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Simon S, Pawlik J, Mitterer JA, Huber S, Dominkus M, Hofstaetter JG. Ceramic Heads With 12/14 Titanium Sleeves Used on Manufacturer-Non-Compatible Retained Femoral Components Do Not Lead to Implant Failure in Revision Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00806-4. [PMID: 39127312 DOI: 10.1016/j.arth.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Ceramic femoral heads with titanium sleeves are commonly used in revision total hip arthroplasty (rTHA). Companies advise against combination with a retained femoral component from another manufacturer. However, no data are available. The aim of this study was to evaluate and compare the implant failure and revision rates of ceramic heads with a 12/14 titanium sleeve used on manufacturer-compatible versus non-compatible retained femoral components. METHODS A retrospective single-center cohort analysis was performed using a prospectively maintained institutional arthroplasty registry. We identified 439 patients who received a titanium 12/14 ceramic head during rTHA between January 1st, 2007 and December 31st, 2022. There were 229 manufacturer-compatible and 210 manufacturer-non-compatible retained femoral stems, according to the company's official product compatibility list. Implant failure and re-revision rates were evaluated. RESULTS After a median follow-up of 6.6 years (IQR (Interquartile-range): 4.5 to 9.3), there was no significant difference (P = 0.770) in the re-revision rate between the manufacturer-compatible group (17.0%) and the non-compatible group (18.1%). Revision-free survival after rTHA was 81.2% in the manufacturer-compatible group and 78.9% in the manufacturer-non-compatible group after 15 years (P = 0.653). Most re-revisions occurred in the first year after rTHA, with 29 of 229 (12.7%) in the manufacturer-compatible group and 24 of 210 (11.4%) in the manufacturer-non-compatible group (P = 0.705). We observed only one implant failure in the manufacturer-non-compatible group, but this was not related to a mismatch problem. CONCLUSION Although legal uncertainties remain, this study showed no increased risk of implant failure or revision rates when a ceramic femoral head with a 12/14 titanium sleeve was used on a non-compatible femoral stem from a manufacturer.
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Affiliation(s)
- Sebastian Simon
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria; AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria
| | - Jan Pawlik
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria
| | - Jennyfer A Mitterer
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria; 2(nd) Department, Orthopedic Hospital Vienna Speising, Vienna, Austria
| | - Stephanie Huber
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria; 2(nd) Department, Orthopedic Hospital Vienna Speising, Vienna, Austria
| | - Martin Dominkus
- 2(nd) Department, Orthopedic Hospital Vienna Speising, Vienna, Austria
| | - Jochen G Hofstaetter
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria; 2(nd) Department, Orthopedic Hospital Vienna Speising, Vienna, Austria.
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Lanting BA, Sogbein OA, MacDonald SJ, Shah N, Kok TL, Willing R, Teeter MG. Quantification of trunnion damage in a series of intact total hip arthroplasty femoral stems previously identified to be at risk of catastrophic failure. Hip Int 2024; 34:363-371. [PMID: 37786293 DOI: 10.1177/11207000231199941] [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] [Indexed: 10/04/2023]
Abstract
BACKGROUND Corrosion at the head-neck junction of femoral stems is a rare complication of total hip arthroplasty (THA) with manifestations ranging from subclinical wear to failure. Prior studies have identified a single femoral component design with an increased propensity for catastrophic trunnion failure. The purpose of the present study was to quantify trunnion damage of this femoral component retrieved from patients undergoing revision THA for non-trunnionosis indications. METHODS 24 femoral components from a single manufacturer were identified for study inclusion. Each prosthesis underwent stereomicroscopic inspection. Corrosion and fretting scores were assigned per the Goldberg criteria to quadrants of the trunnion. Material loss was calculated based on cone angles across trunnion quadrants. This was carried out using a coordinate measuring machine that digitised each trunnion surface. Stems were compared to a series of femoral stems with the same trunnion design. RESULTS 20 of the 24 (83%) trunnions demonstrated corrosion, all 24 trunnions demonstrated fretting. Corrosion scores did not statistically differ with respect to trunnion zone (p = 0.53), while fretting scores were higher in the inferior compared to the superior zones (p < 0.001). There was no significant difference in cone angles assessing material loss between stems (p = 0.25). CONCLUSIONS Evidence of trunnion damage was observed in each stem retrieved for non-trunnionosis revision. Fretting occurred more frequently about the inferior quadrants. However, digitised trunnion shapes were similar between compared stems exhibiting no material loss. Therefore, it is possible that previous reports of trunnion failures for this implant are not a systemic issue, and that further investigation is required.
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Affiliation(s)
- Brent A Lanting
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
| | - Olawale A Sogbein
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
| | - Steven J MacDonald
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
| | - Nirmit Shah
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Tea-Lyn Kok
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Ryan Willing
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Matthew G Teeter
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
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Bruggink C, Gerards R, Nijs A. Gross trunnion failure in an elderly obese patient presenting 10 years after total hip arthroplasty with a cobalt chromium femoral head: A case report. Int J Surg Case Rep 2024; 118:109525. [PMID: 38555830 PMCID: PMC10987315 DOI: 10.1016/j.ijscr.2024.109525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Trunnionosis of total hip prosthesis is defined as corrosion at the head-neck taper junction combined with local tissue reaction. Trunnionosis is a rare complication of total hip arthroplasty (THA) that is often missed in diagnosis. Severe trunnionosis can result in head-neck dissociation, which is called gross trunnion failure (GTF). CASE PRESENTATION We describe a case of GTF in a 70-year-old male patient 10 years after right total hip arthroplasty with a cobalt chromium (CoCr) femoral head and a titanium alloy stem. A revision of the stem, cup and femoral head was performed. Six months after surgery, the patient is recovering well and walking. DISCUSSION Trunnionosis is associated with hip prostheses with a CoCr femoral head and a titanium alloy stem. Metal Artefact Reduction Sequence (MARS) and serum cobalt and chromium levels are diagnostic tools that can be useful when trunnionosis is suspected. CONCLUSION Trunnionosis remains hard to diagnose in an early stage when gross trunnion failure is not present. This case of a 70-year-old patient with gross trunnion failure 10 years after right total hip arthroplasty supports the literature suggesting that a CoCr femoral head, a high body mass index (BMI), and a longer implantation time are risk factors for developing trunnionosis. When conventional X ray and C-reactive protein are inconclusive, serum cobalt and chromium levels should be determined. When serum cobalt and chromium levels are elevated, a MARS MRI should be performed to confirm trunnionosis.
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Affiliation(s)
- Chiara Bruggink
- Department of Orthopedic Surgery, Amphia Hospital, Breda, Netherlands.
| | - Rogier Gerards
- Department of Orthopedic Surgery, Amphia Hospital, Breda, Netherlands.
| | - Anouk Nijs
- Foundation for Orthopedic Research, Care and Education, Amphia Hospital, Breda, Netherlands
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Napierkowski E, Lee J, Thapa N, Brown E, Salama Y, Allam E. Trunnionosis and prosthesis dissociation after total hip arthroplasty. Radiol Case Rep 2024; 19:1506-1508. [PMID: 38283736 PMCID: PMC10810739 DOI: 10.1016/j.radcr.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024] Open
Abstract
Femoral neck trunnion dissociations are rare complications of total hip replacements. This hardware failure is often due to underlying trunnionosis which is important to recognize. We present a case of a patient with dissociation at the femoral head-neck junction of a total hip arthroplasty (THA) with a Stryker Accolade TMZF femoral stem. There was no significant preceding trauma. The complication was visualized on radiography and confirmed during revision arthroplasty.
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Affiliation(s)
- Eva Napierkowski
- Loyola University Medical Center and Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153 USA
| | - Juhyun Lee
- Loyola University Medical Center and Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153 USA
| | - Nihal Thapa
- Loyola University Medical Center and Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153 USA
| | - Erin Brown
- Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112 USA
| | - Yustina Salama
- Loyola University Medical Center and Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153 USA
| | - Emad Allam
- Loyola University Medical Center and Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153 USA
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Bologna FA, Putame G, Audenino AL, Terzini M. Understanding the role of head size and neck length in micromotion generation at the taper junction in total hip arthroplasty. Sci Rep 2024; 14:6397. [PMID: 38493233 PMCID: PMC10944531 DOI: 10.1038/s41598-024-57017-x] [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: 12/20/2023] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
Modular hip implants allow intra-operative adjustments for patient-specific customization and targeted replacement of damaged elements without full implant extraction. However, challenges arise from relative micromotions between components, potentially leading to implant failure due to cytotoxic metal debris. In this study magnitude and directions of micromotions at the taper junction were estimated, aiming to understand the effect of variations in head size and neck length. Starting from a reference configuration adhering to the 12/14 taper standard, six additional implant configurations were generated by varying the head size and/or neck length. A musculoskeletal multibody model of a prothesized lower limb was developed to estimate hip contact force and location during a normal walking task. Following the implant assembly, the multibody-derived loads were imposed as boundary conditions in a finite element analysis to compute the taper junction micromotions as the relative slip between the contacting surfaces. Results highlighted the L-size head as the most critical configuration, indicating a 2.81 μm relative slip at the mid-stance phase. The proposed approach enables the investigation of geometric variations in implants under accurate load conditions, providing valuable insights for designing less risky prostheses and informing clinical decision-making processes.
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Affiliation(s)
- Federico A Bologna
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy
| | - Giovanni Putame
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy
| | - Alberto L Audenino
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy
| | - Mara Terzini
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy.
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy.
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Diaz-Lopez RA, Wen PH, Shelton JC. Influence of Taper surface topographies on contact deformation and stresses. J Mech Behav Biomed Mater 2023; 148:106213. [PMID: 37952504 DOI: 10.1016/j.jmbbm.2023.106213] [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: 01/02/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
The role of bore and trunnion surface topography on the failure rate of total hip joint replacements due to trunnionosis is not clear despite significant variations in the design of taper components between manufacturers. Taper surface topography, along with other taper design parameters such as clearance, diameter, and assembly force, determine the initial interlock of the contacting surfaces after assembly; this has been related to relative motions that can cause fretting and corrosion at the taper interface. However, in most in-silico parametrical taper studies associated with taper micromotions, the bore and trunnion surfaces have been simplified using a flat surface and/or sinusoidal functions to mimic the surface roughness. The current study tests the hypothesis that the use of simple geometrical functions for the taper surface topography can predict the surface mechanics developed in assembled tapers. Measured and simulated surfaces of bores and trunnions were characterised using common roughness parameters and spectral density estimations. Using the same characterised surface profiles, 2D Finite Element (FE) models of CoCr alloy femoral heads and Ti alloy trunnions were developed. Models simulated assembly conditions at different resultant forces ranging from 0.5 to 4.0 kN, contact conditions were determined and associated with their topographical characteristics. Measured surfaces of bore and trunnion components comprise up to seven dominant spatial frequencies. Flattening of the trunnion microgrooved peaks was observed during the assembly of the taper. When the femoral head bore and trunnion topography were both considered a reduced number of microgrooved peaks were in contact, from 51 in an idealised taper surfaces to 35 in measured surfaces using an assembly reaction force of 4 kN. The contact points in the models developed high plastic strains, which were greater than that associated with failure of the material. Results showed that line and sine wave functions over estimate contact points at the taper interface compared to those surfaces that consider roughness and peak variation. These findings highlight the important role of modelling the full surface topography on the taper contact mechanics, as surface variations in the roughness and waviness change the performance of tapers.
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Affiliation(s)
- R A Diaz-Lopez
- School of Engineering and Materials Science, Queen Mary University of London, UK
| | - P H Wen
- School of Engineering and Materials Science, Queen Mary University of London, UK
| | - J C Shelton
- School of Engineering and Materials Science, Queen Mary University of London, UK.
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7
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McCarthy CJ, Moore J, Condon F. Large head metal-on-metal bearing surface with a TMZF titanium alloy femoral stem with high rates of revision and trunnion failure. J Orthop 2023; 46:164-168. [PMID: 38031627 PMCID: PMC10682508 DOI: 10.1016/j.jor.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Background Mechanically assisted crevice corrosion at the head-neck interface puts implants at risk of trunnionosis, femoral head dissociation, implant failure and the development of metallosis. Metal-on-Metal bearings have very low wear rates, significantly lower than metal-on-polytethylene, but their wear results in cobalt and chromium ion systemic distribution. This is a study of the MITCH metal-on-metal bearing surface coupled with an Accolade TMZF stem. Methods This was a retrospective review of 24 total hip replacements 21 patients in that underwent MITCH TRH/Accolade TMZF implantation at a minimum of 12 years post operatively. The primary outcome of this study was all-cause revision with particular attention to revision due to trunnion failure and/or cobalt and chromium ion level. Results There was a revision rate of 66.7 % (n = 16) at a minimum of twelve years post operatively. Most notably there were six revisions for a gross trunnion failure. Two cases were revised for impending trunnion failure. There were seven cases revised for elevated serum cobalt and chromium levels and one was revised for unexplained pain. Discussion Patients in our study that underwent TMZF alloy cementless stems coupled with large cobalt chromium alloy heads are at high risk of catastrophic trunnion failure. The high rate of trunnnionosis in this implant combination is thought to be related to a significantly different Young's modulus due to a material mismatch coupled with galvanic corrosion.
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Affiliation(s)
- Cathal J McCarthy
- University Hospital Limerick, Limerick, Ireland
- Croom Orthopaedic Hospital, Limerick, Ireland
| | - Joss Moore
- University Hospital Limerick, Limerick, Ireland
- Croom Orthopaedic Hospital, Limerick, Ireland
| | - Finbarr Condon
- University Hospital Limerick, Limerick, Ireland
- Croom Orthopaedic Hospital, Limerick, Ireland
- University of Limerick, Limerick, Ireland
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8
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Soliman MM, Islam MT, Chowdhury MEH, Alqahtani A, Musharavati F, Alam T, Alshammari AS, Misran N, Soliman MS, Mahmud S, Khandakar A. Advancement in total hip implant: a comprehensive review of mechanics and performance parameters across diverse novelties. J Mater Chem B 2023; 11:10507-10537. [PMID: 37873807 DOI: 10.1039/d3tb01469j] [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: 10/25/2023]
Abstract
The UK's National Joint Registry (NJR) and the American Joint Replacement Registry (AJRR) of 2022 revealed that total hip replacement (THR) is the most common orthopaedic joint procedure. The NJR also noted that 10-20% of hip implants require revision within 1 to 10 years. Most of these revisions are a result of aseptic loosening, dislocation, implant wear, implant fracture, and joint incompatibility, which are all caused by implant geometry disparity. The primary purpose of this review article is to analyze and evaluate the mechanics and performance factors of advancement in hip implants with novel geometries. The existing hip implants can be categorized based on two parts: the hip stem and the joint of the implant. Insufficient stress distribution from implants to the femur can cause stress shielding, bone loss, excessive micromotion, and ultimately, implant aseptic loosening due to inflammation. Researchers are designing hip implants with a porous lattice and functionally graded material (FGM) stems, femur resurfacing, short-stem, and collared stems, all aimed at achieving uniform stress distribution and promoting adequate bone remodeling. Designing hip implants with a porous lattice FGM structure requires maintaining stiffness, strength, isotropy, and bone development potential. Mechanical stability is still an issue with hip implants, femur resurfacing, collared stems, and short stems. Hip implants are being developed with a variety of joint geometries to decrease wear, improve an angular range of motion, and strengthen mechanical stability at the joint interface. Dual mobility and reverse femoral head-liner hip implants reduce the hip joint's dislocation limits. In addition, researchers reveal that femoral headliner joints with unidirectional motion have a lower wear rate than traditional ball-and-socket joints. Based on research findings and gaps, a hypothesis is formulated by the authors proposing a hip implant with a collared stem and porous lattice FGM structure to address stress shielding and micromotion issues. A hypothesis is also formulated by the authors suggesting that the utilization of a spiral or gear-shaped thread with a matched contact point at the tapered joint of a hip implant could be a viable option for reducing wear and enhancing stability. The literature analysis underscores substantial research opportunities in developing a hip implant joint that addresses both dislocation and increased wear rates. Finally, this review explores potential solutions to existing obstacles in developing a better hip implant system.
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Affiliation(s)
- Md Mohiuddin Soliman
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohammad Tariqul Islam
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Muhammad E H Chowdhury
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Abdulrahman Alqahtani
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia
- Department of Biomedical Technology, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Farayi Musharavati
- Department of Mechanical & Industrial Engineering, Qatar University, Doha 2713, Qatar.
| | - Touhidul Alam
- Pusat Sains Ankasa (ANGKASA), Institut Perubahan Iklim, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Selangor, Malaysia.
| | - Ahmed S Alshammari
- Department of Electrical Engineering, College of Engineering, University Hail, Hail 81481, Saudi Arabia.
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Norbahiah Misran
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohamed S Soliman
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
- Department of Electrical Engineering, Faculty of Energy Engineering, Aswan University, Aswan, 81528, Egypt
| | - Sakib Mahmud
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Amith Khandakar
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
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9
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Zhang G, Yang S, Cui W, Huang Z, Zhang X, Zhang Y, Li J, Jin Z. Decomposition of micromotion at the head-neck interface in total hip arthroplasty during walking. Comput Methods Biomech Biomed Engin 2023; 26:548-558. [PMID: 35549565 DOI: 10.1080/10255842.2022.2073788] [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] [Indexed: 11/03/2022]
Abstract
Fretting corrosion as one of the leading causes for failure of modular hip prostheses has been associated with micromotion at head-neck taper junction. Decomposition of micromotion is helpful to promote the development of more realistic experiments investigating failure mechanisms of the head-neck junction in total hip arthroplasty. The aim of this study was to decompose the complex three-dimensional micromotion at the head-neck junction into multiple fundamental modes, including three translational and three rotational components. A three-dimensional finite element model composed of head-neck junction, liner and acetabular cup with a typical 12/14 taper size, as well as the taper mismatch of -4', was developed during walking. The analysis was divided into three procedures: a) the assembly simulation of the head and neck during surgery, b) verification with a simplified axisymmetric model, and c) three-dimensional modelling under normal walking. This study revealed that the main forms of micromotion contained circumferential, longitudinal micromotion and longitudinal rolling toggling, and were closely related to the state of motion. The maximum translational micromotion was predicted to be 10.9 μm during the walking gait, with the predominant modes of the circumferential translation of 9.6 μm, the longitudinal translation of 5.5 μm and the longitudinal rotation of 0.29° along the taper junction. These findings may provide design considerations for further experimental testing about fretting and facilitate the understanding of the fretting mechanisms in hip prostheses.
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Affiliation(s)
- Guoxian Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Shu Yang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Wen Cui
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Zhi Huang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Xiaogang Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Yali Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Junyan Li
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Zhongmin Jin
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
- School of Mechanical Engineering, University of Leeds, Leeds, UK
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Soliman MM, Chowdhury MEH, Islam MT, Musharavati F, Mahmud S, Hafizh M, Ayari MA, Khandakar A, Alam MK, Nezhad EZ. Design and Performance Evaluation of a Novel Spiral Head-Stem Trunnion for Hip Implants Using Finite Element Analysis. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16041466. [PMID: 36837096 PMCID: PMC9962303 DOI: 10.3390/ma16041466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 05/27/2023]
Abstract
With an expectation of an increased number of revision surgeries and patients receiving orthopedic implants in the coming years, the focus of joint replacement research needs to be on improving the mechanical properties of implants. Head-stem trunnion fixation provides superior load support and implant stability. Fretting wear is formed at the trunnion because of the dynamic load activities of patients, and this eventually causes the total hip implant system to fail. To optimize the design, multiple experiments with various trunnion geometries have been performed by researchers to examine the wear rate and associated mechanical performance characteristics of the existing head-stem trunnion. The objective of this work is to quantify and evaluate the performance parameters of smooth and novel spiral head-stem trunnion types under dynamic loading situations. This study proposes a finite element method for estimating head-stem trunnion performance characteristics, namely contact pressure and sliding distance, for both trunnion types under walking and jogging dynamic loading conditions. The wear rate for both trunnion types was computed using the Archard wear model for a standard number of gait cycles. The experimental results indicated that the spiral trunnion with a uniform contact pressure distribution achieved more fixation than the smooth trunnion. However, the average contact pressure distribution was nearly the same for both trunnion types. The maximum and average sliding distances were both shorter for the spiral trunnion; hence, the summed sliding distance was approximately 10% shorter for spiral trunnions than that of the smooth trunnion over a complete gait cycle. Owing to a lower sliding ability, hip implants with spiral trunnions achieved more stability than those with smooth trunnions. The anticipated wear rate for spiral trunnions was 0.039 mm3, which was approximately 10% lower than the smooth trunnion wear rate of 0.048 mm3 per million loading cycles. The spiral trunnion achieved superior fixation stability with a shorter sliding distance and a lower wear rate than the smooth trunnion; therefore, the spiral trunnion can be recommended for future hip implant systems.
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Affiliation(s)
- Md Mohiuddin Soliman
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
| | | | - Mohammad Tariqul Islam
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Selangor, Malaysia
| | - Farayi Musharavati
- Department of Mechanical & Industrial Engineering, Qatar University, Doha 2713, Qatar
| | - Sakib Mahmud
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Muhammad Hafizh
- Department of Mechanical & Industrial Engineering, Qatar University, Doha 2713, Qatar
| | | | - Amith Khandakar
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | | | - Erfan Zal Nezhad
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, TX 78249, USA
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11
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Gustafson JA, Mell S, Levine BR, Pourzal R, Lundberg HJ. Interaction of surface topography and taper mismatch on head-stem modular junction contact mechanics during assembly in modern total hip replacement. J Orthop Res 2023; 41:418-425. [PMID: 35488727 PMCID: PMC9617811 DOI: 10.1002/jor.25357] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/11/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
Implant failure due to fretting corrosion at the head-stem modular junction is an increasing problem in modular total hip arthroplasty. The effect of varying microgroove topography on modular junction contact mechanics has not been well characterized. The aim of this study was to employ a novel, microgrooved finite element (FEA) model of the hip taper interface and assess the role of microgroove geometry and taper mismatch angle on the modular junction mechanics during assembly. A two-dimensional, axisymmetric FEA model was created using a modern 12/14 taper design of a CoCrMo femoral head taper and Ti6Al4V stem taper. Microgrooves were modeled at the contacting interface of the tapers and varied based on height and spacing measurements obtained from a repository of measured retrievals. Additionally, taper angular mismatch between the head and stem was varied to simulate proximal- and distal-locked engagement. Forty simulations were conducted to parametrically evaluate the effects of microgroove surface topography and angular mismatch on predicted contact area, contact pressure, and equivalent plastic strain. Multiple linear regression analysis was highly significant (p < 0.001; R2 > 0.74) for all outcome variables. The regression analysis identified microgroove geometry on the head taper to have the greatest influence on modular junction contact mechanics. Additionally, there was a significant second order relationship between both peak contact pressure (p < 0.001) and plastic strain (p < 0.001) with taper mismatch angle. These modeling techniques will be used to identify the implant parameters that maximize taper interference strength via large in-silico parametric studies.
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Affiliation(s)
| | - Steven Mell
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brett R. Levine
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Hannah J. Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Feyzi M, Fallahnezhad K, Taylor M, Hashemi R. An Overview of the Stability and Fretting Corrosion of Microgrooved Necks in the Taper Junction of Hip Implants. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8396. [PMID: 36499893 PMCID: PMC9735617 DOI: 10.3390/ma15238396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Fretting corrosion at the head-neck interface of modular hip implants, scientifically termed trunnionosis/taperosis, may cause regional inflammation, metallosis, and adverse local tissue reactions. The severity of such a deleterious process depends on various design parameters. In this review, the influence of surface topography (in some cases, called microgrooves/ridges) on the overall performance of the microgrooved head-neck junctions is investigated. The methodologies together with the assumptions and simplifications, as well as the findings from both the experimental observations (retrieval and in vitro) and the numerical approaches used in previous studies, are presented and discussed. The performance of the microgrooved junctions is compared to those with a smooth surface finish in two main categories: stability and integrity; wear, corrosion, and material loss. Existing contradictions and disagreements among the reported results are reported and discussed in order to present a comprehensive picture of the microgrooved junctions. The current research needs and possible future research directions on the microgrooved junctions are also identified and presented.
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13
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Metal Articulations as a Source of Total Hip Arthroplasty Pain. J Arthroplasty 2022; 37:1483-1487. [PMID: 35101592 DOI: 10.1016/j.arth.2022.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/03/2022] [Accepted: 01/20/2022] [Indexed: 02/02/2023] Open
Abstract
The consensus systematic risk stratification algorithm from the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and The Hip Society summarizes clinical challenges in evaluation and treatment of metal-on-polyethylene total hip arthroplasty (THA) patients with adverse local tissue reaction (ALTR) due to mechanically assisted crevice corrosion (MACC), reviews up-to-date evidence, and identifies the areas for future research in order to provide a useful resource for orthopedic surgeons providing care to these patients. A painful THA has various intrinsic and extrinsic causes. ALTR is one of the intrinsic causes in patients with painful THA. The occurrence of ALTR due to MACC at modular junctions is likely to be multifactorial, including implant, surgical, and patient factors. Therefore, a systematic evaluation needs to involve a focused clinical history, detailed physical examination, laboratory tests, and imaging in order to identify potential differential diagnoses. There should be a low threshold to perform a systematic evaluation of patients with painful non-metal-on-metal THA, including patients with metal-on-polyethylene THA, and modular dual-mobility THA with the CoCr metal acetabular insert, as early recognition and diagnosis of ALTR due to MACC will facilitate initiation of appropriate treatment prior to significant adverse biological reactions. Specialized tests such as blood metal analysis and metal artifact reduction sequence magnetic resonance imaging are important modalities in evaluation and management of ALTR in patients with painful THA.
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14
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Fernandez-Fairen M. CORR Insights®: Insights into Imprinting: How Is the Phenomenon of Tribocorrosion at Head-Neck Taper Interfaces Related to Corrosion, Fretting, and Implant Design Parameters? Clin Orthop Relat Res 2022; 480:1601-1603. [PMID: 35638900 PMCID: PMC9278905 DOI: 10.1097/corr.0000000000002267] [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] [Received: 04/14/2022] [Accepted: 05/12/2022] [Indexed: 01/31/2023]
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15
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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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16
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McCarty CP, Park SH, Ho NC, Sangiorgio SN, Ebramzadeh E. Taper Material Loss in Total Hip Replacements: Is It Affected by Joint Friction? J Bone Joint Surg Am 2022; 104:796-804. [PMID: 35167500 DOI: 10.2106/jbjs.21.00579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metal debris and corrosion products generated from the taper junctions of modular joint replacements have been recognized as contributors to failure. Therefore, understanding the factors associated with increased taper wear and corrosion is fundamental to improving implant performance. METHODS A cohort of 85 large-diameter metal-on-metal heads and cups retrieved at revision surgery, after 10 to 96 months of service, was evaluated. First, metrology was conducted to quantify head taper material loss and implant articular surface wear. Then, joint frictional moments for each retrieved head-and-cup pair were measured during 10 cycles of simulated physiological gait in a biomechanical model. Taper material loss was evaluated for correlations with frictional moments, articular wear, head diameter, head-cup clearance, and time in vivo. RESULTS Peak resultant frictional moments ranged from 9.1 to 26.3 Nm, averaging 17.3 ± 2.7 Nm. Fretting and corrosion damage during in vivo service resulted in material loss from the head tapers ranging between 0.04 and 25.57 mm3, compared with combined head and cup articular wear of 0.80 to 351.75 mm3 in this cohort. Taper material loss was not correlated with higher frictional moments (R = -0.20 to 0.11, p = 0.07 to 0.81). Higher frictional moments from axial rotation were correlated with higher head and cup wear (R = 0.33, p < 0.01). The correlation between taper material loss and head diameter was weak and did not reach statistical significance (R = 0.20, p = 0.07). Taper material loss was not correlated with nominal head-cup clearance (R = 0.06, p = 0.6). Finally, taper material loss increased significantly over time (R = 0.34, p < 0.01). CONCLUSIONS Despite serious concerns regarding trunnionosis, volumes of head taper wear were generally lower than those of articular surface wear. There was no statistical correlation between taper wear and frictional moments. Therefore, the results suggest that high friction in metal-on-metal implants does not contribute to higher material loss at the head taper, despite high bending moments. CLINICAL RELEVANCE The amount of metal debris and corrosion products from taper junctions of the joint arthroplasties, widely recognized as an insidious cause of failure, was not correlated with joint frictional moments. Multiple factors affect taper wear: implant design, material, size, surface finish, and patient weight and activity level. However, in the present cohort, high friction of metal-on-metal total hip replacements likely did not contribute to increased volume of material loss at taper interfaces, despite increased moments at the locations of taper material loss.
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Affiliation(s)
- Colin P McCarty
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, California
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17
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Wight CM, Schemitsch EH. In vitro testing for hip head-neck taper tribocorrosion: A review of experimental methods. Proc Inst Mech Eng H 2022; 236:9544119221074582. [PMID: 35139678 PMCID: PMC8915230 DOI: 10.1177/09544119221074582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In vitro test methods are challenged by the multi-factorial nature of head-neck taper connection tribocorrosion due to the consequences of simplification. Incorrect study design and misinterpretation of results has led to contradictory findings regarding important factors affecting head-neck taper tribocorrosion. This review seeks to highlight important considerations when developing in vitro test methods, to help researchers strengthen their study design and analyze the implications of others' design decisions. The advantages, disadvantages, limitations and procedural considerations for finite element analyses, electrochemical studies and in vitro simulations related to head-neck taper connection tribocorrosion are discussed. Finite element analysis offers an efficient method for studying large ranges of mechanical parameters. However, they are limited by neglecting electrochemical, biological and fluid flow factors. Electrochemical studies may be preferred if these factors are considered important. Care must be taken in interpreting data from electrochemical studies, particularly when different materials are compared. Differences in material valence and toxicity affect clinical translation of electrochemical studies' results. At their most complex, electrochemical studies attempt to simulate all aspects of headneck taper connection tribocorrosion in a bench top study. Effective execution requires in-depth knowledge of the tribocorrosion phenomenon, the involved mechanisms, and their measures such that each study design decision is fully informed.
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Affiliation(s)
- Christian M Wight
- Institute of Biomaterial and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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18
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Diaz-Lopez R, Wen P, Shelton J. Influence of taper design and loading on taper micromotion. J Mech Behav Biomed Mater 2022; 128:105106. [DOI: 10.1016/j.jmbbm.2022.105106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/05/2021] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
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19
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Herbster M, Berth A, Märtens N, Robra M, Welzel F, Dallmann F, Lohmann CH, Halle T, Bertrand J, Döring J. Intraoperative assembly of anatomical shoulder prosthesis frequently results in malalignment of the modular taper junction. J Orthop Res 2021; 39:2485-2496. [PMID: 33368644 DOI: 10.1002/jor.24975] [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: 07/29/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 02/04/2023]
Abstract
Anatomical shoulder arthroplasties (ASA) may fail because of micromotion at the modular taper junction causing wear due to fretting. Sufficient taper strength can reduce micromotion and potential reasons for failure. However, there are no normative standards for a safe assembly process performed intraoperatively by the surgeon. The purpose of this study is to determine the effect of common intraoperative assembly strategies and to identify critical influencing factors on taper stability. ASA with standard and stemless humeral component in combination with concentric Al2 O3 heads and eccentric CoCr28Mo6 alloyed humeral heads were tested. Taper angles and surface roughness were determined. Force magnitudes and impact directions were recorded using a sensorized head impactor and a three-dimensional force measuring platform. Subsequently, the axial pull-off forces were measured and taper engagement areas were macroscopically evaluated. In comparison to standard stem tapers that were impacted with an assembly device, stemless tapers were impacted into the artificial bone with significantly lower forces. Taper strength correlates to maximum impact force and was higher for CoCr28Mo6 heads with a mean pull-off ratio of 0.56 than for Al2 O3 heads with 0.37. Interestingly, all tapers showed an asymmetric clamping behavior, due to tilting during impaction. This is caused by the variation of the resulting force vector and further promoted by humeral head eccentricity. Assembly technique markedly influences the force magnitude, impact direction, impulse, and consequently taper strength. The resulting force vector and head eccentricity were identified as potential risk factors for taper malalignment.
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Affiliation(s)
- Maria Herbster
- Institute of Materials and Joining Technology, Otto-von-Guericke University, Magdeburg, Germany
| | - Alexander Berth
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Nicole Märtens
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Marcel Robra
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Florian Welzel
- GFE-Gesellschaft für Fertigungstechnik und Entwicklung Schmalkalden e.V., Schmalkalden, Germany
| | | | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Thorsten Halle
- Institute of Materials and Joining Technology, Otto-von-Guericke University, Magdeburg, Germany
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Joachim Döring
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
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20
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Wight CM, Whyne CM, Bogoch ER, Zdero R, Chapman RM, van Citters DW, Walsh WR, Schemitsch E. Effect of head size and rotation on taper corrosion in a hip simulator. Bone Jt Open 2021; 2:1004-1016. [PMID: 34825826 PMCID: PMC8636299 DOI: 10.1302/2633-1462.211.bjo-2021-0147.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIMS This study investigates head-neck taper corrosion with varying head size in a novel hip simulator instrumented to measure corrosion related electrical activity under torsional loads. METHODS In all, six 28 mm and six 36 mm titanium stem-cobalt chrome head pairs with polyethylene sockets were tested in a novel instrumented hip simulator. Samples were tested using simulated gait data with incremental increasing loads to determine corrosion onset load and electrochemical activity. Half of each head size group were then cycled with simulated gait and the other half with gait compression only. Damage was measured by area and maximum linear wear depth. RESULTS Overall, 36 mm heads had lower corrosion onset load (p = 0.009) and change in open circuit potential (OCP) during simulated gait with (p = 0.006) and without joint movement (p = 0.004). Discontinuing gait's joint movement decreased corrosion currents (p = 0.042); however, wear testing showed no significant effect of joint movement on taper damage. In addition, 36 mm heads had greater corrosion area (p = 0.050), but no significant difference was found for maximum linear wear depth (p = 0.155). CONCLUSION Larger heads are more susceptible to taper corrosion; however, not due to frictional torque as hypothesized. An alternative hypothesis of taper flexural rigidity differential is proposed. Further studies are necessary to investigate the clinical significance and underlying mechanism of this finding. Cite this article: Bone Jt Open 2021;2(11):1004-1016.
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Affiliation(s)
- Christian M. Wight
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Cari M. Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Earl R. Bogoch
- Department of Surgery, University of Toronto, Brookfield Chair in Fracture Prevention, Toronto, Ontario, Canada
| | - Radovan Zdero
- London Health Science Centre, Western University, London, Ontario, Canada
| | - Ryan M. Chapman
- London Health Science Centre, Western University, London, Ontario, Canada
| | - Douglas W. van Citters
- Thayer School of Engineering at Dartmouth College, Western University, Hanover, New Hampshire, USA
| | - William R. Walsh
- Surgical and Orthopaedic Research Laboratory, UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Emil Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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21
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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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22
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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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23
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Radiographic Risk Factors Associated With Adverse Local Tissue Reaction in Head-Neck Taper Corrosion of Primary Metal-on-Polyethylene Total Hip Arthroplasty. J Am Acad Orthop Surg 2021; 29:353-360. [PMID: 32796372 DOI: 10.5435/jaaos-d-20-00473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/05/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adverse local tissue reactions (ALTRs) in metal-on-polyethylene (MoP) total hip arthroplasty (THA) with head-neck taper corrosion are multifactorial, involving implant and patient factors. This study aimed to identify any potential clinical risk factors associated with failed MoP THA due to head-neck taper corrosion. METHODS A series of 146 MoP THA patients was investigated: (1) ALTR (n = 42) on metal artifact sequence MRI and (2) non-ALTR (n = 104). Both cohorts were compared regarding femoral neck shaft angle, acetabular implant orientation, component size, femoral head offset, measurement of medial and vertical femoral offsets, and femoral stem alloy. RESULTS The occurrence of ALTR was associated with increased radiographic femoral stem offset (36.0 ± 7.7 mm versus 40.8 ± 7.3 mm, P = 0.008), increased femoral head offset (0.7 ± 3.4 versus 4.5 ± 3.7, P < 0.001), and the use of Ti-12Mo-6Zr-2Fe alloy stems (P = 0.041). The presence of ALTR was notably associated with higher chromium (2.0 versus 0.5 μg/L) and cobalt (7.4 versus 0.7 μg/L, P < 0.001). DISCUSSION This study identified increased femoral head and stem offset and the use of Ti-12Mo-6Zr-2Fe alloy stems as risk factors for clinically relevant ALTR due to head-neck taper corrosion in MoP THA patients. This provides evidenced-based practical information for surgeons in identifying "at-risk" symptomatic MoP THA patients with head-neck taper corrosion for systematic risk stratification.
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24
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Kwon YM, Della Valle CJ, Lombardi AV, Garbuz DS, Berry DJ, Jacobs JJ. Risk Stratification Algorithm for Management of Head-Neck Taper Tribocorrosion in Patients with Metal-on-Polyethylene Total Hip Arthroplasty: Consensus Statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and The Hip Society. J Bone Joint Surg Am 2021; 103:e18. [PMID: 33411461 DOI: 10.2106/jbjs.20.01837] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adverse local tissue reactions (ALTRs) were initially reported as complications associated with metal-on-metal (MoM) bearings; however, there is increasing concern regarding the occurrence of adverse local tissue reactions from mechanically assisted crevice corrosion (MACC) at the femoral head-neck junction or between other modular junctions of the implant containing cobalt chromium parts in patients with metal-on-polyethylene (MoP) bearings. ALTR due to MACC at the head-neck junction has primarily been reported in association with cobalt chromium alloy femoral heads. As pain following total hip arthroplasty may have various intrinsic and extrinsic causes, a systematic approach to evaluation (risk stratification algorithm) based on the currently available data is recommended to optimize patient management. Evaluation should begin by ruling out common causes of pain, including component loosening and periprosthetic joint infection. While specialized tests such as blood metal analysis and metal artifact reduction sequence magnetic resonance imaging (MARS MRI) are useful modalities in evaluating for ALTRs, over-reliance on any single investigative tool in the clinical decision-making process should be avoided. There should be a low threshold to perform a systematic evaluation for ALTR due to MACC in patients with metal-on-polyethylene total hip arthroplasty as early recognition and diagnosis is critical, as delays in appropriate treatment initiation may result in soft-tissue damage, which complicates surgical treatment and is associated with a higher risk of complications and poorer patient outcomes.
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Affiliation(s)
- Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc., The Ohio State University, New Albany, Ohio
| | - Donald S Garbuz
- Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joshua J Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Dutta A, Nutt J, Slater G, Ahmed S. Review: Trunnionosis leading to modular femoral head dissociation. J Orthop 2021; 23:199-202. [PMID: 33551613 DOI: 10.1016/j.jor.2021.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/24/2021] [Indexed: 11/18/2022] Open
Abstract
Component dissociation secondary to trunnionosis is rare, and its causes are multifactorial. It is a major complication of total hip replacement, in most cases requiring revision arthroplasty. In this paper, we present a case of taper/head modular interface dissociation in a metal-on-metal total hip replacement. We review the literature of both trunnionosis, as well as a systematic review of modular dissociation of the femoral component in total hip arthroplasty, identifying commonalities with our own case.
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Affiliation(s)
- Agneish Dutta
- Tunbridge Wells Hospital, Royal Tunbridge Wells, United Kingdom
| | - James Nutt
- Tunbridge Wells Hospital, Royal Tunbridge Wells, United Kingdom
| | - Guy Slater
- Tunbridge Wells Hospital, Royal Tunbridge Wells, United Kingdom
| | - Syed Ahmed
- Tunbridge Wells Hospital, Royal Tunbridge Wells, United Kingdom
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Feyzi M, Fallahnezhad K, Taylor M, Hashemi R. The mechanics of head-neck taper junctions: What do we know from finite element analysis? J Mech Behav Biomed Mater 2021; 116:104338. [PMID: 33524892 DOI: 10.1016/j.jmbbm.2021.104338] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/16/2020] [Accepted: 01/15/2021] [Indexed: 12/18/2022]
Abstract
Modular hip implants are widely used in hip arthroplasty because of the advantages they can offer such as flexibility in material combinations and geometrical adjustments. The mechanical environment of the modular junction in the body is quite challenging due to the complex and varying off-axial mechanical loads of physical activities applied to a tapered interface of two contacting materials (head and neck) assembled by an impact force intraoperatively. Experimental analogies to the in-vivo condition of the taper junction are complex, expensive and time-consuming to implement; hence, computational simulations have been a preferred approach taken by researchers for studying the mechanics of these modular junctions that can help us understand their failure mechanisms and improve their design and longevity after implantation. This paper provides a clearer insight into the mechanics of the head-neck taper junction through a careful review on the finite element studies of the junction and their findings. The effects of various factors on the mechanical outputs namely: stresses, micromotions, and contact situations are reviewed and discussed. Also, the simulation methodology of the studies in the literature is compared. Research opportunities for future are scrutinised through tabulating data and information that have been carefully retrieved form the reported findings.
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Affiliation(s)
- Mohsen Feyzi
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia
| | - Khosro Fallahnezhad
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia
| | - Mark Taylor
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia
| | - Reza Hashemi
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia.
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27
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Feyzi M, Fallahnezhad K, Taylor M, Hashemi R. A review on the finite element simulation of fretting wear and corrosion in the taper junction of hip replacement implants. Comput Biol Med 2020; 130:104196. [PMID: 33516962 DOI: 10.1016/j.compbiomed.2020.104196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/14/2020] [Accepted: 12/20/2020] [Indexed: 12/13/2022]
Abstract
Taperosis/trunnionosis is a scientific term for describing tribocorrosion (fretting corrosion) at the head-neck taper junction of hip implants where two contacting surfaces are undergone oscillatory micromotions while being exposed to the body fluid. Detached ions and emitted debris, as a result of taperosis, migrate to the surrounding tissues and can cause inflammation, infection, and aseptic loosening with an ultimate possibility of implant failure. Improving the tribocorrosion performance of the head-neck junction in the light of minimising the surface damage and debris requires a better understanding of taperosis. Given its complexity associated with both the mechanical and electrochemical aspects, computational methods such as the finite element method have been recently employed for analysing fretting wear and corrosion in the taper junction. To date, there have been more efforts on the fretting wear simulation when compared with corrosion. This is because of the mechanical nature of fretting wear which is probably more straightforward for modelling. However, as a recent research advancement, corrosion has been a focus to be implemented in the finite element modelling of taper junctions. This paper aims to review finite element studies related to taperosis in the head-neck junction to provide a detailed understanding of the design parameters and their role in this failure mechanism. It also reviews and discusses the methodologies developed for simulating this complex process in the taper junction along with the simplifications, assumptions and findings reported in these studies. The current needs and future research opportunities and directions in this field are then identified and presented.
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Affiliation(s)
- Mohsen Feyzi
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia
| | - Khosro Fallahnezhad
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia
| | - Mark Taylor
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia
| | - Reza Hashemi
- College of Science and Engineering, Medical Device Research Institute, Flinders University, Tonsley, SA, 5042, Australia.
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Morlock MM, Hube R, Wassilew G, Prange F, Huber G, Perka C. Taper corrosion: a complication of total hip arthroplasty. EFORT Open Rev 2020; 5:776-784. [PMID: 33312704 PMCID: PMC7722945 DOI: 10.1302/2058-5241.5.200013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The focus on taper corrosion in modular hip arthroplasty increased around 2007 as a result of clinical problems with large-head metal-on-metal (MoM) bearings on standard stems. Corrosion problems with bi-modular primary hip stems focused attention on this issue even more. Factors increasing the risk of taper corrosion were identified in laboratory and retrieval studies: stiffness of the stem neck, taper diameter and design, head diameter, offset, assembly force, head and stem material and loading. The high variability of the occurrence of corrosion in the clinical application highlights its multi-factorial nature, identifying the implantation procedure and patient-related factors as important additional factors for taper corrosion. Discontinuing the use of MoM has reduced the revisions due to metal-related pathologies dramatically from 49.7% (MoM > 32 mm), over 9.2% (MoM ⩽ 32 mm) to 0.8% (excluding all MoM). Further reduction can be achieved by omitting less stiff Ti-alloys and large metal heads (36 mm and above) against polyethylene (PE). Standardized taper assembly of smaller and ceramic heads will reduce the clinical occurrence of taper corrosion even further. If 36 mm heads are clinically indicated, only ceramic heads should be used. Taper-related problems will not comprise a major clinical problem anymore if the mentioned factors are respected.
Cite this article: EFORT Open Rev 2020;5:776-784. DOI: 10.1302/2058-5241.5.200013
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Affiliation(s)
| | | | - Georgi Wassilew
- Department for Orthopaedics and Orthopaedic Surgery, University of Greifswald, Greifswald, Germany
| | - Felix Prange
- TUHH Hamburg University of Technology, Hamburg, Germany
| | - Gerd Huber
- TUHH Hamburg University of Technology, Hamburg, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Orthopedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Pozzuoli A, Berizzi A, Crimì A, Belluzzi E, Frigo AC, Conti GD, Nicolli A, Trevisan A, Biz C, Ruggieri P. Metal Ion Release, Clinical and Radiological Outcomes in Large Diameter Metal-on-Metal Total Hip Arthroplasty at Long-Term Follow-Up. Diagnostics (Basel) 2020; 10:diagnostics10110941. [PMID: 33198180 PMCID: PMC7698262 DOI: 10.3390/diagnostics10110941] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 02/08/2023] Open
Abstract
Total hip arthroplasty (THA) with metal-on-metal (MoM) bearings have shown problems of biocompatibility linked to metal ion release at the local level causing an adverse reaction to metal debris (ARMD) and at a systemic level. The aim of this study was to evaluate clinical and radiological outcomes, and metal ion concentrations in the blood and urine of patients who underwent THA with the LIMA Met-Met hip system. Patients with ceramic-on-ceramic (CoC) bearings were included as a control group. In this study, 68 patients were enrolled: 34 with MoM THAs and 34 with CoC THAs. Patients were evaluated clinically (Harris Hip Score, SF-36) and radiologically at a median of 7.4 years after surgery. Whole blood and urinary cobalt and chromium levels were also assessed. Both types of implants were comparable in terms of clinical and functional results. Ion levels were significantly higher in the MoM group compared with CoC group 7 years after surgery. No correlations were found between metal ion levels and patient demographics, functional and radiological outcomes, and prosthesis features. Patient monitoring is thus advised to establish if prosthesis revision is necessary, especially in the case of MoM THA.
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Affiliation(s)
- Assunta Pozzuoli
- Laboratory of Musculoskeletal Pathology and Oncology, Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Correspondence: (A.P.); (E.B.); Tel.: +39-0498213348 (A.P. & E.B.)
| | - Antonio Berizzi
- Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; (A.B.); (A.C.); (C.B.); (P.R.)
| | - Alberto Crimì
- Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; (A.B.); (A.C.); (C.B.); (P.R.)
| | - Elisa Belluzzi
- Laboratory of Musculoskeletal Pathology and Oncology, Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Correspondence: (A.P.); (E.B.); Tel.: +39-0498213348 (A.P. & E.B.)
| | - Anna Chiara Frigo
- Epidemiology and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, Biostatistics, University of Padova, Via Loredan 18, 35131 Padova, Italy;
| | - Giorgio De Conti
- Department of Radiology, University Hospital of Padova, Via Giustiniani 2, 35128 Padova, Italy;
| | - Annamaria Nicolli
- Laboratory of Industrial Toxicology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (A.N.); (A.T.)
| | - Andrea Trevisan
- Laboratory of Industrial Toxicology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (A.N.); (A.T.)
| | - Carlo Biz
- Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; (A.B.); (A.C.); (C.B.); (P.R.)
| | - Pietro Ruggieri
- Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; (A.B.); (A.C.); (C.B.); (P.R.)
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30
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Wade A, Beadling AR, Neville A, De Villiers D, Cullum CJ, Collins S, Bryant MG. Geometric Variations of Modular Head-Stem Taper Junctions of Total Hip Replacements. Med Eng Phys 2020; 83:34-47. [PMID: 32807346 DOI: 10.1016/j.medengphy.2020.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/03/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Taper degradation in Total Hip Replacements (THR) has been identified as a clinical concern, and the degradation occurring at these interfaces has received increased interest in recent years. Wear and corrosion products produced at the taper junction are associated with adverse local tissue responses, leading to early failure and revision surgery. Retrieval and in-vitro studies have found that variations in taper design affect degradation. However, there is a lack of consistent understanding within the literature of what makes a good taper interface. Previous studies assessed different design variations using their global parameters assuming a perfect cone such as: taper length, cone angle and diameters. This study assessed geometrical variations of as-manufactured head and stem tapers and any local deviations from their geometry. The purpose of this study was to provide a greater insight into possible engagement, a key performance influencing parameter predicted by Morse taper connection theory. This was achieved by taking measurements of twelve different commercially available male tapers and six female tapers using a coordinate measurement machine (CMM). The results suggested that engagement is specific to a particular head-stem couple. This is subject to both their micro-scale deviations, superimposed on their macro-scale differences. Differences in cone angles between female and male tapers from the same manufacturer was found to create a predominately proximal contact. However, distally mismatched couples are present in some metal-on-metal head-stem couples. On a local scale, different deviation patterns were observed from the geometry which appeared to be linked to the manufacturing process. Future work will look at using this measurement methodology to fully characterise an optimal modular taper junction for a THR prosthesis.
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Affiliation(s)
- A Wade
- University of Leeds, School of Mechanical Engineering, Institute of Functional Surfaces, Leeds, UK.
| | - A R Beadling
- University of Leeds, School of Mechanical Engineering, Institute of Functional Surfaces, Leeds, UK
| | - A Neville
- University of Leeds, School of Mechanical Engineering, Institute of Functional Surfaces, Leeds, UK
| | - D De Villiers
- MatOrtho Ltd, Mole Business Park, Randalls Rd, Surrey, UK
| | - C J Cullum
- MatOrtho Ltd, Mole Business Park, Randalls Rd, Surrey, UK
| | - S Collins
- MatOrtho Ltd, Mole Business Park, Randalls Rd, Surrey, UK
| | - M G Bryant
- University of Leeds, School of Mechanical Engineering, Institute of Functional Surfaces, Leeds, UK
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Baumann AP, Vesnovsky O, Topoleski LDT, Donaldson FE, McMinn NLL, Vignola A, Di Prima M. Specimen-Specific Finite Element Models for Predicting Fretting Wear in Total Hip Arthroplasty Tapers. J Biomech Eng 2020; 142:071002. [PMID: 31913446 DOI: 10.1115/1.4045904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Indexed: 11/08/2022]
Abstract
Products from fretting wear and corrosion in the taper junction of total hip arthroplasty (THA) devices can lead to adverse local tissue reactions. Predicting damage as a function of design parameters would aid in the development of more robust devices. The objectives of this study were to develop an automated method for identifying areas of fretting wear on THA taper junctions, and to assess the predictive ability of a finite element model to simulate fretting wear in THA taper junctions. THA constructs were fatigue loaded, thus inducing damage on the stem taper. An automated imaging and analysis algorithm quantified fretting wear on the taper surfaces. Specimen-specific finite element models were used to calculate fretting work done (FWD) at the taper junction. Simulated FWD was correlated to imaged fretting wear. Results showed that the automated imaging approach identified fretting wear on the taper surface. Additionally, finite element models showed the greatest predictive ability for tapers exhibiting distal contact. Finite element models predicted an average of 30.3% of imaged fretting wear. With additional validation, the imaging and finite element techniques may be useful to manufacturers and regulators in the development and review of new THA devices.
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Affiliation(s)
- Andrew P Baumann
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, 10903 New Hampshire Avenue, Building 62, Room 2110, Silver Spring, MD 20993
| | - Oleg Vesnovsky
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, 10903 New Hampshire Avenue, Building 62, Room 2227, Silver Spring, MD 20993
| | - L D Timmie Topoleski
- Department of Mechanical Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250
| | - Finn E Donaldson
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Product Evaluation and Quality, OHT2: Office of Cardiovascular Devices, 10903 New Hampshire Avenue, Building 66, Room 1253, Silver Spring, MD 20993
| | - Nicole L L McMinn
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Product Evaluation and Quality, OHT6: Office of Orthopedic Devices, 10903 New Hampshire Avenue, Building 66, Room 4435, Silver Spring, MD 20993
| | - Amelia Vignola
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, 10903 New Hampshire Avenue, Building 62, Silver Spring, MD 20993
| | - Matthew Di Prima
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, 10903 New Hampshire Avenue, Building 62, Room 2124, Silver Spring, MD 20993
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What Is the Risk of THA Revision for ARMD in Patients with Non-metal-on-metal Bearings? A Study from the Australian National Joint Replacement Registry. Clin Orthop Relat Res 2020; 478:1244-1253. [PMID: 32345846 PMCID: PMC7319380 DOI: 10.1097/corr.0000000000001277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are increasing reports of corrosion between the femoral head and trunnion in primary conventional THA, resulting in metal particulate release often termed trunnionosis. There may be heightened awareness of this condition because of severe soft-tissue reactions initially thought to be solely attributable to prostheses with a metal-on-metal (MoM) bearing surface. It is unclear what percentage of revisions for THA with non-MoM bearing surfaces can be attributed to trunnionosis and to what extent adverse reaction to metal debris (ARMD) seen with MoM bearings may also be seen with other bearing surfaces in THA. QUESTIONS/PURPOSES We analyzed data from a large national registry to ask: (1) What is the revision risk for the indication of ARMD in patients with conventional THA and modern non-MoM bearing surfaces such as metal or ceramic-on-cross-linked polyethylene (XLPE) or ceramic-on-ceramic? (2) What prosthesis factors are associated with an increased risk of such revision? (3) What is the relative revision risk for ARMD in THAs with large-head MoM bearings, small-head MoM bearings, and non-MoM modern bearing surfaces? METHODS The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) longitudinally maintains data on all primary and revision joint arthroplasties, with nearly 100% capture. The study population included all THAs using modern bearing surfaces (defined as metal or ceramic heads-on-XLPE and ceramic-on-ceramic bearing couples) revised because of ARMD between September 1999 and December 2018. Prostheses with modular necks were excluded. The cumulative percent revision (CPR) because of ARMD was determined. The study group consisted of 350,027 THAs with a modern bearing surface, 15,184 THAs with a large-head MoM bearing (≥ 36 mm), and 5474 THAs with a small head MoM bearing (≤ 32 mm). The patients in the group who received the modern bearing surfaces were slightly older than the patients in the groups who received the large- and small-head bearing surfaces, with a mean age 68 years (SD 12) versus a mean age 63 years (SD 12), and a mean age 62 years (SD 11), respectively. There was a higher proportion of women in the modern bearing surface group; 55% (193,312 of 350,027), compared with 43% (6497 of 15,184) in the large-head MoM group and 50% (2716 of 5474) in the small-head MoM group. The outcome measure was the CPR, which was defined using Kaplan-Meier estimates of survivorship to describe the time to the first revision for ARMD at 17 years. Hazard ratios (HR) from Cox proportional hazards models, adjusting for age and sex, were performed to compare the revision rates among groups. The registry defines a revision as a reoperation of a previous hip arthroplasty in which one or more of the prosthetic components is replaced or removed, or one or more components is added. RESULTS The CPR for ARMD for patients with a modern bearing surface at 17 years was 0.1% (95% confidence interval 0.0 to 0.1). After controlling for age and sex, we found that cobalt chrome heads, two specific prostheses (Accolade® I and M/L Taper), and head sizes ≥ 36 mm were associated with an increased risk of revision for ARMD. Metal-on-XLPE had a higher risk of revision for ARMD than ceramic-on-ceramic or ceramic-on-XLPE (HR 3.4 [95% CI 1.9 to 6.0]; p < 0.001). The Accolade 1 and the M/L Taper stems had a higher risk of revision than all other stems (HR, 8.3 [95% CI 4.7 to 14.7]; p < 0.001 and HR 14.4 [95% CI 6.0 to 34.6]; p < 0.001, respectively). Femoral stems with head sizes ≥ 36 mm had a higher rate of revision for ARMD than stems with head sizes ≤ 32 mm (HR 3.2 [95% CI 1.9 to 5.3]; p < 0.001).Large-head MoM bearings had a greater increase in revision for ARMD compared with modern bearing surfaces. The CPR for patients with a large-head MoM bearing at 17 years for ARMD was 15.5% (95% CI 14.5 to 16.6) and it was 0.1% for modern bearing surfaces (HR 340 [95% CI 264.2 to 438.0]; p < 0.001). Modern bearing surfaces likewise had a lower HR for revision for ARMD than did THAs with small-head MoM bearings, which had a 0.9% (95% CI 0.7 to 1.4) CPR compared with modern bearings from 0 to 9 years (HR 10.5 [95% CI 6.2 to 17.7]; p < 0.001). CONCLUSIONS The revision risk for ARMD with modern bearing surfaces in THA is low. The Accolade 1 and the M/L Taper stem have a higher risk of revision for ARMD and cobalt-chrome heads, and head sizes ≥ 36 mm have a higher rate of revision than ≤ 32 mm head sizes. ARMD is a rare failure mode for THA with non-MoM bearings, but in patients presenting with unexplained pain with no other obvious cause, this diagnosis should be considered and investigated further. LEVEL OF EVIDENCE Level III, therapeutic study.
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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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34
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Bechstedt M, Gustafson JA, Mell SP, Gührs J, Morlock MM, Levine BR, Lundberg HJ. Contact conditions for total hip head-neck modular taper junctions with microgrooved stem tapers. J Biomech 2020; 103:109689. [PMID: 32139099 DOI: 10.1016/j.jbiomech.2020.109689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
Abstract
Implant failure due to fretting-corrosion of head-neck modular junctions is a rising problem in total hip arthroplasty. Fretting-corrosion initiates when micromotion leads to metal release; however, factors leading to micromotion, such as microgrooves on the stem taper, are not fully understood. The purpose of this study is to describe a finite element analysis technique to determine head-neck contact mechanics and investigate the effect of stem taper microgroove height during head-neck assembly. Two-dimensional axisymmetric finite element models were created. Models were created for a ceramic femoral head and a CoCrMo femoral head against Ti6Al4V stem tapers and compared to available data from prior experiments. Stem taper microgroove height was investigated with a generic 12/14 model. Head-neck assembly was performed to four maximum loads (500 N, 2000 N, 4000 N, 8000 N). For the stem taper coupled with the ceramic head, the number of microgrooves in contact and plastically deformed differed by 2.5 microgrooves (4%) and 6.5 microgrooves (11%), respectively, between the finite element models and experiment. For the stem taper coupled with the CoCrMo head, all microgrooves were in contact after all assembly loads in the finite element model due to an almost identical conical angle between the taper surfaces. In the experiments, all grooves were only in contact for the 8000 N assembly load. Contact area, plastic (permanent) deformation, and contact pressure increased with increasing assembly loads and deeper microgrooves. The described modeling technique can be used to investigate the relationship between implant design factors, allowing for optimal microgroove design within material couples.
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Affiliation(s)
- Maren Bechstedt
- Institute of Biomechanics, TUHH Hamburg University of Technology, 21073 Hamburg, Germany
| | - Jonathan A Gustafson
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 201, Chicago, IL 60612, United States
| | - Steven P Mell
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 201, Chicago, IL 60612, United States
| | - Julian Gührs
- Institute of Biomechanics, TUHH Hamburg University of Technology, 21073 Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, 21073 Hamburg, Germany
| | - Brett R Levine
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 201, Chicago, IL 60612, United States
| | - Hannah J Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 201, Chicago, IL 60612, United States.
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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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Urish KL, Giori NJ, Lemons JE, Mihalko WM, Hallab N. Trunnion Corrosion in Total Hip Arthroplasty-Basic Concepts. Orthop Clin North Am 2019; 50:281-288. [PMID: 31084829 PMCID: PMC6521866 DOI: 10.1016/j.ocl.2019.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There has been increased interest in the role of corrosion in early implant failures and adverse local tissue reaction in total hip arthroplasty. We review the relationship between the different types of corrosion in orthopaedic surgery including uniform, pitting, crevice, and fretting or mechanically assisted crevice corrosion (MACC). Passive layer dynamics serves a critical role in each of these processes. The femoral head-neck trunnion creates an optimal environment for corrosion to occur because of the limited fluid diffusion, acidic environment, and increased bending moment.
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Affiliation(s)
- Kenneth L. Urish
- Corresponding Author: Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center; Department of Orthopaedic Surgery, Department of Bioengineering, and Clinical and Translational Science Institute, University of Pittsburgh; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA. .
| | - Nicholas John Giori
- VA Palo Alto Health Care System, Palo Alto, CA and Department of Orthopaedic Surgery, Stanford University, Stanford, CA, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342
| | - Jack E. Lemons
- Department of Orthopaedic Surgery, University of Alabama at Birmingham. Birmingham, AL, 1313 13th Street South, Birmingham, AL 35205-5327
| | - William M. Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN 1211 Union Avenue, Suite 510, Memphis TN 38104
| | - Nadim Hallab
- Department of Orthopaedic Surgery, Rush University, Chicago, IL 1653 W. Congress Parkway, Chicago, IL 60612
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Bitter T, Khan I, Marriott T, Lovelady E, Verdonschot N, Janssen D. The effects of manufacturing tolerances and assembly force on the volumetric wear at the taper junction in modular total hip arthroplasty. Comput Methods Biomech Biomed Engin 2019; 22:1061-1072. [DOI: 10.1080/10255842.2019.1627524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Thom Bitter
- Orthopaedic Research lab, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | | | | | - Nico Verdonschot
- Orthopaedic Research lab, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Laboratory for Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, Enschede, The Netherlands
| | - Dennis Janssen
- Orthopaedic Research lab, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Snethen K, Hernandez J, Harman M. The effect of manufacturing tolerances on the mechanical environment of taper junctions in modular TKR. J Mech Behav Biomed Mater 2019; 97:49-57. [PMID: 31100485 DOI: 10.1016/j.jmbbm.2019.04.018] [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: 07/19/2018] [Revised: 10/19/2018] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
Taper design is known to influence corrosive behavior in taper junctions used in modular orthopaedic devices. Manufacturing tolerance of bore-cone tapers is a critical design parameter due to the effect on taper fit, but the effect of variations in manufacturing tolerance on the mechanics of taper junctions has not been well characterized, particularly in modular total knee replacement (TKR). The purpose of this study was to investigate the effect of manufacturing tolerance on stress and micromotion of modular TKR taper junctions. A 3D finite element (FE) model of a modular TKR taper junction was developed and assigned elastoplastic material properties. Model taper geometry was varied by perturbing the angle mismatch by 0.05° between ±0.25° and represented expected variation in manufacturing tolerance. Stress and micromotion were calculated during dynamic FE simulations for each taper junction geometry under varying activity loads and material combinations. Although an increase in angle mismatch generally resulted in higher stress and micromotion, plastic material behavior disrupted this trend for larger angle mismatches. Model predictions corresponded with corrosion behavior evident in vitro. If the FE results obtained here apply in vivo, the absence of elastoplastic material properties in a taper model may grossly overestimate the micromotion and underestimate corrosion behavior and ion release. It is recommended that manufacturing tolerances of bore-cone tapers in modular TKR designs should produce angle mismatches within 0.1° at the taper junction.
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Affiliation(s)
- Kyle Snethen
- Bioengineering Department, Clemson University, Clemson, USA
| | | | - Melinda Harman
- Bioengineering Department, Clemson University, Clemson, USA.
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The Influence of Assembly Force on the Material Loss at the Metallic Head-Neck Junction of Hip Implants Subjected to Cyclic Fretting Wear. METALS 2019. [DOI: 10.3390/met9040422] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The impaction force required to assemble the head and stem components of hip implants is proven to play a major role in the mechanics of the taper junction. However, it is not clear if the assembly force could have an effect on fretting wear, which normally occurs at the junction. In this study, an adaptive finite element model was developed for a CoCr/CoCr head-neck junction with an angular mismatch of 0.01° in order to simulate the fretting wear process and predict the material loss under various assembly forces and over a high number of gait cycles. The junction was assembled with 2, 3, 4, and 5 kN and then subjected to 1,025,000 cycles of normal walking gait loading. The findings showed that material removal due to fretting wear increased when raising the assembly force. High assembly forces induced greater contact pressures over larger contact regions at the interface, which, in turn, resulted in more material loss and wear damage to the surface when compared to lower assembly forces. Although a high assembly force (greater than 4 kN) can further improve the initial strength and stability of the taper junction, it appears that it also increases the degree of fretting wear. Further studies are needed to investigate the assembly force in the other taper designs, angular mismatches, and material combinations.
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Lanting B, Naudie DDR, McCalden RW. Clinical Impact of Trunnion Wear After Total Hip Arthroplasty. JBJS Rev 2018; 4:01874474-201608000-00003. [PMID: 27603271 DOI: 10.2106/jbjs.rvw.15.00096] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Trunnionosis, characterized by corrosion and fretting of the taper, is a well-known entity commonly demonstrated in retrieval specimens. While there have been a number of recent reports regarding the potential for adverse local tissue reactions related to trunnionosis, it remains a relatively infrequent cause for failure of total hip replacement implants. A number of factors, including both biomechanical and bioelectrochemical factors, have a known impact on the development and severity of trunnionosis. Furthermore, specific implant design and material-related factors have been shown to influence the risk of trunnionosis leading to adverse local tissue reactions. Retention of a well-fixed femoral stem, in spite of corrosion of the male taper junction, is acceptable in the majority of cases. A ceramic head, often in combination with a titanium adaptor sleeve, is the most common replacement reported in the current literature to treat trunnionosis. In patients with modular-neck total hip replacements, revision of the femoral stem is likely required if corrosion at the modular neck-stem junction is encountered.
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Affiliation(s)
- Brent Lanting
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.,Joint Replacement Institute, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - Douglas D R Naudie
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.,Joint Replacement Institute, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - Richard W McCalden
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.,Joint Replacement Institute, London Health Sciences Center, University Hospital, London, Ontario, Canada
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Mueller U, Panzram B, Braun S, Sonntag R, Kretzer JP. Mixing of Head-Stem Components in Total Hip Arthroplasty. J Arthroplasty 2018; 33:945-951. [PMID: 29174405 DOI: 10.1016/j.arth.2017.10.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/17/2017] [Accepted: 10/21/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Implant manufacturers proclaim that the tapers of modular total hip arthroplasty are not standardized and can vary from manufacturer to manufacturer. That is why the combination of various components from different manufacturers ("Mix and Match") is not permitted. In this study, different taper combinations were investigated experimentally to assess the effect of "Mix and Match" regarding the taper connection strength. METHODS Torque-off tests using hip stems and metal femoral heads from 6 different implant manufacturers were performed. First the components were tested as intended and afterwards the stems were combined with metal heads from other manufacturers. RESULTS There was no significant difference in taper connection strength when stems from the manufacturers Link, Smith & Nephew, and Zimmer were combined with heads from other manufacturers. The Biomet stems showed a significantly reduced taper connection strength if femoral heads of Aesculap, DePuy, or Smith & Nephew were used. On the contrary, the DePuy stems in combination with the originally intended femoral heads showed a significantly lower taper connection strength compared to the use of heads from Link, Biomet, and Zimmer. The same was observed for the Aesculap stems in combination with Zimmer heads. CONCLUSION The results of this study suggest that mixing components from different manufacturers may affect the taper connection strength and could reduce the stability. As safety should be a high priority in patient treatment, any potential risks should be avoided. Therefore, mixing and matching of heads and femoral stems from different manufacturers cannot be recommended.
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Affiliation(s)
- Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Panzram
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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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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Bitter T, Khan I, Marriott T, Lovelady E, Verdonschot N, Janssen D. Finite element wear prediction using adaptive meshing at the modular taper interface of hip implants. J Mech Behav Biomed Mater 2018; 77:616-623. [DOI: 10.1016/j.jmbbm.2017.10.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/04/2017] [Accepted: 10/26/2017] [Indexed: 11/25/2022]
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Fallahnezhad K, Farhoudi H, Oskouei RH, Taylor M. A finite element study on the mechanical response of the head-neck interface of hip implants under realistic forces and moments of daily activities: Part 2. J Mech Behav Biomed Mater 2018; 77:164-170. [DOI: 10.1016/j.jmbbm.2017.08.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/22/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
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Evidence based recommendations for reducing head-neck taper connection fretting corrosion in hip replacement prostheses. Hip Int 2017; 27:523-531. [PMID: 29027189 DOI: 10.5301/hipint.5000545] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This systematic review seeks to summarise the published studies investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion at the head-neck taper connection, and provide clinical recommendations to reduce its occurrence. METHODS PubMed, MEDLINE and EMBASE electronic databases were searched using the terms taper, trunnion, cone and head-neck junction. Articles investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion were retrieved, reviewed and graded according to OCEBM levels of evidence and grades of recommendation. RESULTS The initial search yielded 1,224 unique articles, and 91 were included in the analysis. CONCLUSIONS There is fair evidence to recommend against the use of high offset femoral heads, larger diameter femoral heads, and to pay particular consideration to fretting corrosion's progression with time and risk with heavier or more active patients. Particular to metal-on-metal hip prostheses, there is fair evidence to recommend positioning the acetabular component to minimise edge loading. Particular to metal-on-polyethylene hip prostheses, there is fair evidence to recommend the use of ceramic femoral heads, against use of cast cobalt alloy femoral heads, and against use of low flexural rigidity femoral stems. Evidence related to taper connection design is largely conflicting or inconclusive. Head-neck taper connection fretting corrosion is a multifactorial problem. Strict adherence to the guidelines presented herein does not eliminate the risk. Prosthesis selection is critical, and well-controlled studies to identify each design parameter's relative contribution to head-neck taper connection fretting corrosion are required.
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Farhoudi H, Fallahnezhad K, Oskouei RH, Taylor M. A finite element study on the mechanical response of the head-neck interface of hip implants under realistic forces and moments of daily activities: Part 1, level walking. J Mech Behav Biomed Mater 2017; 75:470-476. [DOI: 10.1016/j.jmbbm.2017.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
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47
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Fallahnezhad K, Oskouei RH, Badnava H, Taylor M. An adaptive finite element simulation of fretting wear damage at the head-neck taper junction of total hip replacement: The role of taper angle mismatch. J Mech Behav Biomed Mater 2017; 75:58-67. [DOI: 10.1016/j.jmbbm.2017.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/22/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022]
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Does a micro-grooved trunnion stem surface finish improve fixation and reduce fretting wear at the taper junction of total hip replacements? A finite element evaluation. J Biomech 2017; 63:47-54. [DOI: 10.1016/j.jbiomech.2017.07.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 07/27/2017] [Accepted: 07/29/2017] [Indexed: 11/30/2022]
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Mueller U, Braun S, Schroeder S, Sonntag R, Kretzer JP. Same Same but Different? 12/14 Stem and Head Tapers in Total Hip Arthroplasty. J Arthroplasty 2017; 32:3191-3199. [PMID: 28552447 DOI: 10.1016/j.arth.2017.04.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/27/2017] [Accepted: 04/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Taper corrosion has been identified to be a major concern in total hip arthroplasty during the past years. So far, the mechanisms that lead to taper corrosion in modular taper junctions are not fully understood. However, it has been shown that corrosion is also influenced by the geometry and topography of the taper, and these parameters vary among the implant manufacturers. The purpose of this study was to investigate the variations of common stem and head tapers regarding design and surface characteristics. METHODS An analysis of selected commercially available 12/14 stem and head tapers was performed. As geometric parameters, the taper angle, the opening taper diameter, and the taper length were measured using a coordinate measuring machine. Several topographic parameters were determined using a tactile roughness measurement instrument. RESULTS Although all investigated tapers are so-called 12/14 tapers, this study showed that the stem and head tapers differ among the manufacturers. The stem tapers were clearly different in both geometry and topography, and the range in variation of the topographic parameter was greater than it was for the geometric parameter. In contrast, the head tapers were different in their geometry, although not in topography. CONCLUSION Ultimately, this study provides an overview on the characteristics and variations of modular hip taper connections, and in addition, a new classification system regarding the surface finish is presented. These findings could be further considered in experimental corrosion or retrieval studies.
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Affiliation(s)
- Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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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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