthesiologists score, articulation type, and fixation methods. There were 10,104 primary THAs included; median age was 69 years (range, 13 to 101) with 61.5% women. A posterior approach was performed in 71.6%. There were 3,295 hips with 28-mm heads (32.6%), 4,858 (48.1%) with 32-mm heads, and 1,951 (19.3%) with 36-mm heads. RESULTS Overall rate of revision was 1.7% with the lowest rate recorded for the 36-mm group (2.7 versus 1.3 versus 1.1%). Cox regression analyses showed a decreased risk of all-cause revision for 32 and 36-mm head sizes as compared to 28-mm; this was statistically significant for the 32-mm group (P = .01). Risk of revision for dislocation was significantly reduced in both 32-mm (P = .03) and 36-mm (P = .03) head sizes. Analysis of all cause revision excluding dislocation showed no significant differences between head sizes. CONCLUSIONS We found a significantly reduced risk of revision for all causes, but particularly revision for dislocation with larger head sizes. Concerns regarding increased risk of early revision for aseptic loosening, polyethylene wear, or taper corrosion with larger heads appear to be unfounded in this cohort of 10,104 patients with up to 17 years follow-up.
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Affiliation(s)
- Hosam E Matar
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Bernard H van Duren
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Reshid Berber
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Peter J James
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Andrew R J Manktelow
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Mace AO, Kurtz MA, Gilbert JL. Fretting and Fretting Corrosion Behavior of Additively Manufactured Ti-6Al-4V and Ti-Nb-Zr Alloys in Air and Physiological Solutions. J Funct Biomater 2024; 15:38. [PMID: 38391891 PMCID: PMC10889821 DOI: 10.3390/jfb15020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Additive manufacturing (AM) of orthopedic implants has increased in recent years, providing benefits to surgeons, patients, and implant companies. Both traditional and new titanium alloys are under consideration for AM-manufactured implants. However, concerns remain about their wear and corrosion (tribocorrosion) performance. In this study, the effects of fretting corrosion were investigated on AM Ti-29Nb-21Zr (pre-alloyed and admixed) and AM Ti-6Al-4V with 1% nano yttria-stabilized zirconia (nYSZ). Low cycle (100 cycles, 3 Hz, 100 mN) fretting and fretting corrosion (potentiostatic, 0 V vs. Ag/AgCl) methods were used to compare these AM alloys to traditionally manufactured AM Ti-6Al-4V. Alloy and admixture surfaces were subjected to (1) fretting in the air (i.e., small-scale reciprocal sliding) and (2) fretting corrosion in phosphate-buffered saline (PBS) using a single diamond asperity (17 µm radius). Wear track depth measurements, fretting currents and scanning electron microscopy/energy dispersive spectroscopy (SEM/EDS) analysis of oxide debris revealed that pre-alloyed AM Ti-29Nb-21Zr generally had greater wear depths after 100 cycles (4.67 +/- 0.55 µm dry and 5.78 +/- 0.83 µm in solution) and higher fretting currents (0.58 +/- 0.07 µA). A correlation (R2 = 0.67) was found between wear depth and the average fretting currents with different alloys located in different regions of the relationship. No statistically significant differences were observed in wear depth between in-air and in-PBS tests. However, significantly higher amounts of oxygen (measured by oxygen weight % by EDS analysis of the debris) were embedded within the wear track for tests performed in PBS compared to air for all samples except the ad-mixed Ti-29Nb-21Zr (p = 0.21). For traditional and AM Ti-6Al-4V, the wear track depths (dry fretting: 2.90 +/- 0.32 µm vs. 2.51 +/- 0.51 μm, respectively; fretting corrosion: 2.09 +/- 0.59 μm vs. 1.16 +/- 0.79 μm, respectively) and fretting current measurements (0.37 +/- 0.05 μA vs. 0.34 +/- 0.05 μA, respectively) showed no significant differences. The dominant wear deformation process was plastic deformation followed by cyclic extrusion of plate-like wear debris at the end of the stroke, resulting in ribbon-like extruded material for all alloys. While previous work documented improved corrosion resistance of Ti-29Nb-21Zr in simulated inflammatory solutions over Ti-6Al-4V, this work does not show similar improvements in the relative fretting corrosion resistance of these alloys compared to Ti-6Al-4V.
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Affiliation(s)
- Annsley O Mace
- Clemson-Medical University of South Carolina Bioengineering Program, Department of Bioengineering, Clemson University, Charleston, SC 29464, USA
| | - Michael A Kurtz
- Clemson-Medical University of South Carolina Bioengineering Program, Department of Bioengineering, Clemson University, Charleston, SC 29464, USA
| | - Jeremy L Gilbert
- Clemson-Medical University of South Carolina Bioengineering Program, Department of Bioengineering, Clemson University, Charleston, SC 29464, USA
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Martelli A, Erani P, Pazzagli N, Cannillo V, Baleani M. Surface Analysis of Ti-Alloy Micro-Grooved 12/14 Tapers Assembled to Non-Sleeved and Sleeved Ceramic Heads: A Comparative Study of Retrieved Hip Prostheses. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1067. [PMID: 36770073 PMCID: PMC9920329 DOI: 10.3390/ma16031067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Ti6Al4V titanium alloy (Ti-alloy) sleeved ceramic heads have become widely used in revision surgery when the hip stem is left in situ. This solution guarantees a new junction between the bore of the ceramic head and the Ti-alloy sleeve, regardless of any possible, slight surface damage to the Ti-alloy taper of the stem. However, this solution introduces an additional Ti-alloy/Ti-alloy interface pairing, which is potentially susceptible to mechanically assisted crevice corrosion. This study evaluated both qualitatively and quantitatively the damage that occurred in vivo on Ti-alloy micro-grooved 12/14 tapers of (i) primary implants with non-sleeved ceramic heads (Group 1), (ii) secondary implants with non-sleeved ceramic heads (Group 2), and (iii) secondary implants with sleeved ceramic heads (Group 3). A total of 45 explants-15 for each group, including short-, medium- and long-neck heads-underwent optical evaluation for surface damage (Goldberg scoring), surface roughness analysis, and SEM/EDX analysis. The Goldberg scores did not reveal different patterns in the tapers' surface damage; surface damage was classified as absent or mild (surface damage score ≤2) in 94%, another 94%, and 92% of the analysed regions for Group 1, Group 2, and Group 3, respectively. Small but significant differences in morphological changes occurred in the tapers of the three groups: reductions no greater than a few percentage points in median values of roughness parameters were found in Group 1 and Group 2, while negligible changes were found in Group 3. SEM/EDX analysis revealed little (i.e., a slight increase in the oxygen content) to undetectable changes in the chemical composition on the Ti-alloy surface independently of the group. These results suggest that the Ti-alloy/Ti-alloy sleeve/taper junction is only mildly susceptible to mechanically assisted crevice corrosion. Assembling a sleeved ceramic head, with variable neck lengths up to a "long-neck", to a Ti-alloy micro-grooved 12/14 taper of a stem left in situ does not seem to increase the risk of revision due to trunnionosis, as long as junction stability (i.e., the proper seating of the sleeved ceramic head on the 12/14 taper) is achieved intraoperatively.
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Affiliation(s)
- Andrea Martelli
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Ingegneria Enzo Ferrari, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
| | - Paolo Erani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Nicola Pazzagli
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Valeria Cannillo
- Dipartimento di Ingegneria Enzo Ferrari, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
| | - Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Lucchini S, Baleani M, Giardina F, Martelli A, Castagnini F, Bordini B, Traina F. A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture. J Orthop Surg Res 2022; 17:293. [PMID: 35658905 PMCID: PMC9164427 DOI: 10.1186/s13018-022-03190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ceramic bearings are used in total hip arthroplasty due to their excellent wear behaviour and biocompatibility. The major concern related to their use is material brittleness, which significantly impacts on the risk of fracture of ceramic components. Fracture toughness improvement has contributed to the decrease in fracture rate, at least of the prosthetic head. However, the root cause behind these rare events is not fully understood. This study evaluated head fracture occurrence in a sizeable cohort of patients with fourth-generation ceramic-on-ceramic implants and described the circumstances reported by patients in the rare cases of head fracture. METHODS The clinical survivorship of 29,495 hip prostheses, with fourth-generation ceramic bearings, was determined using data from a joint replacement registry. The average follow-up period was 5.2 years (range 0.1-15.6). Retrieval analysis was performed in one case for which the ceramic components were available. RESULTS Clinical outcomes confirmed the extremely low fracture rate of fourth-generation ceramic heads: only two out of 29,495 heads fractured. The two fractures, both involving 36 mm heads, occurred without a concurrent or previous remarkable trauma. Considering the feature of the fractured head, a multi-stage crack growth mechanism has been hypothesized to occur following damage at the head-neck taper interface. CONCLUSIONS Surgeons must continue to pay attention to the assembly of the femoral head: achieving a proper head seating on a clean taper is a prerequisite to decrease the risk of occurrence of any damage process within head-neck junction, which may cause high stress concentration at the contact surface, promoting crack nucleation and propagation even in toughened ceramics.
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Affiliation(s)
- Stefano Lucchini
- IRCCS Istituto Ortopedico Rizzoli, Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e Ginocchio, Bologna, Italy
| | - Massimiliano Baleani
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Bologna, Italy.
| | - Federico Giardina
- IRCCS Istituto Ortopedico Rizzoli, Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e Ginocchio, Bologna, Italy
| | - Andrea Martelli
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Bologna, Italy
| | - Francesco Castagnini
- IRCCS Istituto Ortopedico Rizzoli, Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e Ginocchio, Bologna, Italy
| | - Barbara Bordini
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Bologna, Italy
| | - Francesco Traina
- IRCCS Istituto Ortopedico Rizzoli, Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e Ginocchio, Bologna, Italy
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Bormann T, Nebel L, Müller U, Mai PT, Gibmeier J, Renkawitz T, Kretzer JP. Influence of FeCl 3 and H 2O 2 in corrosion testing of modular taper connections in total hip arthroplasty: An in vitro study. Acta Biomater 2022; 145:427-435. [PMID: 35417798 DOI: 10.1016/j.actbio.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/22/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
Corrosion at the modular taper junctions in total hip arthroplasty is clinically relevant because wear particles and ions generated at this interface can lead to adverse local tissue reactions or even implant failure. In vitro tribo-corrosion tests are usually accomplished in saline solutions or calf serum (CS), but the addition of H2O2 and FeCl3 have been suggested to mimic inflammatory conditions in the joint. Inflammatory conditions may aggravate corrosive processes and, therefore, should lead in vitro to a more severe and realistic tribo-corrosive material attack. Corrosion testing at 12/14 tapers comprising a CoCrMo head taper and a Ti6Al4V trunnion was accomplished in five electrolytes (Ringer's solution (RS), RS with 30 mM H2O2 and/or 0.7 mM FeCl3 and CS) under dynamical loading for five million cycles. Resulting material loss was determined gravimetrically and by ion analysis. The tribo-corrosive material degradation was investigated by light and electron microscopy. FeCl3 enhanced the material loss from taper connections while H2O2 did not lead to a significant alteration of total material loss. In comparison to pure RS, corrosion testing in CS decreased material loss at the head taper while it increased material loss at the trunnion. The combination of FeCl3 and H2O2 led to an enhanced occurrence of micro cracks at the trunnion surface. Adding FeCl3 and optionally also H2O2 aggravates material loss in in vitro corrosion testing of taper junctions and leads to harsher and probably more realistic testing conditions. STATEMENT OF SIGNIFICANCE: Tribo-corrosive processes at taper connections in hip implants are complex and can lead to major clinical implications. Joint inflammation is assumed to aggravate taper corrosion in vivo, why FeCl3 and H2O2 have been proposed as additives to electrolytes to simulate inflammatory conditions in vitro. Often used fretting test setups, however, do not involve real taper geometries. Besides, testing is often accomplished in saline solutions or calf serum, which do not induce a clinically significant amount of corrosive material degradation. This study presents an approach to increase tribo-corrosive processes at realistic taper connections by adding FeCl3 and/or H2O2. Unlike H2O2, FeCl3 increased material loss from taper connections. The combination of both additives enhanced micro crack formation at the trunnion surfaces.
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Affiliation(s)
- Therese Bormann
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg 69118, Germany.
| | - Laura Nebel
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg 69118, Germany
| | - Ulrike Müller
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg 69118, Germany
| | - Phuong Thao Mai
- Institute for Applied Materials, Karlsruhe Institute of Technology, Engelbert-Arnold-Strasse 4, Karlsruhe 76131, Germany
| | - Jens Gibmeier
- Institute for Applied Materials, Karlsruhe Institute of Technology, Engelbert-Arnold-Strasse 4, Karlsruhe 76131, Germany
| | - Tobias Renkawitz
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg 69118, Germany
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg 69118, Germany
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Dobria P, Patel A, Levine B. Catastrophic intraoperative failure of a ceramic femoral head. Arthroplast Today 2021; 11:234-238. [PMID: 34692961 PMCID: PMC8515067 DOI: 10.1016/j.artd.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/04/2021] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Approximately 17 years after a primary metal-on-metal total hip arthroplasty, a 59-year-old female developed pain, swelling, and weakness in her right hip accompanied by laboratory findings and imaging suggestive of an adverse local tissue reaction. Acetabular revision was performed to upsize the femoral head and improve hip stability. Upon impaction of the new, non-option ceramic femoral head onto the unsleeved retained stem, the head split into two pieces without fragmentation. The surgery was completed using a cobalt-chromium head, which was impacted without issue onto the stem’s taper. Although BIOLOX delta femoral heads do not require titanium sleeves, we believe that careful consideration should be given to their use in revision total hip arthroplasty with ceramic heads, regardless of the extent of trunnion damage noted intraoperatively.
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Affiliation(s)
- Paul Dobria
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Corresponding author. 3333 Green Bay Rd, North Chicago, IL 60064, USA. Tel.: +1 773 750 1369.
| | - Arpan Patel
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Brett Levine
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
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10
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McCarthy SM, Hall DJ, Mathew MT, Jacobs JJ, Lundberg HJ, Pourzal R. Are Damage Modes Related to Microstructure and Material Loss in Severely Damaged CoCrMo Femoral Heads? Clin Orthop Relat Res 2021; 479:2083-2096. [PMID: 34019490 PMCID: PMC8373544 DOI: 10.1097/corr.0000000000001819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/19/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fretting and corrosion in metal-on-polyethylene total hip arthoplasty (THA) modular junctions can cause adverse tissue reactions that are responsible for 2% to 5% of revision surgeries. Damage within cobalt-chromium-molybdenum (CoCrMo) alloy femoral heads can progress chemically and mechanically, leading to damage modes such as column damage, imprinting, and uniform fretting damage. At present, it is unclear which of these damage modes are most detrimental and how they may be linked to implant alloy metallurgy. The alloy microstructure exhibits microstructural features such as grain boundaries, hard phases, and segregation bands, which may enable different damage modes, higher material loss, and the potential risk of adverse local tissue reactions. QUESTIONS/PURPOSES In this study, we asked: (1) How prevalent is chemically dominated column damage compared with mechanically dominated damage modes in severely damaged metal-on-polyethylene THA femoral heads made from wrought CoCrMo alloy? (2) Is material loss greater in femoral heads that underwent column damage? (3) Do material loss and the presence of column damage depend on alloy microstructure as characterized by grain size, hard phase content, and/or banding? METHODS Surgically retrieved wrought CoCrMo modular femoral heads removed between June 2004 and June 2019 were scored using a modified version of the Goldberg visually based scoring system. Of the total 1002 heads retrieved over this period, 19% (190 of 1002) were identified as severely damaged, exhibiting large areas of fretting scars, black debris, pits, and/or etch marks. Of these, 43% (81 of 190) were excluded for metal-on-metal articulations, alternate designs (such as bipolar, dual-mobility, hemiarthroplasty, metal adaptor sleeves), or previous sectioning of the implant for past studies. One sample was excluded retroactively as metallurgical analysis revealed that it was made of cast alloy, yielding a total of 108 for further analysis. Information on patient age (57 ± 11 years) and sex (56% [61 of 108] were males), reason for removal, implant time in situ (99 ± 78 months), implant manufacturer, head size, and the CoCrMo or titanium-based stem alloy pairing were collected. Damage modes and volumetric material loss within the head tapers were identified using an optical coordinate measuring machine. Samples were categorized by damage mode groups by column damage, imprinting, a combination of column damage and imprinting, or uniform fretting. Metallurgical samples were processed to identify microstructural characteristics of grain size, hard phase content, and banding. Nonparametric Mann-Whitney U and Kruskal-Wallis statistical tests were used to examine volumetric material loss compared with damage mode and microstructural features, and linear regression was performed to correlate patient- and manufacturer-specific factors with volumetric material loss. RESULTS Chemically driven column damage was seen in 48% (52 of 108) of femoral heads, with 34% (37 of 108) exhibiting a combination of column damage and imprinting, 12% (13 of 108) of heads displaying column damage and uniform fretting, and 2% (2 of 108) exhibiting such widespread column damage that potentially underlying mechanical damage modes could not be verified. Implants with column damage showed greater material loss than those with mechanically driven damage alone, with median (range) values of 1.2 mm3 (0.2 to 11.7) versus 0.6 mm3 (0 to 20.7; p = 0.03). Median (range) volume loss across all femoral heads was 0.9 mm3 (0 to 20.7). Time in situ, contact area, patient age, sex, head size, manufacturer, and stem alloy type were not associated with volumetric material loss. Banding of the alloy microstructure, with a median (range) material loss of 1.1 mm3 (0 to 20.7), was associated with five times higher material loss compared with those with a homogeneous microstructure, which had a volume loss of 0.2 mm3 (0 to 4.1; p = 0.02). Hard phase content and grain size showed no correlation with material loss. CONCLUSION Chemically dominated column damage was a clear indicator of greater volume loss in this study sample of 108 severely damaged heads. Volumetric material loss strongly depended on banding (microstructural segregations) within the alloy. Banding of the wrought CoCrMo microstructure should be avoided during the manufacturing process to reduce volumetric material loss and the release of corrosion products to the periprosthetic tissue. CLINICAL RELEVANCE Approximately 30% of THAs rely on wrought CoCrMo femoral heads. Most femoral heads in this study exhibited a banded microstructure that was associated with larger material loss and the occurrence of chemically dominated column damage. This study suggests that elimination of banding from the alloy could substantially reduce the release of implant debris in vivo, which could potentially also reduce the risk of adverse local tissue reactions to implant debris.
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Affiliation(s)
| | - Deborah J. Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Joshua J. Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hannah J. Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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11
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Karaismailoglu B, Karaismailoglu TN. Femoral Head Perforation After Primary Hip Arthroplasty: Unseen Complication of Ceramic-on-Ceramic Interface: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00045. [PMID: 34319929 DOI: 10.2106/jbjs.cc.20.00551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 33-year-old woman, who underwent bilateral ceramic-on-ceramic total hip arthroplasty 3 years previously, presented with right groin pain and mechanical grinding without a history of trauma. Radiographs revealed luxation of the femoral head, and computerized tomography showed perforation of the ceramic femoral head. The patient underwent revision with a metal-on-polyethylene articulation and retained femoral stem. Two years of follow-up yielded good clinical outcome with no evidence of osteolysis or polyethylene wear. CONCLUSION The perforation of a ceramic femoral head should be kept in mind as one of the possible implant failure mechanisms after primary hip arthroplasty.
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Affiliation(s)
- Bedri Karaismailoglu
- Orthopaedics and Traumatology Department, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, İstanbul, Turkey
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12
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Grace TR, Goh GS, Lee GC, Kamath AF, Kurtz SM, Courtney PM. Dual Mobility Reduces Dislocations-Why I Use It in All Revisions. J Arthroplasty 2021; 36:S63-S69. [PMID: 33526395 DOI: 10.1016/j.arth.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Instability remains the most common complication after revision total hip arthroplasty (THA) and presents a unique treatment dilemma for the orthopedic surgeon. Dual mobility (DM) bearing articulations have been used in France since the 1970s, but have only become more widely adopted in the United States over the last decade. The purpose of this symposium was to discuss the role for DM bearings in revision THA. METHODS We reviewed the existing literature on outcomes after DM bearing articulations in revision THA. We also report several case examples of the use of DM in difficult revision THA cases, including acetabular bone loss, failed constrained liner, and adverse local tissue reaction. Finally, we briefly discuss the limitations associated with the use of DM. RESULTS Several large retrospective series demonstrate that DM bearings reduce the incidence of dislocation after revision THA when compared with conventional single bearing THA. Specific complications related to DM bearings including polyethylene wear, loosening, intraprosthetic dislocation, and corrosion remain a concern, but appear to have drastically improved over time with modern implant designs. CONCLUSION Contemporary DM designs have been established as an effective bearing option to reduce instability in revision THA, although concerns do exist. High-quality prospective studies are necessary to further define the role this bearing option has in the coming years.
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Affiliation(s)
- Trevor R Grace
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gwo-Chin Lee
- Penn Presbyterian Medical Center, University of Pennsylvania School of Medicine, Department of Orthopaedic Surgery, Philadelphia, PA
| | - Atul F Kamath
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH
| | - Steven M Kurtz
- Exponent Inc and Drexel University School of Biomedical Engineering, Science, and Health Systems, Philadelphia, PA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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13
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El-Zein ZS, Gehrke CK, Croley JS, Siljander MP, Mallow MA, Flierl MA, Verner JJ, Baker EA. Assessing Taper Geometry, Head Size, Head Material, and Their Interactions in Taper Fretting Corrosion of Retrieved Total Hip Arthroplasty Implants. J Arthroplasty 2021; 36:S386-S394.e4. [PMID: 33832796 DOI: 10.1016/j.arth.2021.02.041] [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: 11/30/2020] [Revised: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Decreased fretting and corrosion damage at the taper interface of retrieved ceramic-on-polyethylene total hip arthroplasty (THA) implants has been consistently reported; however, resultant fretting corrosion as a function of femoral head size and taper geometry has not been definitively explained. METHODS Eight cohorts were defined from 157 retrieved THA implants based on femoral head composition (n = 95, zirconia-toughened alumina, ZTA vs n = 62, cobalt-chromium alloy, CoCr), head size (n = 56, 32mm vs n = 101, 36mm), and taper geometry (n = 84, 12/14 vs n = 73, V40). THA implants were evaluated and graded for taper fretting and corrosion. Data were statistically analyzed, including via a 23 factorial modeling. RESULTS Factorial-based analysis indicated the significant factors related to both resultant (summed) fretting and corrosion damage were head material and taper geometry; head material-taper geometry interaction was also a significant factor in resultant corrosion damage. Lower rates of moderate-to-severe fretting and corrosion damage were exhibited on ZTA heads (ZTA = 13%, CoCr = 38%), smaller heads (32mm = 18%, 36mm = 26%), and 12/14 tapers (12/14 = 13%, V40 = 35%). ZTA+32mm heads demonstrated the lowest rates of moderate-to-severe fretting and corrosion damage (12/14 = 2%, V40 = 7%), whereas CoCr heads with V40 tapers demonstrated the greatest rates of moderate-to-severe damage (32mm = 47%, 36mm = 59%). CONCLUSION In this series, retrieved implants with ZTA, 32-mm heads paired with 12/14 tapers exhibited lower rates of moderate-to-severe damage. Factorial analysis showed head material, taper geometry, and their interactions were the most significant factors associated with resultant damage grades. Isolating implant features may provide additional information regarding factors leading to fretting and corrosion damage in THA. LEVEL OF EVIDENCE IV (case series).
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Affiliation(s)
- Zein S El-Zein
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI
| | - Corinn K Gehrke
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI
| | - J Sawyer Croley
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI
| | | | - Murphy A Mallow
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI
| | - Michael A Flierl
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI; Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI
| | - James J Verner
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI; Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI
| | - Erin A Baker
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI; Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI
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14
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Spece H, Ouellette ES, Jones OL, MacDonald DW, Piuzzi NS, Lee GC, Mont MA, Klein GR, Kurtz SM. Fretting Corrosion, Third-Body Polyethylene Damage, and Cup Positioning in Primary vs Revision Dual Mobility Total Hip Arthroplasty. J Arthroplasty 2021; 36:S80-S87. [PMID: 33610405 DOI: 10.1016/j.arth.2021.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dual mobility (DM) articulations were introduced for total hip arthroplasty to reduce the risk of instability for patients who have a high risk of dislocation. The use of DM constructs in both primary and revision total hip arthroplasty has been steadily increasing, leading to concerns regarding potential risks of fretting corrosion, polyethylene wear, metal release, and failure due to component positioning. METHODS A total of 56 retrieved DM constructs were collected. The inner and outer polyethylene liner surfaces were assessed for 7 damage mechanisms, and fretting corrosion was evaluated for the femoral stem, head, and modular liner. Three polyethylene liners with the greatest amounts of embedded debris were examined using scanning electron microscopy. Energy-dispersive X-ray spectroscopy was used to determine the elemental content of the debris. Acetabular cup orientation was analyzed radiographically using the EBRA (Einzel-Bild-Roentgen-Analyse) method. RESULTS The devices were revised most frequently for infection (36%), loosening (21%), and instability/dislocation (18%). The most common polyethylene damage mechanisms were scratching, pitting, burnishing, and embedded debris, and no difference in total damage was found between primary and revision cases. Scanning electron microscopy/energy-dispersive X-ray spectroscopy revealed that debris morphology and composition were consistent with porous titanium coating, resulting from cup loosening or broken screws and augments. A total of 71% and 50% of the constructs were determined to be within the Lewinnek safe zone for inclination and anteversion, respectively. CONCLUSION The most notable mechanisms of surface damage were due to third-body debris, especially for the polyethylene surfaces which articulate against cobalt-chromium femoral heads and acetabular liners. Scratching of the femoral head and the metal liner from this debris may support the clinical use of ceramic for DM bearing surfaces in the future.
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Affiliation(s)
- Hannah Spece
- Implant Research Core, Drexel University School of Biomedical Engineering, Science, and Health Systems, Philadelphia, PA
| | - Eric S Ouellette
- Department of Biomedical Engineering, Exponent Inc, Philadelphia, PA
| | - Olivia L Jones
- Implant Research Core, Drexel University School of Biomedical Engineering, Science, and Health Systems, Philadelphia, PA
| | - Daniel W MacDonald
- Implant Research Core, Drexel University School of Biomedical Engineering, Science, and Health Systems, Philadelphia, PA
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Gwo-Chin Lee
- Penn Presbyterian Medical Center, University of Pennsylvania School of Medicine, Department of Orthopaedic Surgery, Philadelphia, PA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital at Northwell Health, New York City, NY
| | - Gregg R Klein
- Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, NJ
| | - Steven M Kurtz
- Implant Research Core, Drexel University School of Biomedical Engineering, Science, and Health Systems, Philadelphia, PA; Department of Biomedical Engineering, Exponent Inc, Philadelphia, PA
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15
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Pagani NR, LeRoy TE, Menendez ME, Stoker GE, Lococo DV, Nairus JG. Gross Trunnion Failure of a Type 1 Taper After Metal-on-Polyethylene Total Hip Arthroplasty: A Report of 2 Cases. JBJS Case Connect 2021; 11:01709767-202106000-00133. [PMID: 34166254 DOI: 10.2106/jbjs.cc.21.00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CASE We describe 2 cases of gross trunnion failure (GTF) in males with Centers for Disease Control and Prevention Class 3 obesity 10 years after metal-on-polyethylene total hip arthroplasty (THA) with a titanium-alloy femoral stem and Type 1 taper. One patient received a large diameter cobalt-chromium femoral head, whereas the other received a smaller diameter head, both with high-offset femoral stems. CONCLUSION This is the first report of GTF involving the Echo Bi-Metric femoral stem after metal-on-polyethylene THA, and surgeons should consider the potential complication of GTF when using this specific femoral stem with metal heads in obese male patients.
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Affiliation(s)
- Nicholas R Pagani
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
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16
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Cadel ES, Topoleski LDT, Vesnovsky O, Anderson CR, Hopper RH, Engh CA, Di Prima MA. A comparison of metal/metal and ceramic/metal taper-trunnion modular connections in explanted total hip replacements. J Biomed Mater Res B Appl Biomater 2021; 110:135-143. [PMID: 34164932 PMCID: PMC9292311 DOI: 10.1002/jbm.b.34897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/28/2021] [Accepted: 06/13/2021] [Indexed: 12/27/2022]
Abstract
Corrosion and wear are commonly found at the taper-trunnion connection of modular total hip arthroplasty (THA) explanted devices. While metal/metal (M/M) modular taper-trunnion connections exhibit more wear/corrosion than ceramic/metal (C/M) modular taper-trunnion connections, damage is present in both, regardless of material. This study used a combination of assessment techniques including clinical data, visual scoring assessment, optical imaging, profilometry, and x-ray photoelectron microscopy (XPS), to investigate wear mechanisms and damage features at the modular taper-trunnion connection of 10 M/M and 8 C/M explanted THAs. No correlation was found between any demographic variable and corrosion wear and assessment scores. All assessment techniques demonstrated that the stem trunnions had more damage than head tapers for both explant groups and agreed that C/M explants had less corrosion and wear compared to M/M explants. However, visual assessment scores differed between assessment techniques when evaluating the tapers and trunnions within the two groups. Profilometry showed an increase (p <.05) in surface roughness for stem trunnions compared to head tapers for both explant groups. X-ray photoelectron spectroscopy performed on deposits from two M/M explants found chromium and molybdenum carbides beneath the surface while chromium sulfate and aged bone mineral were found on the surface suggesting that the debris is a result of corrosion rather than wear. These results indicate that taper-trunnion damage is more prevalent for M/M explants, but C/M explants are still susceptible to damage. More comprehensive analysis of damage is necessary to better understand the origins of taper-trunnion damage.
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Affiliation(s)
- Eileen S Cadel
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - L D Timmie Topoleski
- US Food and Drug Administration, Silver Spring, Maryland, USA.,University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Oleg Vesnovsky
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Robert H Hopper
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | - Charles A Engh
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
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17
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Stockhausen KE, Riedel C, Belinski AV, Rothe D, Gehrke T, Klebig F, Gebauer M, Amling M, Citak M, Busse B. Variability in stem taper surface topography affects the degree of corrosion and fretting in total hip arthroplasty. Sci Rep 2021; 11:9348. [PMID: 33931680 PMCID: PMC8087796 DOI: 10.1038/s41598-021-88234-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 03/19/2021] [Indexed: 12/29/2022] Open
Abstract
Degradation at the modular head-neck interface in total hip arthroplasty (THA) is predominately expressed in the form of corrosion and fretting, potentially causing peri-prosthetic failure by adverse reactions to metal debris. This retrieval study aimed to quantify variations in stem taper surface topographies and to assess the influence on the formation of corrosion and/or fretting in titanium alloy stem tapers combined with metal and ceramic heads. Four hip stem designs (Alloclassic, CLS, Bicontact and SL-Plus) were characterized using high-resolution 3D microscopy, and corrosion and fretting were rated using the Goldberg scoring scheme. Quantification of the taper surface topographies revealed a high variability in surface characteristics between threaded stem tapers: Alloclassic and CLS tapers feature deeply threaded trapezoid-shaped profiles with thread heights over 65 µm. The sawtooth-shaped Bicontact and triangular SL-Plus taper are characterized by low thread heights below 14 µm. Significantly lower corrosion and fretting scores were observed in lightly threaded compared to deeply threaded tapers in ceramic head combinations. No significant differences in corrosion or fretting scores with thread height were found in pairings with metal heads. Understanding the relationship between stem taper surface topography and the formation of corrosion and fretting could help to improve the performance of modern THAs and lead to longer-lasting clinical results.
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Affiliation(s)
- Kilian Elia Stockhausen
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Christoph Riedel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Alex Victoria Belinski
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany.,Department of Mechanical Engineering, University of California, 6141 Etcheverry Hall, Berkeley, CA, USA
| | - Dorothea Rothe
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Felix Klebig
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Matthias Gebauer
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany. .,Interdisciplinary Competence Center for Interface Research (ICCIR), Martinistr. 52, 20251, Hamburg, Germany. .,Forum Medical Technology Health Hamburg (FMTHH), Butenfeld 34, 22529, Hamburg, Germany.
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18
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Kretzer JP, Uhler M, Jäger S, Bormann T, Sonntag R, Schonhoff M, Schröder S. [Tribology in hip arthroplasty : Benefits of different materials]. DER ORTHOPADE 2021; 50:259-269. [PMID: 33630110 DOI: 10.1007/s00132-021-04077-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
When it comes to total hip replacements, choosing the suitable material combination is of clinical relevance. The present review article examines the technical differences in wear and corrosion of the relevant material combinations of ceramics, metals, ceramized metals and various types of polyethylene. The material characteristics, which were often tested under standardized conditions in the laboratory, are compared with clinical results on the basis of evidence-graded clinical studies and on the basis of register studies. This article thus represents an up-to-date snapshot of the expectations and actual clinical outcomes of the present choice of material combinations. It shows that some tendencies from the field of materials research, e.g. with regard to cross-linked polyethylene, coincide with observations from practical clinical experience, while for other materials, a proven technical superiority has not yet been confirmed as an evident advantage in clinical practice.
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Affiliation(s)
- J Philippe Kretzer
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - Maximilian Uhler
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Sebastian Jäger
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Therese Bormann
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Robert Sonntag
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Mareike Schonhoff
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Stefan Schröder
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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19
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Ishii S, Homma Y, Baba T, Shirogane Y, Kaneko K, Ishijima M. Does increased diameter of metal femoral head associated with highly cross-linked polyethylene augment stress on the femoral stem and cortical hypertrophy? INTERNATIONAL ORTHOPAEDICS 2021; 45:1169-1177. [PMID: 33619587 DOI: 10.1007/s00264-021-04994-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Cortical hypertrophy (CH) after total hip arthroplasty (THA) is thought as a process of femoral cortical functional adaptation against the stem. However, no study has been performed to investigate the association between CH and femoral head size. The purpose of this study is to investigate the factors related to femoral CH around the cementless stem after THA. METHODS THAs in 31 patients using 36-mm metal head and as a control, age-matched 62 THAs with 32-mm metal head have been analyzed. Radiographs were reviewed at four years to determine cortical thickness change from immediate post-operative one. Pre-operative and immediate post-operative radiographs were used to calculate the femoral morphology, canal fill ratio, stem alignment, and femoral and acetabular offset. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for CH. RESULTS Patients with a 36-mm metal head had a significantly higher rate of severe CH (P = 0.001) than those with a 32-mm metal head. The multivariate logistic regression analysis with dependent variables of CH showed that the use of a 36-mm metal head had a significantly positive effect on CH. The odds ratio of a 36-mm metal head in mild CH was 2.517 (95% confidence interval, 1.032-6.143; P = 0.043), and that in severe CH was 8.273 (95% confidence interval, 2.679-25.551; P = 0.000). Age and the canal flare index were weakly and negatively influenced by mild CH. CONCLUSIONS The use of a 36-mm metal head was the dominant risk factor for CH.
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Affiliation(s)
- Seiya Ishii
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuichi Shirogane
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Eichler D, Barry J, Lavigne M, Massé V, Vendittoli PA. No radiological and biological sign of trunnionosis with Large Diameter Head Ceramic Bearing Total Hip Arthroplasty after 5 years. Orthop Traumatol Surg Res 2021; 107:102543. [PMID: 32276843 DOI: 10.1016/j.otsr.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Trunnionosis of large diameter (LDH) metal-on-metal total hip arthroplasty (THA) was linked to high systemic chromium (Cr) and cobalt (Co) ion levels and local adverse reactions to metal debris (ARMD). The safety of CoC LDH THA is not yet available at mid-term. Measuring whole blood Ti level of ceramic on ceramic (CoC) LDH THA with a titanium (Ti) stem is an indirect way to assess the performance of its head-neck taper modular junction. Therefore, we wanted to determine: (1) if the whole blood Ti ion levels in patients with LDH CoC THA after a minimum of 5 years of implantation is within the expected values for similar well performing Ti THA, (2) if Ti level scientifically increases over time, which would suggest the presence of a progressive modular head/neck junction wear process, (3) if clinical or radiographical manifestations of implant dysfunction are present? HYPOTHESIS Ti blood levels of LDH CoC THA will indirectly reflect the expected levels due to passive corrosion of the implants and will be stable over time. PATIENTS AND METHODS We report the whole blood Ti, Cr, and Co levels at 5years minimum for 57 patients with unilateral primary LDH CoC THA with head sizes ranging from 36 to 48mm using Ti stem and acetabular component. To compare Ti ion levels modification over time, in 25 patients were a previous measurement (1-3years) was available, we compared it to their last follow-up results (>5 years). Mean Ti level in well performing Ti THAs is recognized to be around 2.0 ug/L. Although, there are no universally accepted Ti levels associated with problematic implant, we used safety threshold of 10 ug/L. Clinical and radiological outcomes were recorded at last follow-up. RESULTS At 79 months mean follow-up, all mean Ti levels were 1.9μg/L (min 1.2, max 4.4) and all subject had values below the safety threshold of 10ug/L. In the subgroup of 25 cases with a previous measurement, there was a decrease in mean Ti levels between 20 months and 78 months follow-up (2.2μg/L (1.6-3.9) versus 2.0μg/L (1.4-2.8), p=0.007). No statistically significant relation was observed between Ti level at last FU and bearing diameter (rho=0.046, p=0.0734) or the presence or absence of a Ti adaptor sleeve (p=0.454): 1.94ug/L (min 1.20, max 2.80) versus 1.90ug/L (min 1.20, max 4.40). At last follow up, no patients presented osteolysis signs on radiographs, clinical signs of ARMD or were reoperated. Most patients had excellent clinical with 98% of them reporting minor (29%) or no functional limitation (69%) and 44% perceive their THA as a natural hip joint. However, 3/57patients (5%) temporarily experienced hip squeaking and 18/57 (31%) reported clicking sound. CONCLUSION With the tested LDH CoC THA, Ti levels were low and related the uneventful and unavoidable passive corrosion of implant surfaces. Mid-term measurement of Ti in subjects with LDH CoC did not reveal any indirect signs of trunnionosis, which should already be observable by this time. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- David Eichler
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Janie Barry
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Martin Lavigne
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Vincent Massé
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Pascal-André Vendittoli
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada.
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21
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McGrory BJ. Letter to the Editor on "Disassociation of a Cold-Welded Bimodular Titanium Femoral Stem by Intraoperative Ice Cooling". Arthroplast Today 2020; 6:1055-1056. [PMID: 33385050 PMCID: PMC7772448 DOI: 10.1016/j.artd.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/14/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Brian J. McGrory
- Corresponding author. Division of Joint Replacements, Department of Surgery, Maine Medical Center, Tufts University School of Medicine, 5 Bucknam Road, Suite 1D, Falmouth, ME 04105, USA. Tel.: +1 207 781 1551.
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22
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Khullar P, Zhu D, Gilbert JL. Fretting corrosion of Si 3 N 4 vs CoCrMo femoral heads on Ti-6Al-V trunnions. J Orthop Res 2020; 38:1617-1626. [PMID: 32249959 DOI: 10.1002/jor.24681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/07/2020] [Accepted: 03/25/2020] [Indexed: 02/04/2023]
Abstract
Fretting corrosion at the head-neck taper junction was compared between silicon nitride (Si3 N4 ) and commercially available cobalt chrome (CoCrMo) femoral heads on titanium (Ti-6Al-4V) trunnions. An electrochemical setup was used to capture the fretting currents (characterized by oxide abrasion and repassivation) during cyclic loading. Onset load, pull-off force (disassembly load), short term and long term (1 million cycles) fretting currents were used to compare the fretting corrosion performance between the test group (Si3 N4 /Ti-6Al-4V) and the control group (CoCrMo/Ti-6Al-4V). Incremental cyclic fretting corrosion tests showed that the Si3 N4 /Ti-6Al-4V combination had statistically lower (P < .05) average fretting current of 0.189 µA (SD = 0.114 µA) compared to 0.685 µA (SD = 0.630 µA) for CoCrMo/Ti-6Al-4V for cyclic load of 3200 N. Similarly, for the one million cycle fretting corrosion tests, the Si3 N4 /Ti-6Al-4V couples had statistically lower (P < .05) average current (0.048 µA, SD = 0.025 µA) vs CoCrMo/Ti-6Al-4V couples (0.366 µA, SD = 0.143 µA). The Si3 N4 heads also had higher onset loads (P < .05) for fretting (vs CoCrMo, 2200 N vs 1740 N) indicating a difference in surface contact mechanics between the two groups. Scanning electron microscopy with energy dispersive spectroscopy confirmed material transfer from the trunnions to the heads for both groups tested, and from head to trunnion for the CoCrMo heads. Minimal Si3 N4 transfer was noted. The electrochemical, mechanical, and microscopic inspection data supported the hypothesis that Si3 N4 /Ti-6Al-4Vcombination had better fretting corrosion performance compared to CoCrMo/Ti-6Al-4V.
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Affiliation(s)
- Piyush Khullar
- Clemson-MUSC Bioengineering Program, Charleston, South Carolina.,Department of Bioengineering, Clemson University, Clemson, South Carolina
| | - Dongkai Zhu
- Clemson-MUSC Bioengineering Program, Charleston, South Carolina.,Department of Bioengineering, Clemson University, Clemson, South Carolina
| | - Jeremy L Gilbert
- Clemson-MUSC Bioengineering Program, Charleston, South Carolina.,Department of Bioengineering, Clemson University, Clemson, South Carolina.,Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina
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23
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Haschke H, Falkenberg A, Morlock MM, Huber G. Do SiNx coatings bear the potential to reduce the risk of micromotion in modular taper junctions? Proc Inst Mech Eng H 2020; 234:897-908. [PMID: 32507037 DOI: 10.1177/0954411920930616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fretting corrosion is one contributor to the clinical failure of modular joint arthroplasty. It is initiated by micromotion in metal junctions exposed to fluids. Omitting metal-on-metal contacts could help to reduce the corrosion risk. The coating of one metal taper partner with a ceramic-based silicon nitride (SiNx) coating might provide this separation. The aim of the study was to identify whether a SiNx coating of the male taper component influences the micromotion within a taper junction. Hip prosthesis heads made of CoCr29Mo6 (Aesculap) and Ti6Al4V (Peter Brehm) were assembled (2000 N) to SiNx-coated and uncoated stem tapers made of Ti6Al4V and CoCr29Mo6 (2×2×2 combinations, each n = 4). Consecutive sinusoidal loading representing three daily activities was applied. Contactless relative motion in six degrees of freedom was measured using six eddy-current sensors. Micromotion in the junction was determined by compensating for the elastic deformation derived from additional monoblock measurements. After pull-off, the taper surfaces were microscopically inspected. Micromotion magnitude reached up to 8.4 ± 0.8 µm during loading that represented stumbling. Ti6Al4V stems showed significantly higher micromotion than those made of CoCr29Mo6, while taper coating had no influence. Statistical differences in pull-off forces were found for none of the taper junctions. Microscopy revealed CoCr29Mo6 abrasion from the head taper surface if combined with coated stem tapers. Higher micromotion of Ti6Al4V tapers was probably caused by the lower Young's modulus. Even in the contact areas, the coating was not damaged during loading. The mechanics of coated tapers was similar to uncoated prostheses. Thus, the separation of the two metal surfaces with the objective to reduce in vivo corrosion appears to be achievable if the coating is able to withstand in vivo conditions. However, the hard ceramic-based stem coating lead to undesirable debris from the CoCr29Mo6 heads during loading.
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Affiliation(s)
- Henning Haschke
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
| | - Adrian Falkenberg
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
| | - Gerd Huber
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
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24
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Abstract
The femoral head size influences dislocation, range of motion (ROM), functional outcome, wear, and survival after total hip arthroplasty (THA). These aspects of different head sizes with contemporary bearings in primary THA have been reviewed. Based on the existing evidence, for highly-cross-linked polyethylene (HXLPE) bearings, a 32 mm cobalt chromium (CoCr) or ceramic head appears to be a suitable choice. If a 36 mm head with HXLPE is desired, a ceramic head may be preferable over CoCr due to reduced risk of fretting and corrosion with the former. For ceramic-on-ceramic (CoC) bearings, head sizes >36 mm do not appear to provide any significant benefit over 36 mm heads. Also, large ceramic heads may lead to increased risk of squeaking. If non-cross-linked PE bearing is considered for use, it would be prudent to opt for <32 mm head size.
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Affiliation(s)
- Siddharth M Shah
- S L Raheja (A Fortis Associate) hospital, Mahim West, Mumbai, India
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25
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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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26
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Falkenberg A, Dickinson EC, Morlock MM. Adapter sleeves are essential for ceramic heads in hip revision surgery. Clin Biomech (Bristol, Avon) 2020; 71:1-4. [PMID: 31671337 DOI: 10.1016/j.clinbiomech.2019.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Removing a head during isolated acetabular revision surgery can cause damage to the stem taper surface from extraction tool contact. Implanting a ceramic head on the damaged stem taper might elevate the fracture risk, which can be mitigated with the use of titanium adapter sleeves. The aim of this study was to investigate whether the improved fracture strength of modern generation ceramic heads allows the direct implantation on damaged stem tapers without an adapter sleeve. METHODS Finite element models of taper junctions with and without adapter sleeve were generated. Different stem taper damages were modelled to investigate the influence on the ceramic head fracture load under axial compression. FINDINGS Heads without adapter sleeves exhibited slightly higher or equal fracture strengths compared with sleeved heads for most scenarios. However, a small metal elevation on the stem taper caused a drastic decrease of the fracture strength if no adapter sleeve was used (-96%). The sleeved head was not influenced by the metal elevation damage. INTERPRETATION Adapter sleeves are essential to ensure patient safety and prosthesis longevity whenever implanting ceramic heads on used stem tapers.
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Affiliation(s)
- Adrian Falkenberg
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany.
| | - Emilie C Dickinson
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
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27
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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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28
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[Total hip arthroplasty in young patients : Bearings and custom-made prostheses]. DER ORTHOPADE 2019; 48:292-299. [PMID: 30737518 DOI: 10.1007/s00132-019-03692-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Carefully and correctly implanted components are the prerequisite for the lifespan of a prosthesis. Whether higher levels of activity lead to prior failure of total hip arthroplasty in young patients is controversially discussed. The right choice of bearings is still of great relevance. BEARINGS Ceramic-on-ceramic as well as polyethylene-on-ceramic bearings achieve comparable results, although ceramic-on-ceramic bearings should be avoided in patients with high demands on their range of motion. Polyethylene-on-metal bearings also show good clinical results, if corrosion between head and stem is absent. Metal-on-metal bearings lead to adverse systemic effects due to metal wear and should be implanted in individual cases only, e. g. as hip resurfacing. Alternative bearings have to give proof of effectivity first. Custom-made prostheses constitute an option for young patients with special conditions of hip anatomy. Planning and study results of these prostheses are elucidated in this review article.
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29
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Kurtz SM, Lau E, Baykal D, Odum SM, Springer BD, Fehring TK. Are Ceramic Bearings Becoming Cost-Effective for All Patients Within a 90-Day Bundled Payment Period? J Arthroplasty 2019; 34:1082-1088. [PMID: 30799268 DOI: 10.1016/j.arth.2019.01.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/31/2018] [Accepted: 01/31/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We analyzed whether the total hospital cost in a 90-day bundled payment period for ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) total hip arthroplasty (THA) bearings was changing over time, and whether the cost differential between ceramic bearings and metal-on-polyethylene (M-PE) bearings was approaching the previously published tipping point for cost-effectiveness of US$325. METHODS A total of 245,077 elderly Medicare patients (65+) who underwent primary THA between 2010 and 2015 were identified from the United States Medicare 100% national administrative hospital claims database. The total inpatient cost, calculated up to 90 days after index discharge, was computed using cost-to-charge ratios, and hospital payment was analyzed. The differential total inpatient cost of C-PE and COC bearings, compared to metal-on-polyethylene (M-PE), was evaluated using parametric and nonparametric models. RESULTS After adjustment for patient and clinical factors, and the year of surgery, the mean hospital cost up to 90 days for primary THA with C-PE or COC was within ±1% of the cost for primary THA with M-PE bearings (P < .001). From the nonparametric analysis, the median total hospital cost was US$296-US$353 more for C-PE and COC than M-PE. Cost differentials were found to decrease significantly over time (P < .001). CONCLUSION Patient and clinical factors had a far greater impact on the total cost of inpatient THA surgery than bearing selection, even when including readmission costs up to 90 days after discharge. Our findings indicate that the cost-effectiveness thresholds for ceramic bearings relative to M-PE are changing over time and increasingly achievable for the Medicare population.
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Affiliation(s)
| | - Edmund Lau
- Health Sciences, Exponent, Inc, Menlo Park, CA
| | | | - Susan M Odum
- Atrium Health, Musculoskeletal Institute and OrthoCarolina Research Institute, Charlotte, NC
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30
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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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31
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Bhalekar RM, Smith SL, Joyce TJ. Hip simulator testing of the taper-trunnion junction and bearing surfaces of contemporary metal-on-cross-linked-polyethylene hip prostheses. J Biomed Mater Res B Appl Biomater 2019; 108:156-166. [PMID: 30924612 DOI: 10.1002/jbm.b.34374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/18/2019] [Accepted: 03/11/2019] [Indexed: 12/28/2022]
Abstract
Adverse reaction to metal debris released from the taper-trunnion junction of modular metal-on-polyethylene (MoP) total hip replacements (THRs) is an issue of contemporary concern. Therefore, a hip simulator was used to investigate material loss, if any, at both the articulating and taper-trunnion surfaces of five 32-mm metal-on-cross-linked-polyethylene THRs for 5 million cycles (Mc) with a sixth joint serving as a dynamically loaded soak control. Commercially available cobalt-chromium-molybdenum femoral heads articulating against cross-linked polyethylene (XLPE) acetabular liners were mounted on 12/14 titanium (Ti6Al4V) trunnions. Weight loss (mg) was measured gravimetrically and converted into volume loss (mm3 ) for heads, liners, and trunnions at regular intervals. Additionally, posttest volumetric wear measurements of the femoral tapers were obtained using a coordinate measuring machine (CMM). The surface roughness (Sa) of femoral tapers was measured posttest. After 5 Mc, the mean volumetric wear rate for XLPE liners was 2.74 ± 0.74 mm3 /Mc. The CMM measurements confirmed material loss from the femoral taper with the mean volumetric wear rate of 0.045 ± 0.024 mm3 /Mc. The Sa on the worn area of the femoral taper showed a significant increase (p < 0.001) compared with the unworn area. No other long-term hip simulator tests have investigated wear from the taper-trunnion junction of contemporary MoP THRs. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:156-166, 2020.
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Affiliation(s)
- Rohan M Bhalekar
- School of Engineering, Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
| | - Simon L Smith
- School of Engineering, Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
| | - Thomas J Joyce
- School of Engineering, Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
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Arnholt CM, MacDonald DW, Klein GR, Cates HE, Rimnac CM, Kurtz SM, Kocagoz S, Chen AF. What Is the Incidence of Cobalt-Chromium Damage Modes on the Bearing Surface of Contemporary Femoral Component Designs for Total Knee Arthroplasty? J Arthroplasty 2018; 33:3313-3319. [PMID: 29871834 PMCID: PMC6146069 DOI: 10.1016/j.arth.2018.05.020] [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: 02/15/2018] [Revised: 04/25/2018] [Accepted: 05/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the incidence of metal release in contemporary total knee arthroplasty and the patient-related factors associated with this release. METHODS In total, 256 retrieved cobalt-chromium femoral components were collected through a multi-institutional orthopedic implant retrieval program (implanted: 1-15 years). Implants were mainly revised for loosening (84/256), instability (62/256), and infection (46/256). Third-body damage was assessed using a semiquantitative scoring method. Microscale electro-corrosion damage (MECD) was evaluated using digital optical microscopy. Radii of curvature were measured from representative components to calculate anterior-posterior and medial-lateral ratios. Femoral component surface roughness was measured using a white light interferometer. Using a multivariable linear model, associations between damage score, implant, and patient factors were tested. Spearman's ρ correlation tests were performed to determine the association between roughness measurements and damage score. RESULTS Mild to severe damage was observed in 52% (134/256) of the components. In the multivariable linear model, anterior-posterior ratio (β = -8.07; P < .001), loosening (β = -0.52; P = .006), and patient weight (β = 0.01; P = .007) were associated with damage score. Suspected MECD damage was observed in 82% (209/256) of components. The Ra value (ρ = 0.196; P = .002) and Rq value (ρ = 0.157; P = .012) increased as the damage score increased. CONCLUSION The findings of this retrieval study support that similar damage mechanisms exist in contemporary and long-term total knee arthroplasty devices. Additionally, we observed associations between loosening, anterior-posterior conformity, and patient weight with increased surface damage.
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Affiliation(s)
- Christina M. Arnholt
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104
| | - Daniel W. MacDonald
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104
| | - Gregg R. Klein
- Hartzband Center for Hip & Knee Replacement, Paramus, NJ
| | | | - Clare M. Rimnac
- Department of Mechanical and Aerospace Engineering and the Center for the Evaluation of Implant Performance, Case Western Reserve University, 10900 Euclid Ave., Cleveland, Ohio 44106
| | - Steven M. Kurtz
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104,Exponent, Inc., 3440 Market Street, Suite 600, Philadelphia, PA 19104
| | | | - Sevi Kocagoz
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104
| | - Antonia F. Chen
- Brigham and Women’s Hospital, Department of Orthopaedics, Harvard Medical School, Boston, MA 02115
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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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Shapiro JA, Eskildsen SM, Del Gaizo DJ. Systemic cobaltism manifesting as oral mucosal discoloration and metallic gustation after metal-on-metal hip resurfacing. Arthroplast Today 2018; 4:436-440. [PMID: 30560172 PMCID: PMC6287233 DOI: 10.1016/j.artd.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 01/23/2023] Open
Abstract
Systemic cobaltism is a debilitating complication of metal-on-metal (MoM) arthroplasty. In this report, we review a case of a 54-year-old female with metallosis from a MoM hip resurfacing and varying degrees of black discoloration of her tongue and metallic gustation as a result of systemic cobaltism. After explanting the metal components, thorough debridement, and conversion to ceramic-on-polyethylene arthroplasty, the patient's oral mucosal discoloration and metallic gustation resolved. This represents the first documentation of systemic cobaltism from MoM hip resurfacing manifesting as oral mucosal discoloration and metallic gustation with resolution after explant, debridement, and conversion to ceramic-on-polyethylene total hip arthroplasty.
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Affiliation(s)
- Joshua A Shapiro
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Scott M Eskildsen
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel J Del Gaizo
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
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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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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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Kim YH, Park JW, Kim JS. Adapter Sleeves Are Not Needed to Reduce the Risk of Fracture of a New Ceramic Head Implanted on a Well-Fixed Stem. Orthopedics 2018; 41:158-163. [PMID: 29738600 DOI: 10.3928/01477447-20180501-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/12/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to assess (1) the prevalence of the fracture of ceramic heads implanted on used trunnions of well-fixed stems without using a titanium adapter sleeve; (2) the prevalence of trunnionosis secondary to fretting and/or corrosion at the trunnion of the well-fixed stem; and (3) clinical and radiographic results and the survival rate of the revised acetabular components. Eighty-eight patients (100 hips) underwent isolated revision of the acetabular components for polyethylene wear and osteolysis of the acetabulum. The study group consisted of 70 men and 18 women with a mean age of 52.8 years (range, 31-54 years) when the primary total hip arthroplasty was performed. Evidence of fretting and corrosion of the trunnion of all prostheses was examined macroscopically using a magnifying lens. Degree of fretting and corrosion of the trunnion was assessed using a 4-point scoring technique. A new 36-mm alumina delta ceramic head was implanted on the trunnion of a well-fixed stem without using a titanium adapter sleeve in all hips. The mean follow-up after revision of the acetabular component was 12.8 years (range, 10-14 years). Among the 100 new ceramic heads implanted on a well-fixed stem, no fracture of the ceramic head occurred at a mean follow-up of 12.8 years. The median fretting and corrosion scores for the trunnions were 1.5±1.1 and 1.3±0.9 points, respectively. The mean Harris hip score at the final follow-up was 89±15 points (range, 63-100 points). Survivorship of the revised acetabular components at 14 years was 95% (95% confidence interval, 87.6%-98.6%). [Orthopedics. 2018; 41(3):158-163.].
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Kurtz SM, Lau EC, Baykal D, Odum SM, Springer BD, Fehring TK. Are Ceramic Bearings Becoming Cost-Effective for All Patients? J Arthroplasty 2018; 33:1352-1358. [PMID: 29336858 DOI: 10.1016/j.arth.2017.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/10/2017] [Accepted: 12/13/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to analyze whether the cost for ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) bearings used in primary total hip arthroplasty (THA) was changing over time, and if the cost differential between ceramic bearings and metal-on-polyethylene (M-PE) bearings was approaching the previously published tipping point for cost-effectiveness of $325. METHODS A total of 245,077 elderly Medicare patients (65+) who underwent primary THA between 2010 and 2015 were identified from the United States Medicare 100% national administrative hospital claims database. The inpatient hospital cost, calculated using cost-to-charge ratios, and hospital payment were analyzed. The differential cost of C-PE and COC bearings, compared to M-PE, were evaluated using parametric and nonparametric models. RESULTS After adjustment for patient and clinical factors, and the year of surgery, the mean hospital cost and payments for primary THA with a C-PE or COC was within ±1% of the cost for primary THA with M-PE bearings (P < .001). From the nonparametric analysis, the median hospital cost was $318-$360 more for C-PE and COC than M-PE. The differential in median Medicare payment for THA with ceramic bearings compared to M-PE was <$100. Cost differentials were found to decrease significantly over time (P < .001). CONCLUSION Patient and clinical factors had a far greater impact on the cost of inpatient THA surgery than bearing selection. Because we found that costs and cost differentials for ceramic bearings were decreasing over time, and approaching the tipping point, it is likely that the cost-effectiveness thresholds relative to M-PE are likewise changing over time and should be revisited in light of this study.
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Affiliation(s)
| | | | | | - Susan M Odum
- OrthoCarolina Research Institute, Charlotte, North Carolina
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Abstract
INTRODUCTION Metal ion release from wear and corrosion at the femoral head-stem taper junction can evoke local adverse reactions to metal debris (ARMD). In a specific large-diameter head (LDH) total hip arthroplasty (THA) system, ceramic femoral heads of 44 to 48 mm are available with a titanium (Ti) adaptor sleeve, while heads of 36- to 40-mm come without sleeves. The hypothesis of this study is that the Ti adaptor sleeve with LDH ceramic-on-ceramic (CoC) bearings will not cause wear or corrosion at the taper junction and, thus, will not generate high whole blood Ti ion levels. METHODS We compared whole blood Ti levels at minimum 1-year follow-up in 27 patients with unilateral primary LDH CoC THA with head sizes ranging from 36 to 48 mm using a Ti stem and acetabular component. RESULTS Although Ti ion levels in patients with 36- to 40-mm head diameters without Ti sleeve were found to be statistically significantly higher (2.3 μg/l: 1.6-3.1, SD 0.44) compared to those with a Ti sleeve (1.9 μg/l: 1.6-2.2, SD 0.19) (p = 0.020), the found difference has no clinical importance. No patients presented clinical signs of ARMD, and the clinical results in both groups were similar. CONCLUSIONS LDH CoC THA Ti levels were low and probably related to unavoidable passive corrosion of implant surfaces. Measurement of Ti in subjects with ceramic LDH, with or without Ti adaptor sleeve, did not disclose undirected signs of trunnionosis.
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Leopold SS. Editor's Spotlight/Take 5: Polyethylene Wear Increases in Liners Articulating With Scratched Oxidized Zirconium Femoral Heads. Clin Orthop Relat Res 2018; 476:179-181. [PMID: 29389781 PMCID: PMC6259697 DOI: 10.1007/s11999.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Seth S Leopold
- S. S. Leopold Editor-In-Chief, Clinical Orthopaedics and Related Research®, Philadelphia, PA, USA
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Berstock JR, Whitehouse MR, Duncan CP. Trunnion corrosion: what surgeons need to know in 2018. Bone Joint J 2018; 100-B:44-49. [PMID: 29292339 PMCID: PMC6424439 DOI: 10.1302/0301-620x.100b1.bjj-2017-0569.r1] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/19/2017] [Indexed: 11/05/2022]
Abstract
AIMS To present a surgically relevant update of trunnionosis. MATERIALS AND METHODS Systematic review performed April 2017. RESULTS Trunnionosis accounts for approximately 2% of the revision total hip arthroplasty (THA) burden. Thinner (reduced flexural rigidity) and shorter trunnions (reduced contact area at the taper junction) may contribute to mechanically assisted corrosion, exacerbated by high offset implants. The contribution of large heads and mixed metallurgy is discussed. CONCLUSION Identifying causative risk factors is challenging due to the multifactorial nature of this problem. Cite this article: Bone Joint J 2018;100-B(1 Supple A):44-9.
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Affiliation(s)
- J R Berstock
- Musculoskeletal Research Unit, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - M R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - C P Duncan
- Vancouver General Hospital, University of British Columbia, JP North 3rd floor, Room 3114, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada
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Kyomoto M, Shoyama Y, Saiga K, Moro T, Ishihara K. Reducing fretting-initiated crevice corrosion in hip simulator tests using a zirconia-toughened alumina femoral head. J Biomed Mater Res B Appl Biomater 2017; 106:2815-2826. [DOI: 10.1002/jbm.b.34062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/02/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Masayuki Kyomoto
- Department of Materials Engineering, School of Engineering; The University of Tokyo; Tokyo Japan
- Division of Science for Joint Reconstruction, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
- Medical R&D Center, Corporate R&D Group, KYOCERA Corporation; Yasu Japan
| | | | - Kenichi Saiga
- Division of Science for Joint Reconstruction, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
- Medical R&D Center, Corporate R&D Group, KYOCERA Corporation; Yasu Japan
| | - Toru Moro
- Division of Science for Joint Reconstruction, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Kazuhiko Ishihara
- Department of Materials Engineering, School of Engineering; The University of Tokyo; Tokyo Japan
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McGrory BJ, Jorgensen AH. High Early Major Complication Rate After Revision for Mechanically Assisted Crevice Corrosion in Metal-on-Polyethylene Total Hip Arthroplasty. J Arthroplasty 2017; 32:3704-3710. [PMID: 28781018 DOI: 10.1016/j.arth.2017.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/14/2017] [Accepted: 07/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Failed total hip arthroplasty caused by mechanically assisted crevice corrosion (MACC) has serious consequences such as adverse local tissue reaction. Revision is currently indicated for significant hip pain, stiffness, and dysfunction; hip instability; progressive bone loss; and soft tissue destruction. Outcomes of this revision surgery are not yet completely understood. METHODS We examined the surgical outcomes at a minimum of 6 months (average, 25; range, 7-68 months) in a cohort of 27 consecutive patients who underwent revision total hip arthroplasty for MACC associated with a single implant vendor and taper type. RESULTS Major orthopedic complications occurred in 7 of 27 patients (25.9%), each after the original revision surgery. Five additional major complications occurred in subsequent surgeries. Postoperative hip dislocation occurred in 6 of 27 (22.2%), deep infection occurred in 3 of 27 (11.1%), and aseptic acetabular loosening, seroma requiring irrigation and debridement, pulmonary embolism, periprosthetic fracture, and reintubation each occurred in 1 of 27 (3.7%). Harris hip scores improved significantly with surgery (P = .0002), but overall, scores were lower for those who had major complications (70.9 vs 89.2), and only 20 of 27 patients (74.1%) had good or excellent outcomes. CONCLUSION Symptomatic MACC is a potentially devastating diagnosis, because of decreased soft tissue and bone viability associated with adverse local tissue reaction. This leads to a high early major complication rate.
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Affiliation(s)
- Brian J McGrory
- Tufts University School of Medicine, Boston, Massachusetts; Maine Joint Replacement Institute, Portland, Maine; Maine Medical Center Division of Joint Replacements, Falmouth, Maine
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Metallisation of Biolox Delta® ceramic head: What's wrong? Hip Int 2017; 27:e15-e18. [PMID: 28983889 DOI: 10.5301/hipint.5000544] [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] [Accepted: 05/24/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Since the recent failure of certain coating models, hybrid implants (coated acetabular inserts with conventional stems) and stems with modular necks, there has been growing interest in the consequences of the generation and release of metal particles at the prosthetic interfaces. The use of ceramic heads has recently been described as an option for reducing the production of metal ions and their consequences. CASE REPORT The present case report describes the first complete metallisation of a ceramic head secondary to an excessive release of metal ions at the head-neck junction. CONCLUSIONS We believe this to have occurred due to the use of 12/14 cones of different manufacturers.
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Pseudotumor in ceramic-on-metal total hip arthroplasty. Arthroplast Today 2017; 3:220-224. [PMID: 29204484 PMCID: PMC5712035 DOI: 10.1016/j.artd.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 12/27/2022] Open
Abstract
The increasing demand for total hip arthroplasty (THA) in relatively young, high-demand patients has led to the use of hard-on-hard bearing surfaces. Adverse local tissue reaction/pseudotumor and elevated serum metal ion levels are commonly reported complications encountered in metal-on-metal THA, while audible articulation and rim fracture are reported in ceramic-on-ceramic THA. For this reason, ceramic-on-metal THA was implemented as an ideal hard-on-hard bearing combination. In this report, we describe a case of bilateral simultaneous ceramic-on-metal THA in a 69-year-old woman who presented 7 years postoperatively with unilateral hip pain associated with underlying pseudotumor and elevated serum cobalt and chromium ion levels. Pre-revision workup, intraoperative findings, and postoperative evaluation are included and suggest acetabular malposition as a potential source for complication.
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Ceramic Bearings with Titanium Adapter Sleeves Implanted During Revision Hip Arthroplasty Show Minimal Fretting or Corrosion: a Retrieval Analysis. HSS J 2017; 13:241-247. [PMID: 28983216 PMCID: PMC5617823 DOI: 10.1007/s11420-017-9566-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The BIOLOX® option system, consisting of a BIOLOX® delta ceramic femoral head with a titanium alloy adapter sleeve, is being increasingly utilized in revision hip arthroplasty. The sleeve protects the ceramic head from fracture and improper motion about the stem trunnion when a damaged trunnion is encountered at revision surgery. Corrosion and fretting due to metal-metal contact at the taper region of hip prosthesis create the potential of causing periprosthetic osteolysis and adverse local tissue reactions. QUESTIONS/PURPOSES The objective of this study was to identify the type and extent of damage to retrieved sleeves and ceramic heads to determine their in vivo performance. METHODS Twenty-four ceramic heads with titanium alloy sleeves were examined. The articular and taper surfaces for each ceramic head were assessed for metal transfer using a subjective grading system. All surfaces of the 24 titanium sleeves and stem trunnions (only available for 7 of 24 cases) were assessed for corrosion and fretting using an established grading system. Scanning electron microscopy and energy dispersive X-ray analysis were conducted on representative sample of sleeves. RESULTS Fretting and corrosion were higher at the inner surface of the taper sleeve than the outer sleeve. Mean fretting scores at the inner taper and outer taper sleeve surfaces were 1.8 and 1.2, respectively. The mean corrosion score at the inner taper surface was 1.8; no corrosion was observed on the outer surface of any taper sleeve. SEM and EDS analyses provided further indications of low levels of damage. CONCLUSION Fretting and corrosion were less severe than previously reported for conventional THA metal-metal taper connections, indicating that a ceramic head and titanium sleeve is a safe alternative in revision THA.
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Affiliation(s)
- Mitchell C Weiser
- 1Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Diseases, and Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, NY 2Department of Orthopedics & Rehabilitation, University of Miami, Coral Gables, Florida 3Department of Mechanical and Materials Engineering and Department of Physical Therapy, Florida International University, Coral Gables, Florida
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Wasterlain AS, Bello RJ, Vigdorchik J, Schwarzkopf R, Long WJ. Surgeons' Perspectives on Premium Implants in Total Joint Arthroplasty. Orthopedics 2017; 40:e825-e830. [PMID: 28662250 DOI: 10.3928/01477447-20170619-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/03/2017] [Indexed: 02/03/2023]
Abstract
Declining total joint arthroplasty reimbursement and rising implant prices have led many hospitals to restrict access to newer, more expensive total joint arthroplasty implants. The authors sought to understand arthroplasty surgeons' perspectives on implants regarding innovation, product launch, costs, and cost-containment strategies including surgeon gain-sharing and patient cost-sharing. Members of the International Congress for Joint Reconstruction were surveyed regarding attitudes about implant technology and costs. Descriptive and univariate analyses were performed. A total of 126 surgeons responded from all 5 regions of the United States. Although 76.9% believed new products advance technology in orthopedics, most (66.7%) supported informing patients that new implants lack long-term clinical data and restricting new implants to a small number of investigators prior to widespread market launch. The survey revealed that 66.7% would forgo gain-sharing incentives in exchange for more freedom to choose implants. Further, 76.9% believed that patients should be allowed to pay incremental costs for "premium" implants. Surgeons who believed that premium products advance orthopedic technology were more willing to forgo gain-sharing (P=.040). Surgeons with higher surgical volume (P=.007), those who believed implant companies should be allowed to charge more for new technology (P<.001), and those who supported discussing costs with patients (P=.004) were more supportive of patient cost-sharing. Most arthroplasty surgeons believe technological innovation advances the field but support discussing the "unproven" nature of new implants with patients. Many surgeons support alternative payment models permitting surgeons and patients to retain implant selection autonomy. Most respondents prioritized patient beneficence and surgeon autonomy above personal financial gain. [Orthopedics. 2017; 40(5):e825-e830.].
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MacDonald DW, Chen AF, Lee GC, Klein GR, Mont MA, Kurtz SM, Cates HE, Kraay MJ, Rimnac CM. Fretting and Corrosion Damage in Taper Adapter Sleeves for Ceramic Heads: A Retrieval Study. J Arthroplasty 2017; 32:2887-2891. [PMID: 28668212 DOI: 10.1016/j.arth.2017.04.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/05/2017] [Accepted: 04/13/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND During revision surgery with a well-fixed stem, a titanium sleeve can be used in conjunction with a ceramic head to achieve better stress distribution across the taper surface. In vitro testing suggests that corrosion is not a concern in sleeved ceramic heads; however, little is known about the in vivo fretting corrosion of the sleeves. The purpose of this study was to investigate fretting corrosion in sleeved ceramic heads in retrieved total hip arthroplasties. METHODS Thirty-seven sleeved ceramic heads were collected during revision. The femoral heads and sleeves were implanted 0.0-3.3 years. The implants were revised predominantly for instability, infection, and loosening. Fifty percent of the retrievals were implanted during a primary surgery. Fretting corrosion was assessed using the Goldberg-Higgs semiquantitative scoring system. RESULTS Mild-to-moderate fretting corrosion scores (score = 2-3) were observed in 92% of internal tapers, 19% of external tapers, and 78% of the stems. Severe fretting corrosion was observed in 1 stem trunnion that was previously retained during revision surgery and none of the retrieved sleeves. There was no difference in corrosion damage of sleeves used in primary or revision surgery. CONCLUSION The fretting corrosion scores in this study were predominantly mild and lower than reported fretting scores of cobalt-chrome heads in metal-on-polyethylene bearings. Although intended for use in revisions, we found that the short-term in vivo corrosion behavior of the sleeves was similar in both primary and revision surgery applications. From an in vivo corrosion perspective, sleeves are a reasonable solution for restoring the stem taper during revision surgery.
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Affiliation(s)
- Daniel W MacDonald
- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania
| | - Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregg R Klein
- Department of Orthopaedic Surgery, Hartzband Center for Hip and Knee Replacement, Paramus, New Jersey
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Kurtz
- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania; Department of Biomedical Engineering, Exponent, Inc, Philadelphia, Pennsylvania
| | | | - Harold E Cates
- Department of Orthopaedic Surgery, Tennessee Orthopaedic Clinics, Knoxville, Tennessee
| | - Matthew J Kraay
- Department of Mechanical and Aerospace Engineering, Center for the Evaluation of Implant Performance, Case Western Reserve University, Cleveland, Ohio
| | - Clare M Rimnac
- Department of Mechanical and Aerospace Engineering, Center for the Evaluation of Implant Performance, Case Western Reserve University, Cleveland, Ohio
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Urish KL, Hamlin BR, Plakseychuk AY, Levison TJ, Higgs G, Kurtz S, DiGioia AM. Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head. J Arthroplasty 2017; 32:2857-2863. [PMID: 28478184 PMCID: PMC5572503 DOI: 10.1016/j.arth.2017.03.075] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/11/2017] [Accepted: 03/31/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Gross trunnion failure (GTF) is a rare complication in total hip arthroplasty (THA) reported across a range of manufacturers. Specific lots of the Stryker low friction ion treatment (LFIT) anatomic cobalt chromium alloy (CoCr) V40 femoral head were recalled in August 2016. In part, the recall was based out of concerns for disassociation of the femoral head from the stem and GTF. METHODS We report on 28 patients (30 implants) with either GTF (n = 18) or head-neck taper corrosion (n = 12) of the LFIT CoCr femoral head and the Accolade titanium-molybdenum-zirconium-iron alloy femoral stems. All these cases were associated with adverse local tissue reactions requiring revision of the THA. RESULTS In our series, a conservative estimate of the incidence of failure was 4.7% (n = 636 total implanted) at 8.0 ± 1.4 years from the index procedure. Failures were associated with a high-offset 127° femoral stem neck angle and increased neck lengths; 43.3% (13 of 30) of the observed failures included implant sizes outside the voluntary recall (27.8% [5 of 18] of the GTF and 75.0% [8 of 12] of the taper corrosion cases). Serum cobalt and chromium levels were elevated (cobalt: 8.4 ± 7.0 μg/mL; chromium: 3.4 ± 3.3 μ/L; cobalt/chromium ratio: 3.7). The metal artifact reduction sequence magnetic resonance imaging demonstrated large cystic fluid collections typical with adverse local tissue reactions. During revision, a pseudotumor was observed in all cases. Pathology suggested a chronic inflammatory response. Impending GTF could be diagnosed based on aspiration of black synovial fluid and an oblique femoral head as compared with the neck taper on radiographs. CONCLUSION In our series of the recalled LFIT CoCr femoral head, the risk of impending GTF or head-neck taper corrosion should be considered as a potential diagnosis in a painful LFIT femoral head and Accolade titanium-molybdenum-zirconium-iron alloy THA with unknown etiology. Almost half of the failures we observed included sizes outside of the voluntary recall.
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Affiliation(s)
- Kenneth L. Urish
- The Bone & Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15212. Phone: 412.736.4261; Fax: 717.531.7583,Corresponding Author: The Bone & Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center; Department of Orthopaedic Surgery, College of Medicine, University of Pittsburgh, Pittsburgh, PA 15212.
| | - Brian R. Hamlin
- The Bone & Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15212. Phone: 412.736.4261; Fax: 717.531.7583
| | - Anton Y. Plakseychuk
- The Bone & Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15212. Phone: 412.736.4261; Fax: 717.531.7583
| | - Timothy J. Levison
- The Bone & Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15212. Phone: 412.736.4261; Fax: 717.531.7583
| | - Genymphas Higgs
- Implant Research Center, 3401 Market St., Suite 345, Philadelphia, PA. Phone: 215-901-4520
| | - Steven Kurtz
- Implant Research Center, 3401 Market St., Suite 345, Philadelphia, PA. Phone: 215-901-4520
| | - Anthony M. DiGioia
- The Bone & Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15212. Phone: 412.736.4261; Fax: 717.531.7583
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