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Zajc J, Fokter SK. Bimodular femoral stems in primary total hip arthroplasty. Expert Rev Med Devices 2023; 20:1051-1064. [PMID: 37753590 DOI: 10.1080/17434440.2023.2264177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION This review critically examines the efficacy of dual-modular stems in primary total hip arthroplasty. Given the variability and non-comparability of certain femoral stem designs and stem-neck couplings, with some even being withdrawn from the market, this review offers an in-depth analysis of predominant implant performances. AREAS COVERED The paper explores a brief historical summary related to dual-modular stems, including the complications associated with their use, diagnostic tools for evaluation, analysis of both recalled and currently available models, as well as alternative therapeutic options. This information is pertinent for both clinical and research domains. EXPERT OPINION While dual-modular systems were initially touted to offer several advantages, the evidence substantiating these benefits has been ambiguous. Further, these systems introduce the risk of alternative complications. In specific cases involving patients with developmental hip dysplasia and certain proximal femoral deformities requiring complex reconstructions, dual-modular systems might be relevant. Nonetheless, the use of long interchangeable necks in patients with a body mass index above 30 kg/m2 is discouraged, and pairing a long varus-oriented neck with an extra-long femoral head should be avoided in all patients.
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Affiliation(s)
- Jan Zajc
- Clinical Department of Orthopedic Surgery, University Medical Center Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Samo K Fokter
- Clinical Department of Orthopedic Surgery, University Medical Center Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Huang ZY, Wang SC, Zhang HJ, Shao L, Di ZL, Tao K. Pseudotumor and delayed recurrent dislocation after total hip arthroplasty with a modular femoral neck: A case report. Medicine (Baltimore) 2022; 101:e29056. [PMID: 35356923 PMCID: PMC10684238 DOI: 10.1097/md.0000000000029056] [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: 01/28/2022] [Accepted: 02/24/2022] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Pseudotumor formation after hip arthroplasty is a rare complication that can occur not only at the head-neck junction but also at the modular neck-stem junction. Dislocation is a challenging and common complication of primary and revision total hip arthroplasty compared with other complications. Similarly, the association between pseudotumors and delayed recurrent dislocation remains unclear. PATIENT CONCERNS We report the case of a 73-year-old woman with pseudotumor formation after total hip arthroplasty combined with a modular femoral neck. A delayed recurrent dislocation occurred in this case. Approximately 4weeks after the first revision surgery, redislocation occurred. DIAGNOSIS The patient was eventually diagnosed with delayed recurrent artificial hip dislocation combined with a periprosthetic pseudotumor of the right hip. INTERVENTIONS During the first revision surgery, a thickened, indurated cyst measuring 8×3×8cm with a red-brown wall containing brown fluid was completely excised. A cemented stem, combined with a BIOLOX Forte ceramic head, was implanted. Approximately 4weeks after surgery, redislocation occurred, and we cemented an elevated rim liner on the acetabular component with a metal head. OUTCOMES At the last follow-up, 49 months after revision surgery, the patient was asymptomatic with a Harris hip score of 90. The patient had a satisfactory prognosis after treatment. LESSONS The application of the modular-neck stem should be cautiously performed, particularly for modular prostheses containing different alloys. Pseudotumors and insufficient soft-tissue tension both contribute to hip instability, which may eventually lead to delayed repeated dislocation. In addition, femoral offset must be considered. Cement-liner technology may be used for aging patients who are less active. This case report, focusing on pseudotumors and delayed recurrent dislocations, aimed to identify factors that may support this diagnosis, which is easy to miss. Consequently, it can provide further details on the treatment process and alert orthopedic surgeons to this infrequent but important cause of delayed recurrent dislocation.
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Affiliation(s)
- Zhe-Yu Huang
The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, People’s Republic of China.
| | - Shi-Cheng Wang
The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, People’s Republic of China.
| | - Hao-Jun Zhang
The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, People’s Republic of China.
| | - Long Shao
The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, People’s Republic of China.
| | - Zheng-Lin Di
The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, People’s Republic of China.
| | - Kun Tao
The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, People’s Republic of China.
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Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches. MATERIALS 2021; 14:ma14113078. [PMID: 34199983 PMCID: PMC8200202 DOI: 10.3390/ma14113078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 12/13/2022]
Abstract
Titanium (Ti) alloys have been proven to be one of the most suitable materials for orthopaedic implants. Dual modular stems have been introduced to primary total hip arthroplasty (THA) to enable better control of the femoral offset, leg length, and hip stability. This systematic review highlights information acquired for dual modular Ti stem complications published in the last 12 years and offers a conclusive discussion of the gathered knowledge. Articles referring to dual modular stem usage, survivorship, and complications in English were searched from 2009 to the present day. A qualitative synthesis of literature was carried out, excluding articles referring solely to other types of junctions or problems with cobalt-chromium alloys in detail. In total, 515 records were identified through database searching and 78 journal articles or conference proceedings were found. The reasons for a modular neck fracture of a Ti alloy are multifactorial. Even though dual modular stems have not shown any clinical benefits for patients and have been associated with worse results regarding durability than monolithic stems, some designs are still marketed worldwide. Orthopaedic surgeons should use Ti6Al4V dual modular stem designs for primary THA in special cases only.
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Richardson CG, Laende EK, Gross M, Dunbar MJ. Prospective clinical study using radiostereometric analysis (RSA) to evaluate fixation of a modular cemented polished femoral stem. Hip Int 2021; 31:191-195. [PMID: 31615281 DOI: 10.1177/1120700019881429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The long-term clinical success of cemented polished tapered femoral components has been demonstrated in prospective as well as registry studies. This stem design type has also been well studied with radiostereometric analysis (RSA) and provides a standard to evaluate alternative designs of polished tapered cemented femoral components. This prospective study evaluates the subsidence of a polished cemented stem with a modular neck design utilising RSA. METHODS 26 patients were prospectively enrolled in the study and 23 were available for RSA analysis at 2 years. RESULTS The average subsidence of the femoral implant was 1.1 mm (SD 0.4 mm) at 2 years post operation. There were no revisions in this group, specifically no failures of the modular stem-neck design as has been seen with other implants. CONCLUSIONS The RSA subsidence pattern at 2 years of this cemented femoral stem is similar to other successful designs with long-term follow-up. The implications over time of stem neck modularity for cemented polished tapered femoral components requires further evaluation.
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Affiliation(s)
- C Glen Richardson
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Elise K Laende
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Gross
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Michael J Dunbar
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
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Kiernan S, Kaptein B, Flivik C, Sundberg M, Flivik G. Unexpected varus deformity and concomitant metal ion release and MRI findings of modular-neck hip stems: descriptive RSA study in 75 hips with 8 years' follow-up. Acta Orthop 2021; 92:67-73. [PMID: 33297800 PMCID: PMC7919878 DOI: 10.1080/17453674.2020.1853387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Modular-neck hip stems have been identified with corrosion-related problems from the neck-stem junction. We report an ongoing varus deformity of modular-neck hip stems with simultaneous metal ion release observed during a study comparing the migration of modular vs. standard hip stems.Patients and methods - We followed 50 patients with modular and 25 with standard neck stems using radiostereometry (RSA). At 5-year follow-up, we noted a compromised integrity of the modular stem with varus deformity in the neck-stem interface. Changes in head-tip distance as well as whole-blood ion concentration and MRI findings were analyzed. The modular stems were followed further up to 8 years.Results - The head-tip distance decreased continuously by 0.15 mm per year resulting in 1.2 (95% CI 1.0-1.4) mm at 8 years for modular stems, while for the standard stems at 5 years, the decrease was 0.09 (CI 0.0-0.2) mm or 0.02 mm/year. For the modular stems, the reduction in head-tip distance correlated to the increase in whole-blood cobalt concentration at 8 years but not to the MRI grading of tissue reactions. At 5 years, cobalt levels were 4.9 µg/L for modular stems and at 8 years 4.8 µg/L, whereas for standard stems this was 1.0 µg/L. After 8 years, 9 of 72 stems had been revised for different reasons, but only 1 with obvious adverse local tissue reaction (ALTR).Interpretation - We present a surprisingly large progressive deformation at the modular neck-stem junction, but so far without a definite clinical problem. Even the femoral head seems to show slight compression onto the taper over time. A high rate of revisions for the modular type of this stem has raised general concerns, and it has been recalled from the market.
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Affiliation(s)
- Sverrir Kiernan
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden; ,Correspondence:
| | - Bart Kaptein
- Department of Orthopedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Carl Flivik
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden;
| | - Martin Sundberg
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden;
| | - Gunnar Flivik
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden;
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Extra-Articular Impingement at the Anterior Inferior Iliac Spine: A Cause of Refractory Periarticular Pain After Total Hip Arthroplasty. Arthroplast Today 2020; 6:845-849. [PMID: 33088882 PMCID: PMC7567039 DOI: 10.1016/j.artd.2020.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 06/07/2020] [Accepted: 07/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Periarticular pain after total hip arthroplasty (THA) can significantly impair the postoperative functionality. Extra-articular impingement between the greater trochanter and the anterior inferior iliac spine is presented as a cause of refractive pain after THA. Methods Twenty patients were treated for refractive periarticular pain and limited internal rotation between January 2014 and April 2016. All patients underwent a positive chair rise test, pelvic inclination test, and Marcainisation test. Patients were treated with bone resection of the anterior part of the greater trochanter with or without component revision. Results At a mean follow-up of 20 months, all functional outcomes had improved significantly. All patients were willing to undergo the surgery again. Sixteen (80%) indicated the result as very good, 3 (15%) as good, and one (5%) as poor. Two patients developed a postoperative heterotopic ossification that required resection. Conclusions Extra-articular impingement should be considered as a possible cause of refractive groin pain after THA. Bony resection through the Hueter interval provides immediate pain relief with improved functional outcomes 1 year after surgery.
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Inoue D, Restrepo C, Nourie B, Hozack WJ. Clinical Results of Revision Hip Arthroplasty for Neck-Taper Corrosion and Adverse Local Tissue Reactions Around a Modular Neck Stem. J Arthroplasty 2020; 35:S289-S293. [PMID: 32199761 DOI: 10.1016/j.arth.2020.02.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adverse local tissue reactions (ALTRs) around a modular neck stem at our institution lead to a 13.5% rate of revision. The purpose of this study was to report the clinical results of revision total hip arthroplasty (THA) in this patient population. METHODS We identified 80 hips in 77 patients who underwent revision THA due to neck-stem corrosion. Intraoperative and postoperative complications, clinical outcomes, re-revision rates, and the postoperative ion levels were recorded. RESULTS The mean follow-up period after revision was 45.3 ± 16.3 months (range 24-81 months). There were no intraoperative mechanical complications during the revision surgery. Eight hips (10%) had postoperative complications related to the revision implant, of which 6/8 came to re-revision: postoperative implant dislocation in 4 hips-2 treated nonsurgically, aseptic loosening of femoral component in 2 hips, and periprosthetic femoral fracture in 2 hips. No patients had recurrence of ALTR nor the recurrence of groin pain within the follow-up period. With 2 exceptions, ion levels normalized within one year of the revision surgery. The survival rate was 94% (95% confidence interval 84-98) at 32 months and 82% (95% confidence interval 56-93) at 63 months after revision THA (using re-revision THA due to any reason as the endpoint). CONCLUSION Intraoperative complication, postoperative complication, and re-revision rates are equivalent to femoral revision surgeries for other causes (infection, fracture, loosening). We recommend selecting revision-type stems to minimize the risk of femoral loosening or periprosthetic fracture, and larger femoral heads or dual mobility bearings to minimize the risk of dislocation.
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Affiliation(s)
- Daisuke Inoue
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA; Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Camilo Restrepo
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Blake Nourie
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| | - William J Hozack
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA
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Inoue D, Restrepo C, Nourie B, Restrepo S, Hozack WJ. Patients With Modular-Neck Total Hip Arthroplasty: A Brief Five-Year Follow-Up Study. J Arthroplasty 2020; 35:S268-S272. [PMID: 32199762 DOI: 10.1016/j.arth.2020.02.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We have previously reported the early clinical results of a modular-neck stem identifying an early 2-year revision rate of 13% due to neck-stem corrosion. This report updates our findings to a midterm mean follow-up of 5 years. METHODS This is a consecutive retrospective review of 186 modular-neck hips in 175 patients with a mean follow-up period was 60.1 ± 22.9 months (range 24-100). We reviewed clinical findings, routine radiographs, detailed imaging (metal artifact reduction software-magnetic resonance imaging, ultrasound), and serum ion levels of cobalt and chromium. We performed a survival analysis with the endpoint defined as revision total hip arthroplasty due to neck-stem corrosion. RESULTS We revised 41 hips (22.0%) for neck-stem corrosion. Clinical symptoms (groin pain ± local swelling) were consistently present in those that came for revision. Mean serum cobalt ion levels increased as time passed in all patients. Detailed image findings showed that larger fluid collections and local soft tissue masses were seen predominately in symptomatic patients. However, 14% of patients who underwent revision did not have positive magnetic resonance imaging or ultrasound findings. The survival rate was 87% (95% confidence interval 81-92) at 3 years postoperatively and 72% (95% confidence interval 64-80) at 7 years postoperatively. CONCLUSION The revision rate for this modular-neck stem due to neck-stem corrosion at mid-term follow-up almost doubled in comparison to previous short-term results. It seems reasonable to consider clinical follow-up alone as symptoms, rather than blood testing for ion levels, seem to be the defining characteristic of failure.
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Affiliation(s)
- Daisuke Inoue
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA; Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Camilo Restrepo
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Blake Nourie
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Santiago Restrepo
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| | - William J Hozack
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA
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Grupp TM, Baxmann M, Jansson V, Windhagen H, Heller KD, Morlock MM, Knaebel HP. How to proceed with asymptomatic modular dual taper hip stems in the case of acetabular revision. MATERIALS 2020; 13:ma13051098. [PMID: 32121627 PMCID: PMC7084958 DOI: 10.3390/ma13051098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
How to proceed with a clinically asymptomatic modular Metha® Ti alloy stem with dual taper CoCr neck adapter in case of acetabular revision? To systematically answer this question the status of research and appropriate diagnostic methods in context to clinically symptomatic and asymptomatic dual taper stem-neck couplings has been evaluated based on a systematic literature review. A retrieval analysis of thirteen Metha® modular dual taper CoCr/Ti alloy hip stems has been performed and a rational decision making model as basis for a clinical recommendation was developed. From our observations we propose that in cases of acetabular revision, that for patients with a serum cobalt level of > 4 µg/L and a Co/Cr ratio > 3.6, the revision of the modular dual taper stem may be considered. Prior to acetabular revision surgery a systematic diagnostic evaluation should be executed, using specific tests such as serum metal (Co, Cr) ion analysis, plain antero-posterior and lateral radiographs and cross-sectional imaging modalities (Metal Artefact Reduction Sequence Magnetic Resonance Imaging). For an asymptomatic Metha® dual taper Ti alloy/CoCr stem-neck coupling at the stage of acetabular revision careful clinical decision making according to the proposed model should be followed and overreliance on any single examination should be avoided, considering the complete individual differential diagnosis and patient situation.
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Affiliation(s)
- Thomas M. Grupp
- Aesculap AG Research & Development, 78532 Tuttlingen, Germany;
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern Ludwig Maximilians University Munich, 81377 Munich, Germany;
- Correspondence: ; Tel.: +49-7461-95-2667; Fax: +49-7461-95-382667
| | - Marc Baxmann
- Aesculap AG Research & Development, 78532 Tuttlingen, Germany;
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern Ludwig Maximilians University Munich, 81377 Munich, Germany;
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany;
| | - Karl-Dieter Heller
- Department of Orthopaedic Surgery, Herzogin-Elisabeth-Hospital, 38124 Braunschweig, Germany;
| | - Michael M. Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, 21073 Hamburg, Germany;
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Aboltins CA, Antoci V, Bhattacharyya S, Cross M, Ducheyne P, Freiberg AA, Hailer N, Kay P, Ketonis C, Klement MR, Köse N, Lee M, Mitchell P, Nandi S, Palacio JC, Perry K, Prieto H, Shahi A, Trebše R, Turner D, Wu CT, Yazdi H. Hip and Knee Section, Prevention, Prosthesis Factors: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S309-S320. [PMID: 30348551 DOI: 10.1016/j.arth.2018.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Di Laura A, Hothi HS, Henckel J, Kwon YM, Skinner JA, Hart AJ. Retrieval Findings of Recalled Dual-Taper Hips. J Bone Joint Surg Am 2018; 100:1661-1672. [PMID: 30277996 PMCID: PMC6211785 DOI: 10.2106/jbjs.17.00790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The recent high-profile recalls of several dual-taper hip designs pose questions regarding why those designs perform poorly. We aimed to characterize taper damage in 1 recalled design to understand failure mechanisms to inform surgeons on which patients should be considered at risk of revision and when to revise. METHODS High-precision measurement equipment was used to characterize the metal loss from the neck-stem interface of 116 retrieved Rejuvenate femoral stems (Stryker Howmedica Osteonics) revised because of an adverse reaction to metal debris. Head-neck taper surfaces were also investigated, and clinical and laboratory data were examined. RESULTS The neck-stem junction of each implant was moderately to severely corroded and showed a characteristic wear pattern on both male and female taper surfaces. The severity of taper damage was positively correlated with time to revision (coefficient, 0.040 [95% confidence interval (CI), 0.028 to 0.051]; p < 0.0001) and with serum cobalt concentration (coefficient, 0.02 [95% CI, 0.01 to 0.02]; p < 0.0001) and serum chromium concentration (coefficient, 0.04 [95% CI, 0.009 to 0.070]; p = 0.0142). CONCLUSIONS A forensic examination of the retrieved components that failed secondary to an adverse reaction to metal debris showed, in all cases, visible corrosion. Of the implant and patient factors investigated, we did not identify any predictors of corrosion. The severity of damage was found to increase with time; cobalt was significantly elevated over chromium. CLINICAL RELEVANCE Surgeons should scrupulously follow and consider revision for patients with this implant design to avoid extensive tissue excision. Blood metal ion tests may aid in identifying the mechanisms of taper corrosion.
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Affiliation(s)
- Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom,E-mail address for A. Di Laura:
| | - Harry S. Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Young-Min Kwon
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John A. Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Alister J. Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Effect of simulated inflammatory conditions and potential on dissolution and surface oxide of CoCrMo alloy: In situ electrochemical atomic force microscopy study. Electrochim Acta 2018. [DOI: 10.1016/j.electacta.2017.12.151] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Konya MN, Korkusuz F, Maralcan G, Demir T, Aslan A. The use of a proximal femoral nail as a hip prosthesis: A biomechanical analysis of a newly designed implant. Proc Inst Mech Eng H 2018; 232:200-206. [DOI: 10.1177/0954411917751561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Complication rates of hip fractures after proximal femoral nail are not rare. In such fractures, treatment invariably comprises the extraction of proximal femoral nail and the introduction of a different hip prosthesis. To solve this problem, we aimed to develop a new implant, the modular nail prosthesis, which combines an intramedullary nail with a hip prosthesis. The aim of this study was to determine the effect of stress load distribution on the stem using finite element analysis under laboratory conditions. For this, the shortest stem of 175 mm was chosen. In addition, six proximal femoral nail–hip prosthesis combinations were produced and tested with a biomechanical test device and passed 2300-N load bearing. According to the test results, our newly developed modular nail prosthesis can be converted to hip prosthesis securely.
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Affiliation(s)
- Mehmet Nuri Konya
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Feza Korkusuz
- Department of Sports Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokhan Maralcan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Teyfik Demir
- Department of Mechanical Engineering, TOBB University of Economics and Technology, Ankara, Turkey
| | - Ahmet Aslan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Antalya, Turkey
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Pelayo-de-Tomás JM, Rodrigo-Pérez JL, Novoa-Parra CD, Lizaur-Utrilla A, Morales-Suárez-Varela M, Blas-Dobón JA. Cementless modular neck stems: are they a safe option in primary total hip arthroplasty? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:463-469. [PMID: 29082427 DOI: 10.1007/s00590-017-2071-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/14/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE The objective was to assess aseptic complications and functional outcome using a primary total hip arthroplasty with modular neck. METHODS Prospective cohort of 317 consecutive patients. The mean age was 61.1 (range, 41-84) years. The H-Max-M model (Lima, Italy) system was used in all patients. The functional assessment was made by the Harris Hip Score, Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index and visual analogue scale for pain. Radiological outcomes were also assessed, and adverse events and complications were noted. RESULTS The mean follow-up was 6.1 (range, 2-8) years. Functional outcome significantly improved in most patients. There were 3 deep infections (0.9%) and 17 aseptic complications (5.3%) including 1 intraoperative acetabular fracture, 3 later periprosthetic femoral fractures, 1 broken ceramic insert, 1 acetabular loosening, 3 femoral loosening and 1 broken titanium modular neck in a obese patient. No pseudotumors or elevated serum levels of metal ions were found among the patients with radiolucent lines or aseptic loosening. CONCLUSIONS The findings in the present study showed that the H-MAX-M stem provided satisfactory functional outcome in most patients with a low rate of complications attributable to the modular neck design. We consider that using this novel modular neck-stem coupling design can be an alternative to the conventional monoblock stems in patients without overweight.
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Affiliation(s)
- José M Pelayo-de-Tomás
- Department of Orthopaedic Surgery, Doctor Peset University Hospital, Av Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - José L Rodrigo-Pérez
- Department of Orthopaedic Surgery, Doctor Peset University Hospital, Av Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - Carlos D Novoa-Parra
- Department of Orthopaedic Surgery, Doctor Peset University Hospital, Av Gaspar Aguilar, 90, 46017, Valencia, Spain.
| | | | - María Morales-Suárez-Varela
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - José Antonio Blas-Dobón
- Department of Orthopaedic Surgery, Doctor Peset University Hospital, Av Gaspar Aguilar, 90, 46017, Valencia, Spain
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15
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Collet T, Atanasiu JP, de Cussac JB, Oufroukhi K, Bothorel H, Saffarini M, Badatcheff F. Midterm outcomes of titanium modular femoral necks in total hip arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:395. [PMID: 29152495 DOI: 10.21037/atm.2017.07.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Modular femoral necks present surgical and biomechanical advantages in total hip arthroplasty (THA), but their benefits remain controversial due to risks of corrosion and fracture at the additional junction. This study aimed to report 10-year survival and clinical outcomes of a titanium femoral stem with a titanium modular neck in consecutive series. Methods The authors reviewed the records of 97 patients (99 THAs) using uncemented modular stem and ceramic-on-ceramic acetabular components. Patients were evaluated at minimum follow-up of 5 years using the Harris Hip Score (HHS) and Postel Merle-D'Aubigné score (PMA). Survival was calculated using the Kaplan-Meier (KM) method with any reoperation or revision as endpoint. Results From the original cohort, 14 patients died, 6 were lost to follow-up, and 5 had revision operations with exchange of the femoral stem. The KM survival at 10 years was 94.2% (CI, 86.5-97.5). Clinical assessment was performed on 67 of the 72 patients (69 of the 74 hips) presently living with their original THA components. At mean follow-up of 9.4±1.0 years (median, 10; range, 5-11), the HHS was 93.6±8.2 and the PMA score 17.0±1.6. The X-rays revealed no signs of adverse reactions or bone loss. Conclusions The uncemented titanium hip stem with modular titanium neck provided a satisfactory 10-year survival and clinical outcomes. Neck modularity enabled restoration of patient-specific femoral offset and limb length thanks to five possible neck configurations, though greater follow up is required to confirm the long-term benefits and safety of this design concept.
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Affiliation(s)
- Thurial Collet
- Polyclinique de l'Europe, Unité de chirurgie orthopédique réparatrice et sportive, St Nazaire, France
| | - Jean-Pierre Atanasiu
- Chirurgie Orthopédique et Traumatologique, Polyclinique de Poitiers, Poitiers Cedex, France
| | - Jean-Baptiste de Cussac
- Polyclinique de l'Europe, Unité de chirurgie orthopédique réparatrice et sportive, St Nazaire, France
| | - Kamal Oufroukhi
- Clinique Chirurgicale de la Loire, Rue des Rolletières, Saumur, France
| | | | - Mo Saffarini
- Medical Technology, ReSurg SA, Nyon, Switzerland
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16
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Di Laura A, Quinn PD, Panagiotopoulou VC, Hothi HS, Henckel J, Powell JJ, Berisha F, Amary F, Mosselmans JFW, Skinner JA, Hart AJ. The Chemical Form of Metal Species Released from Corroded Taper Junctions of Hip Implants: Synchrotron Analysis of Patient Tissue. Sci Rep 2017; 7:10952. [PMID: 28887488 PMCID: PMC5591307 DOI: 10.1038/s41598-017-11225-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/21/2017] [Indexed: 02/08/2023] Open
Abstract
The mechanisms of metal release from the articulation at the head cup bearing and the tapered junctions of orthopaedic hip implants are known to differ and the debris generated varies in size, shape and volume. Significantly less metal is lost from the taper junction between Cobalt-Chromium-Molybdenum (CoCrMo) and Titanium (Ti) components (fretting-corrosion dominant mechanism), when compared to the CoCrMo bearing surfaces (wear-corrosion dominant mechanism). Corrosion particles from the taper junction can lead to Adverse Reactions to Metal Debris (ARMD) similar to those seen with CoCrMo bearings. We used synchrotron methods to understand the modes underlying clinically significant tissue reactions to Co, Cr and Ti by analysing viable peri-prosthetic tissue. Cr was present as Cr2O3 in the corroded group in addition to CrPO4 found in the metal-on-metal (MoM) group. Interestingly, Ti was present as TiO2 in an amorphous rather than rutile or anatase physical form. The metal species were co-localized in the same micron-scale particles as result of corrosion processes and in one cell type, the phagocytes. This work gives new insights into the degradation products from metal devices as well as guidance for toxicological studies in humans.
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Affiliation(s)
- Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
| | - Paul D Quinn
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, United Kingdom
| | - Vasiliki C Panagiotopoulou
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Jonathan J Powell
- Biomineral Research Group, Dept Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Fitim Berisha
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Fernanda Amary
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - J Fred W Mosselmans
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, United Kingdom
| | - John A Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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17
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Excellent mid-term results of a new polished tapered modular cemented stem: a study of 113 hip replacements with minimum 5-year follow-up. Hip Int 2017; 27:455-459. [PMID: 28222212 PMCID: PMC6380089 DOI: 10.5301/hipint.5000486] [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] [Accepted: 11/11/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND This prospective cohort study reports the medium-term clinical and radiographic results of 113 hips treated with a hybrid total hip replacement (THR) with a new cemented tapered cobalt-chrome (Co-Cr) stem with a titanium (Ti) modular neck (ProfemurXm®). METHOD Between October 2008 and December 2010 we performed 115 consecutive hybrid THR with the ProfemurXm® in 105 patients. RESULTS Survivorship of the implant (stem and modular neck) at a mean of 6.5 years (min 5-max 8) was 100% with the endpoint revision for any reason. No implant was at risk for revision or showed signs of loosening. The mean Harris Hip Score was 89/100, mean Oxford Hip Score was 43/48, mean WOMAC was 91/100. No patient had thigh pain, no patient reported squeaking. There were no dislocations in this cohort. No implant showed development of radiolucent lines (RLL), either at the stem-cement or cement-bone interface. No hip showed osteolysis or calcar resorption. The mean femoral subsidence of the stem within the cement mantel was 0.31 mm (range 0-0.6 mm) after 6.5 years. With the use of this modular stem, 93% of hips showed no measurable leg length difference after THR, and leg length could be restored within a 5-mm limit in 99% of hips. CONCLUSIONS The mid-term results of this new polished stem were excellent, without adverse effects from the use of modularity.
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18
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Aljenaei F, Catelas I, Louati H, Beaulé PE, Nganbe M. Effects of hip implant modular neck material and assembly method on fatigue life and distraction force. J Orthop Res 2017; 35:2023-2030. [PMID: 27862223 DOI: 10.1002/jor.23481] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/03/2016] [Indexed: 02/04/2023]
Abstract
Hip implant neck fractures and adverse tissue reactions associated with fretting-corrosion damage at modular interfaces are a major source of concern. Therefore, there is an urgent clinical need to develop accurate in vitro test procedures to better understand, predict and prevent in vivo implant failures. This study aimed to simulate in vivo fatigue fracture and distraction of modular necks in an in vitro setting, and to assess the effects of neck material (Ti6Al4V vs. CoCrMo) and assembly method (hand vs. impact) on the fatigue life and distraction of the necks. Fatigue tests were performed on the cementless PROFEMUR® Total Hip Modular Neck System under two different loads and number of cycles: 2.3 kN for 5 million cycles, and 7.0 kN for 1.3 million cycles. The developed in vitro simulation setup successfully reproduced in vivo modular neck fracture mode and location. Neck failure occurred at the neck-stem taper and the fracture ran from the distal lateral neck surface to the proximal medial entry point of the neck into the stem. None of the necks failed under the 2.3 kN load. However, all hand-assembled Ti6Al4V necks failed under the 7.0 kN load. In contrast, none of the hand-assembled CoCrMo necks and impact-assembled necks (Ti6Al4V or CoCrMo) failed under this higher load. In conclusion, Ti6Al4V necks were more susceptible to fatigue failure than CoCrMo necks. In addition, impact assembly substantially improved the fatigue life of Ti6Al4V necks and also led to overall higher distraction forces for both neck materials. Overall, this study shows that the material and assembly method can affect the fatigue strength of modular necks. Finally, improper implant assembly during surgery may result in diminished modular neck survivability and increased failure rates. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2023-2030, 2017.
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Affiliation(s)
- Fahad Aljenaei
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Isabelle Catelas
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada.,Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Hakim Louati
- Orthopaedic Biomechanics Laboratory, Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Division of Orthopaedic Surgery, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.,Orthopaedic Biomechanics Laboratory, Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Division of Orthopaedic Surgery, Ottawa, Ontario, Canada
| | - Michel Nganbe
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
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19
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Colas S, Allalou A, Poichotte A, Piriou P, Dray-Spira R, Zureik M. Exchangeable Femoral Neck (Dual-Modular) THA Prostheses Have Poorer Survivorship Than Other Designs: A Nationwide Cohort of 324,108 Patients. Clin Orthop Relat Res 2017; 475:2046-2059. [PMID: 28194710 PMCID: PMC5498370 DOI: 10.1007/s11999-017-5260-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/19/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Exchangeable neck stems, defined as those with a dual taper (that is, a modular junction between the femoral head and the femoral neck and an additional junction between the neck and the stem body), were introduced in THA to improve restoration of joint biomechanics (restoring anteversion, offset, and limb length) and reduce the risk of dislocation. However exchangeable necks have been reported to result in adverse effects such as stem fractures and acute local tissue reaction. Whether they result in a net improvement to or impairment of reconstructive survivorship remains controversial. QUESTIONS/PURPOSES (1) To compare the prosthetic survivorship and all-cause revision risk of exchangeable femoral neck THAs versus fixed neck THAs, taking known prosthetic revision risk factors into account; and (2) to compare the cause-specific revision risk of exchangeable femoral neck THAs versus fixed neck THAs, adjusting for known prosthetic risk factors. METHODS Using French national health-insurance databases, we identified all French patients older than 40 years who underwent primary THA from 2009 through 2012. To ensure accuracy of the data, we considered only beneficiaries of the general insurance scheme (approximately 77% of the population). Characteristics of the prosthesis and the patients receiving an exchangeable femoral neck THA were compared with those receiving a fixed femoral neck THA (defined as femoral stem with only the head being exchangeable). Revision was the event of interest. Followup started on the date the THA was performed, until the patient experienced revision, died, was lost to followup, or until the followup period ended (December 31, 2014), whichever came first. Competing risk THA survivorship was calculated and compared (purpose 1), as were cause-specific Cox regression models (purpose 2). The study cohort included 324,108 individuals with a mean age of 77 years. A total of 24% underwent THA for acute trauma, and 3% of the group received an exchangeable neck THA. During the median 45-month followup (mean, 42 months; minimum, 1 day; maximum, 6 years), 11,968 individuals underwent prosthetic revision. RESULTS The cumulative revision incidence was 6.5% (95% CI, 5.8%-7.3%) for exchangeable neck THAs versus 4.7% (95% CI, 4.6%-4.8%) for fixed neck THAs (p < 0.001). After controlling for potential confounding variables including age, sex, comorbidities, indication for THA, cementation, bearing surface, and the characteristics of the center where the implantation was performed, we found that the exchangeable femoral neck THA was associated with an increased hazard ratio (HR) of revision of 1.26 (95% CI, 1.14-1.38; p < 0.001) compared with the fixed neck THA. When dealing with cause-specific revision, exchangeable neck THAs had a higher incidence of revision for implant failure or periprosthetic fracture, and for mechanical complications; adjusted HRs were, respectively, 1.68 (95% CI, 1.24-2.27; p < 0.001) and 1.27 (95% CI, 1.13-1.43; p < 0.001), for exchangeable neck THAs compared with fixed ones. CONCLUSIONS Exchangeable neck THAs had poorer survivorship independent of other prosthetic revision risk factors. Accordingly, expected anatomic and functional benefits should be carefully assessed before choosing this design. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Sandrine Colas
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Assia Allalou
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | | | | | - Rosemary Dray-Spira
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Mahmoud Zureik
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
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20
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Su SL, Koch CN, Nguyen TM, Burket JC, Wright TM, Westrich GH. Retrieval Analysis of Neck-Stem Coupling in Modular Hip Prostheses. J Arthroplasty 2017; 32:2301-2306. [PMID: 28262451 DOI: 10.1016/j.arth.2017.02.016] [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: 10/04/2016] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Dual-taper modular stems have suffered from high revision rates caused by adverse local tissue reactions secondary to fretting and corrosion. We compared the fretting and corrosion behavior of a group of modular neck designs to that of a design that had been recalled for risks associated with fretting and corrosion at the modular neck junction. METHODS We previously analyzed fretting and corrosion on 60 retrieved Rejuvenate modular neck-stem implants. Here we compare those results to results from 26 retrieved implants from 7 other modular neck designs. For the 26 additional cases, histology slides of tissue collected at revision were reviewed and graded for aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). Multivariate analyses were performed to assess differences in fretting and corrosion, adjusting for confounding factors (eg, length of implantation). RESULTS The Rejuvenate design had higher damage and corrosion scores than the other 7 designs (P < .01). Histologic samples from the recalled design were 20 times more likely to show ALVAL than samples from the other designs (P < .01). Mixed metal couples had higher fretting (P < .01) and corrosion (P = .02) scores than non-mixed metal couples. CONCLUSION Fretting and corrosion occurred on all modular neck-stem retrievals regardless of design. However, mixed metal couples suffered more corrosion than homogenous couples. This may be due to the lower modulus of the titanium alloy used for the stem, allowing for increased metal transfer and surface damage when loaded against a cobalt alloy modular neck, which in turn could account for the higher ALVAL and corrosion scores. Due to increased corrosion risk with mixed metals and increased neck fracture risk with non-mixed metal stem and necks, we suggest that clinicians avoid implantation of modular neck-stem systems.
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Affiliation(s)
- Sherwin L Su
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Chelsea N Koch
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Thu M Nguyen
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Jayme C Burket
- Healthcare Research Institute, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
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21
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Dundon JM, Ramkumar PN, Lajam C. Tribocorrosion in Total Hip Arthroplasty. JBJS Rev 2017; 5:01874474-201703000-00005. [DOI: 10.2106/jbjs.rvw.16.00055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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22
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Metal ion levels in ceramic-on-ceramic THR with cobalt-chrome modular necks: analysis of cobalt and chromium serum levels in 23 healthy hip patients. Hip Int 2017; 27:21-25. [PMID: 27791242 DOI: 10.5301/hipint.5000430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Modular necks in total hip replacement (THR) can be a source of metal ion release. METHODS We measured the level of cobalt (Co) and chromium (Cr) ions in the serum of 23 healthy volunteers with a well-functioning ceramic-on-ceramic THR of a particular design, containing a cobalt-chrome (Co-Cr) stem and a Co-Cr modular neck. RESULTS Average Co in serum was 1,71 µg/l; median Co was 1.50 µg/l. No patient had Co levels higher than 3.70 µg/l. Average Cr level was 0.49 µg/l; in all but one patient Cr was below the detection limit (<0.50 µg/l). Co was higher for varus necks compared to all other subtypes: 2.14 µg/l vs 1.58 µg/l (p<0.05). The same system with Titanium modular necks shows lower Co serum levels: 1.26 µg/l (p<0.01 ). In conclusion, the hybrid THR Profemur Xm® - Procotyle L® with a Co-Cr modular neck on a Co-Cr stem design shows very low Cr ion serum levels in a randomly selected group of well-functioning hip patients. CONCLUSIONS Co ion serum levels are low, but significantly higher for 8° varus necks, and Co levels are significantly higher than values of this system with a Titanium modular neck.
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23
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Kwon YM, Antoci V, Eisemon E, Tsai TY, Yan Y, Liow MHL. "Top-Out" Removal of Well-Fixed Dual-Taper Femoral Stems: Surgical Technique and Radiographic Risk Factors. J Arthroplasty 2016; 31:2843-2849. [PMID: 27444847 DOI: 10.1016/j.arth.2016.05.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/29/2016] [Accepted: 05/23/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Contemporary "dual-taper" modular femoral neck-stem designs have been associated with taper corrosion-related adverse local tissue reaction (ALTR) requiring revision surgery and stem removal. Extended trochanteric osteotomy is recognized as the workhorse procedure for revision hip surgery. The aim of our study is to describe our "top-out" stem removal surgical technique and identify preoperative radiographic risk factors associated with periprosthetic fractures when using this technique. METHODS This is a single-center, single-surgeon, retrospective case series. Operative and clinic records were reviewed for patients with dual-taper modular femoral neck-stem junction who underwent revision surgery for taper tribocorrosion-related ALTR. RESULTS Eighty-three patients (36 men and 47 women; mean age, 61.8 ± 10.3; body mass index, 30.2 ± 8.6) were revised using the top-out technique. Significant improvements in postoperative Harris hip score (P = .004), EuroQol 5-dimension questionnaire (EQ-5D; P < .001), and EQ-5D US-adjusted scores (P < .001) were observed at 19-months follow-up. Our study reports periprosthetic fracture incidence of 14% and reoperation rate of 7%. Periprosthetic fractures were positively correlated with radiographic parameters such as overhang distance (R = 0.376; P = .002) and overhang ratio (R = 0.312; P = .01) and negatively correlated with radiographic implant medial calcar prominence (R = -0.299; P = .01). CONCLUSION Removal of well-fixed femoral components can be challenging, and the burden of revision surgery for taper tribocorrosion-related ALTR of these femoral stems is likely to rise. A top-out technique with systematic preoperative planning with radiographs provides a viable, alternative surgical option to remove well-fixed femoral component while preserving the femoral bony envelope.
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Affiliation(s)
- Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Valentin Antoci
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric Eisemon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yu Yan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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24
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Elmallah RK, Cherian JJ, Meneghini RM, Hozack WJ, Westrich GH, Mont MA. How to Approach a Recalled Dual Modular Hip Implant: An Update. J Arthroplasty 2016; 31:2646-2652. [PMID: 27542855 DOI: 10.1016/j.arth.2016.06.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/08/2016] [Accepted: 06/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study was to provide an update on the "Modular taper junction corrosion and failure: how to approach a recalled total hip arthroplasty implant" (Pivec et al JOA 2014) publication. METHODS We performed a comprehensive review of the literature in English, with search terms referencing to the diagnosis, management, and outcomes of patients who underwent total hip arthroplasty with a recalled dual modular hip implant. RESULTS Based on this review and the new guidelines by the American Academy of Orthopedic Surgeons and the Hip Society, we propose an updated algorithm for the diagnosis and management of patients with these recalled implants. CONCLUSION When encountering patients with these prostheses, it is imperative to take a step-by-step approach to evaluate whether patients are having potential complications. We hope that this has further clarified the appropriate steps that need to be carried out when confronted with these recalled devices.
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Affiliation(s)
- Randa K Elmallah
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeffrey J Cherian
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Robert M Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - William J Hozack
- Department of Orthopedic surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Geoffrey H Westrich
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Michael A Mont
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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25
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Tischler EH, Plummer DR, Chen AF, Della Valle CJ, Parvizi J. Leukocyte Esterase: Metal-on-Metal Failure and Periprosthetic Joint Infection. J Arthroplasty 2016; 31:2260-3. [PMID: 27094243 DOI: 10.1016/j.arth.2016.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 03/01/2016] [Accepted: 03/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adverse local tissue reactions (ALTRs) and periprosthetic joint infection can occur after metal-on-metal total hip arthroplasty (THA), both potentially generating purulent synovial fluid (SF) and elevated white cell count. This makes it difficult to distinguish between diagnoses; therefore, we evaluated leukocyte esterase (LE) strip test's reliability in ruling out periprosthetic joint infection in ALTR revision THA. METHODS Sixty-one patients with ALTRs and an LE strip test were evaluated, excluding 15 cases with SF metallic debris. LE strip tests were classified -/trace, + (mildly positive), and ++ (strongly positive). RESULTS LE strip tests were ++, +, -/trace in 8 patients (13.1%), 14 (23.0%), and 39 (63.9%), respectively. Means and ranges of SF white cell count and polymorphonuclear percentage were 1291.4 (0-10,886 cells/μL), and 46.1% (0%-94%), respectively. CONCLUSION ++ LE strip test, in conjunction with preoperative work-ups, reliably rules out infection in 92.9% of patients undergoing THA revision secondary to ALTR.
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Affiliation(s)
- Eric H Tischler
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Antonia F Chen
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Javad Parvizi
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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26
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Barlow BT, Ortiz PA, Fields KG, Burge AJ, Potter HG, Westrich GH. Magnetic Resonance Imaging Predicts Adverse Local Tissue Reaction Histologic Severity in Modular Neck Total Hip Arthroplasty. J Arthroplasty 2016; 31:2325-31. [PMID: 27118350 DOI: 10.1016/j.arth.2016.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The association between advanced imaging, serum metal ion levels, and histologic adverse local tissue reaction (ALTR) severity has not been previously reported for Rejuvenate modular neck femoral stems. METHODS A cohort of 90 patients with 98 Rejuvenate modular neck femoral stems was revised by a single surgeon from July 2011 to December 2014. Before revision, patients underwent multiacquisition variable resonance image combination sequence magnetic resonance imaging (MRI), and serum cobalt and chromium ion levels were measured. Histologic samples from the revision surgery were scored for synovial lining, inflammatory infiltrate, and tissue organization as proposed by Campbell. Regression based on the generalized estimating equations approach was used to assess the univariate association between each MRI, demographic, and metal ion measure and ALTR severity while accounting for the correlation between bilateral hips. Random forest analysis was then used to determine the relative importance of MRI characteristics, demographics, and metal ion levels in predicting ALTR severity. RESULTS Synovial thickness as measured on MRI was found to be the strongest predictor of ALTR histologic severity in a recalled modular neck femoral stem. CONCLUSION MRI can accurately describe ALTR in modular femoral neck total hip arthroplasty. MRI characteristics, particularly maximal synovial thickness and synovitis volume, predicted histologic severity. Serum metal ion levels do not correlate with histologic severity in Rejuvenate modular neck total hip arthroplasty.
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Affiliation(s)
- Brian T Barlow
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Philippe A Ortiz
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Kara G Fields
- Epidemiology and Biostatistics Core, Hospital for Special Surgery, New York, New York
| | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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High serum ion levels in Conserve Plus big femoral head cemented total hip arthroplasty. Hip Int 2016; 26:474-478. [PMID: 27646510 DOI: 10.5301/hipint.5000385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 02/04/2023]
Abstract
AIM We report the short-term clinical, radiographic and ion level data of the Conserve Plus metal-on-metal (MoM) big femoral head (BFH) total hip arthroplasty (THA), used with a cemented cobalt-chrome (Co-Cr) Profemur Xm stem and a titanium (Ti) modular neck. RESULTS In a consecutive series of 40 hips, survivorship at 3 years was 92.5% with revision for any reason. Average Harris Hip Score was 91.3. There were no implant loosenings. No osteolysis was observed. 5 patients had signs of adverse local tissue reaction (ALTR); their clinical scores were not different from the whole cohort. All but 1 patient had their Co serum ion levels measured. The average Co level was 14,1 µg/l (range 0.9-29.0; median 13.0 µg/l). Clinical scores did not correlate with ion level data. A comparative group of 42 hip resurfacing arthroplasties from the same manufacturer had significantly lower serum Co levels: 1.51 µg/l (range 0.9-4.0; median 0.9 µg/l). CONCLUSIONS All patients with the MoM BFH THA design should be followed regularly and should have ion level testing.
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Metal ion levels in ceramic-on-ceramic THR with modular necks: analysis of cobalt and chromium serum levels in 30 healthy hip patients. Hip Int 2016; 25:484-7. [PMID: 26391261 DOI: 10.5301/hipint.5000257] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Modular necks in total hip replacement (THR) can be a source of metal ion release. There are no data to date on the level of cobalt and chromium ions in the serum of patients with a cobalt-chrome stem and a titanium modular neck. METHODS Serum ion levels were measured in healthy volunteers with a well-functioning ceramic-on-ceramic THR. RESULTS Average cobalt in serum was 1.21 µg/l for unilateral THR and 2.2 µg/l for bilateral THR. No patient had cobalt levels higher than 2.4 µg/l. No patient had measurable chromium levels. There were no differences in cobalt levels for hips with short necks versus hips with long necks. CONCLUSIONS The hybrid THR Profemur® Xm - Procotyl® L with a titanium modular neck on a cobalt-chrome stem design shows no signs of abnormal toxic ion levels (cobalt or chromium) in a randomly selected group of well-functioning hip patients.
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Early Outcomes of Revision Surgery for Taper Corrosion of Dual Taper Total Hip Arthroplasty in 187 Patients. J Arthroplasty 2016; 31:1549-54. [PMID: 26895822 DOI: 10.1016/j.arth.2016.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/28/2015] [Accepted: 01/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Modular dual taper femoral neck designs have been associated with taper corrosion requiring revision surgery. However, outcomes after revision dual taper total hip arthroplasty in patients with symptomatic adverse local tissue reaction due to taper corrosion remain largely unknown. METHODS A total of 198 revision surgeries in 187 patients with dual taper femoral stem total hip arthroplasty with minimum 12-month follow-up were evaluated. RESULTS At mean follow-up of 18 months, at least 1 complication had occurred in 39 patients (20%) of 198 revisions. Single episode of dislocation, treated with close reduction, occurred in 16, whereas 2 patients required rerevision due to multiple dislocations. Infection requiring rerevision occurred in 3 patients. Adverse local tissue reaction recurrence requiring reoperation occurred in 6 patients. Implant survivorship for revision for any cause was 86% at 30 months. The reoperation rate of revised dual taper was 8% (16 out of 198 hips). The median serum levels of cobalt, chromium, and cobalt/chromium ratio decreased (P < .01) from 5.3 μg/L (range: 2.3-48.5 μg/L), 2.6 μg/L (range: 0.2-64 μg/L), and 4.7 (range: 2.1-35) prerevision to 1.4 μg/L (range: 0.2-8.8 μg/L), 0.7 μg/L (range: 0.1-3.9 μg/L), and 2.2 (range: 0.4-8.8) postrevision, respectively. CONCLUSION This pilot study demonstrates that intraoperative tissue necrosis was associated with a high rate of early complications (20%) and revisions (8%), suggesting the importance of a systematic evaluation of these patients including metal ion levels and metal artifact reduction sequence magnetic resonance imaging in optimizing revision outcome, as early diagnosis will facilitate the initiation of appropriate treatment before significant adverse tissue necrosis.
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30
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Barlow BT, Boles JW, Lee YY, Ortiz PA, Westrich GH. Short-Term Outcomes and Complications After Rejuvenate Modular Total Hip Arthroplasty Revision. J Arthroplasty 2016; 31:857-62. [PMID: 26777570 DOI: 10.1016/j.arth.2015.10.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/29/2015] [Accepted: 10/23/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The early short-term outcomes and complications after revision of the recalled Rejuvenate modular neck hip arthroplasty have not been previously reported. This study's purpose is to describe the early outcomes and complications after revision of the Rejuvenate modular femoral neck. METHODS A retrospective cohort included 92 patients with 92 Rejuvenate modular neck total hip arthroplasty (THA) who underwent revision surgery between July 2011 and April 2014. Preoperative, 1-year, and 2-year patient-reported outcome measures including Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Short Form 12 (SF-12) were described in 92 patients. RESULTS Complications arose in (12 of 92) 13% of patients including 8 greater trochanteric fractures, 1 intraoperative periprosthetic acetabular fracture, 2 dislocations, 1 early aseptic loosening, and 1 infection requiring a 2-stage revision. Overall, 66% of patients with a complication required reoperation. Significant changes were noted between preoperative and 1- and 2-year outcomes with respect to WOMAC pain score (P = .0031), WOMAC total score (P = .021), SF-12 mental component score (P < .0001), and physical component score (P < .0001). CONCLUSIONS Patients can expect an improvement in pain (WOMAC pain) and function (total WOMAC, SF-12 Physical Health Composite Scale), but overall worsening in the SF-12 mental component scores. Patients' physical function improvements are offset by worsened mental function scores. Patients undergoing revision of Rejuvenate modular neck THA implants should be counseled on modest functional improvements and relative frequency of complications.
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Affiliation(s)
- Brian T Barlow
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - John W Boles
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Yuo-Yu Lee
- Epidemiology and Biostatistics Core, Hospital for Special Surgery, New York, New York
| | - Philippe A Ortiz
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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31
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Faizan A, Gerges JJ, Asencio G, Essig J, Munini E, Hozack WJ. Changes in Femoral Version During Implantation of Anatomic Stems: Implications on Stem Design. J Arthroplasty 2016; 31:512-6. [PMID: 26481406 DOI: 10.1016/j.arth.2015.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/21/2015] [Accepted: 09/08/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Component positioning in total hip arthroplasty (THA) is among the primary indicators for longevity and success. Acetabular component positioning has been discussed in literature at length; however, femoral component positioning is also important as it contributes to combined anteversion. METHODS In this study, we examined the changes in femoral anteversion after the implantation of anatomic stem ABG II. A cadaveric study, a computed tomography-based computer modeling study, and a clinical study using a navigation system were conducted to document these changes. RESULTS These studies demonstrated that the anatomic stem ABG II increased the postimplantation femoral version by approximately 7°. The postimplantation versions followed a bimodal distribution. The computed tomography and navigation data also highlighted that the patient population may roughly be divided into 2 groups: the first group that needs anteverted stem and the second group that needs little or no anteversion in the stem to recreate the desired version and offset. CONCLUSION Based upon our data, we propose a new anatomic stem design that is offered in 2 version angles of 0° and 7° to help create the desired version and offset.
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Affiliation(s)
| | | | | | | | | | - William J Hozack
- Department of Orthopedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, Pennsylvania
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Affiliation(s)
- James T Ninomiya
- Department of Orthopaedic Surgery, FMLH Specialty Clinics Building, Medical College of Wisconsin, 5200 West Wisconsin Avenue, Milwaukee, WI 53226. E-mail address:
| | - John C Dean
- West Texas Orthopedics, 10 Desta Drive, Suite 100E, Midland, TX 79705
| | - Stephen J Incavo
- Houston Methodist Hospital, Smith Tower, 6550 Fannin Street, Suite 2600, Houston, TX 77030
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Short-Term Metal Ion Trends Following Removal of Recalled Modular Neck Femoral Stems. J Arthroplasty 2015; 30:1191-6. [PMID: 25820117 DOI: 10.1016/j.arth.2015.02.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/17/2015] [Accepted: 02/21/2015] [Indexed: 02/01/2023] Open
Abstract
Elevated serum metal ions have been well documented with the Rejuvenate modular neck femoral stem (Stryker, Mahwah, NJ); however, the rate at which ion levels decline following revision is less clear. This study included fifty-nine consecutive revisions of Rejuvenate stems for symptomatic ALTR. Blood tests prior to revision and postoperatively at 6weeks, 3months, 6months, and 1year measured serum cobalt and chromium concentrations, ESR, and CRP. At six weeks following revision of a unilateral Rejuvenate, cobalt and chromium levels dropped from preoperative levels by 67% and 42%, respectively. At three months, cobalt levels declined to 19% of preoperative values, but chromium levels remained stable. With this information, surgeons can set realistic expectations for serum metal ion levels following Rejuvenate stem revision.
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Adverse tissue reaction to corrosion at the neck-stem junction after modular primary total hip arthroplasty. Orthop Traumatol Surg Res 2015; 101:123-6. [PMID: 25620029 DOI: 10.1016/j.otsr.2014.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 10/28/2014] [Accepted: 11/05/2014] [Indexed: 02/02/2023]
Abstract
Complications related to the neck-stem junction of modular stems used for total hip arthroplasty (THA) are generating increasing concern. A 74-year-old male had increasing pain and a cutaneous reaction around the scar 1 year after THA with a modular neck-stem. Imaging revealed osteolysis of the calcar and a pseudo-tumour adjacent to the neck-stem junction. Serum cobalt levels were elevated. Revision surgery to exchange the stem and liner and to resect the pseudo-tumour was performed. Analysis of the stem by scanning electron microscopy and by energy dispersive X-ray and white light interferometry showed fretting corrosion at the neck-stem junction contrasting with minimal changes at the head-neck junction. Thus, despite dry assembly of the neck and stem on the back table at primary THA, full neck-stem contact was not achieved, and the resulting micromotion at the interface led to fretting corrosion. This case highlights the mechanism of fretting corrosion at the neck-stem interface responsible for adverse local tissue reactions. Clinical and radiological follow-up is mandatory in patients with dual-modular stems.
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