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Dolinar D, Kocjančič B, Avsec K, Šetina Batič B, Kocijan A, Godec M, Sedlaček M, Debeljak M, Grant JT, Zupanc T, Jenko M. Characterization of Micro-Threaded Stem Taper Surfaces of Cementless Hip Endoprostheses. MATERIALS (BASEL, SWITZERLAND) 2024; 17:2751. [PMID: 38894016 PMCID: PMC11173811 DOI: 10.3390/ma17112751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
We investigated micro-threaded stem taper surface and its impact on premature failures, aseptic loosening, and infection in cementless hip endoprostheses. Our study focused on the fretting, and crevice corrosion of micro-threaded tapers, as well as the characterization of the microstructure and surface properties of two new and three retrieved Zweymüller stem tapers. The retrieved samples were selected and examined based on the head-stem taper interface being the sole source of modularity with a metallic component, specifically between the Ti alloy taper stem and the ceramic head. To determine the surface chemistry and microstructures of both new and retrieved hip endoprostheses stem taper titanium alloy, scanning -electron microscopy (SEM) was employed for morphological and microstructural analyses. Energy dispersive spectroscopy (EDS) was utilized for characterizing chemical element distribution, and electron backscattered diffraction (EBSD) was used for phase analysis. The roughness of the micro-threated stem tapers from different manufacturers was investigated using an optical profilometer, with standard roughness parameters Ra (average surface roughness) and Rz (mean peak to valley height of the roughness profile) being measured. Electrochemical studies revealed no fretting corrosion in retrieved stem tapers with ceramic heads. Consequently, three retrieved tapers and two new ones for comparison underwent potentiodynamic measurements in Hank's solution to determine the corrosion rate of new and retrieved stem taper surfaces. The results showed a low corrosion rate for both new and prematurely failed retrieved samples due to aseptic loosening. However, the corrosion rate was higher in infected and low-grade infected tapers. In conclusion, our study suggests that using ceramic heads reduces taper corrosion and subsequently decreases the incidence of premature failures in total hip arthroplasty.
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Affiliation(s)
- Drago Dolinar
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
- Orthopaedic Surgery Chair, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Boštjan Kocjančič
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
- Orthopaedic Surgery Chair, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Klemen Avsec
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
- Orthopaedic Surgery Chair, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Barbara Šetina Batič
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Aleksandra Kocijan
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Matjaž Godec
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Marko Sedlaček
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Mojca Debeljak
- University Rehabilitation Institute Republic of Slovenia, Linhartova 51, 1000 Ljubljana, Slovenia;
| | - John T. Grant
- Research Institute, University of Dayton, Dayton, OH 45469, USA;
| | - Timon Zupanc
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
| | - Monika Jenko
- MD-RI Institute for Materials Research in Medicine, Bohoričeva 5, 1000 Ljubljana, Slovenia
- MD Medicina, Sanatorium, Bohoričeva 5a, 1000 Ljubljana, Slovenia
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Hunger S, Rotsch C, Günther F, Drossel WG, Heyde CE. Influence of a Modified Procedure of Joining Ceramic Head and Adapter Sleeve on the Stem Taper in Revision: An Experimental Study. Bioengineering (Basel) 2024; 11:170. [PMID: 38391656 PMCID: PMC10886244 DOI: 10.3390/bioengineering11020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
In revision operations, ceramic heads of modular hip implants can be replaced. As the surface of the stem taper can be damaged, additional adapter sleeves are applied. The components are usually connected manually by the surgeon in a one-step procedure by hammer impacts. In this study, we investigated a two-step joining procedure with reproducible impaction force. First, the adapter sleeve and head were joined quasi-statically with a force of 2 kN using an assembly device. In the second step, these components were applied to the stem taper using a pulse-controlled instrument. For reference, the joints were assembled according to standard conditions using a tensile testing machine. An average pull-off force of 1309 ± 201 N was achieved for the components joined by the instrument, and the average measured values for the components joined by the testing machine were 1290 ± 140 N. All specimens achieved a force >350 N when released and therefore met the acceptance criterion defined for this study. This study showed that a modified procedure in two steps with a defined force has a positive effect on the reproducibility of the measured joining forces compared to previous studies.
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Affiliation(s)
- Sandra Hunger
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany
- Department of Orthopaedic, Trauma and Plastic Surgery Clinic, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Christian Rotsch
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany
- Department of Orthopaedic, Trauma and Plastic Surgery Clinic, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Florian Günther
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany
- Department of Orthopaedic, Trauma and Plastic Surgery Clinic, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Welf-Guntram Drossel
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany
- Institute for Machine Tools and Production Processes, Faculty of Mechanical Engineering, Chemnitz University of Technology, 09111 Chemnitz, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedic, Trauma and Plastic Surgery Clinic, University of Leipzig Medical Center, 04103 Leipzig, Germany
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Hunger S, Seidler A, Rotsch C, Heyde CE, Drossel WG. Evaluating the Feasibility and Reproducibility of a Novel Insertion Method for Modular Acetabular Ceramic Liners. Bioengineering (Basel) 2023; 10:1180. [PMID: 37892910 PMCID: PMC10604853 DOI: 10.3390/bioengineering10101180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/24/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Modern hip implants have a modular design. In case of wear or other damage it allows surgeons to change the tribological partners, i.e., the acetabular liner and femoral ball. In both revision and primary surgery, the secure joining of the implant components is important for the success of the operation. The two components, namely the ceramic liner and hip cup, are connected via a conical press connection and should be concentrically aligned to avoid chipping. Malseated liners can reduce the life span in situ. The amount of the joining force, which is usually applied via a hammer, depends on the surgeon. In this study, an alternative joining method for acetabular ceramic liners in hip cups was investigated, which intends to make the process more reproducible and thus safer. For this purpose, a handpiece was used to apply a defined force impulse of 4 kN. For the concentric alignment of a ceramic liner in the hip cup, an adapter was developed based on findings via a qualitative finite element (FE) analysis. Insertion and pushout tests of the acetabular cup-liner connection were performed in the laboratory with the new instrument (handpiece with the connected adapter) to evaluate the functionality of the instrument and the reproducibility of the new insertion method. For comparison, liners and acetabular cups were joined using a testing machine according to the standard. The presented results demonstrate the technical proof-of-concept of the new joining method under laboratory conditions. They meet the acceptance criteria of established manufacturers, which proves the equivalency to proven methods for joining modular implant components. To verify the improvement of the new joining method compared to the conventionally used joining method, an application-oriented study with different surgeons and the new joining instrument under clinical conditions is necessary.
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Affiliation(s)
- Sandra Hunger
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany; (A.S.); (C.R.); (W.-G.D.)
- Department of Orthopaedic, Trauma and Plastic Surgery Clinic, University of Leipzig Medical Center, 04103 Leipzig, Germany;
| | - Alexander Seidler
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany; (A.S.); (C.R.); (W.-G.D.)
- Institute of Machine Elements and Machine Design, Faculty of Mechanical Science and Engineering, Dresden University of Technology, 01062 Dresden, Germany
| | - Christian Rotsch
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany; (A.S.); (C.R.); (W.-G.D.)
- Department of Orthopaedic, Trauma and Plastic Surgery Clinic, University of Leipzig Medical Center, 04103 Leipzig, Germany;
| | - Christoph-Eckhard Heyde
- Department of Orthopaedic, Trauma and Plastic Surgery Clinic, University of Leipzig Medical Center, 04103 Leipzig, Germany;
| | - Welf-Guntram Drossel
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany; (A.S.); (C.R.); (W.-G.D.)
- Institute for Machine Tools and Production Processes, Faculty of Mechanical Engineering, Chemnitz University of Technology, 09111 Chemnitz, Germany
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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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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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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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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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Krull A, Morlock MM, Bishop NE. The Influence of Contamination and Cleaning on the Strength of Modular Head Taper Fixation in Total Hip Arthroplasty. J Arthroplasty 2017. [PMID: 28625686 DOI: 10.1016/j.arth.2017.05.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Intraoperative interface contamination of modular head-stem taper junctions of hip implants can lead to poor fixation strength, causing fretting and crevice corrosion or even stem taper fracture. Careful cleaning before assembly should help to reduce these problems. The purpose of this study was to determine the effect of cleaning (with and without drying) contaminated taper interfaces on the taper fixation strength. METHODS Metal or ceramic heads were impacted onto titanium alloy stem tapers with cleaned or contaminated (fat or saline solution) interfaces. The same procedure was performed after cleaning and drying the contaminated interfaces. Pull-off force was used to determine the influence of contamination and cleaning on the taper strength. RESULTS Pull-off forces after contamination with fat were significantly lower than those for uncontaminated interfaces for both head materials. Pull-off forces after application of saline solution were not significantly different from those for uncontaminated tapers. However, a large variation in taper strength was observed, pull-off forces for cleaned and dried tapers were similar to those for uncontaminated tapers for both head materials. CONCLUSION Intraoperative contamination of taper interfaces may be difficult to detect but has a major influence on taper fixation strength. Cleaning of the stem taper with saline solution and drying with gauze directly before assembly allows the taper strength of the pristine components to be achieved. Not drying the taper results in a large variation in pull-off forces, emphasizing that drying is essential for sufficient and reproducible fixation strength.
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Affiliation(s)
- Annika Krull
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Nicholas E Bishop
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany; Department of Medical Technology, Faculty of Life Science, HAW Hamburg University of Applied Sciences, Hamburg, Germany
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In Vivo Damage of the Head-Neck Junction in Hard-on-Hard Total Hip Replacements: Effect of Femoral Head Size, Metal Combination, and 12/14 Taper Design. MATERIALS 2017; 10:ma10070733. [PMID: 28773095 PMCID: PMC5551776 DOI: 10.3390/ma10070733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/24/2017] [Accepted: 06/25/2017] [Indexed: 11/16/2022]
Abstract
Recently, concerns have been raised about the potential effect of head-neck junction damage products at the local and systemic levels. Factors that may affect this damage process have not been fully established yet. This study investigated the possible correlations among head-neck junction damage level, implant design, material combination, and patient characteristics. Head-neck junctions of 148 retrieved implants were analysed, including both ceramic-on-ceramic (N = 61) and metal-on-metal (N = 87) bearings. In all cases, the male taper was made of titanium alloy. Damage was evaluated using a four-point scoring system based on damage morphology and extension. Patient age at implantation, implantation time, damage risk factor, and serum ion concentration were considered as independent potential predicting variables. The damage risk factor summarises head-neck design characteristics and junction loading condition. Junction damage correlated with both implantation time and damage factor risk when the head was made of ceramic. A poor correlation was found when the head was made of cobalt alloy. The fretting-corrosion phenomenon seemed mainly mechanically regulated, at least when cobalt alloy components were not involved. When a component was made of cobalt alloy, the role of chemical phenomena increased, likely becoming, over implantation time, the damage driving phenomena of highly stressed junctions.
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Morlock M, Bünte D, Gührs J, Bishop N. Corrosion of the Head-Stem Taper Junction-Are We on the Verge of an Epidemic?: Review Article. HSS J 2017; 13:42-49. [PMID: 28167873 PMCID: PMC5264576 DOI: 10.1007/s11420-016-9526-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The modular head taper junction has contributed to the success of total hip arthroplasty (THA) greatly. Taper corrosion and wear problems reported for large and extra-large metal-on-metal bearings as well as for bi-modular THA stems have cast doubt on the benefit of the taper interface. Presently, corrosion problems are being reported for nearly all kinds of artificial hip joints incorporating metal heads, questioning taper connections in general. QUESTIONS/PURPOSES This study aimed to review the mechanical and electrochemical relationships that may lead to taper corrosion, which have been reported more commonly in recent literature, and to also review the contribution of patient characteristics and surgical techniques involved in taper assembly that may contribute to the problem. METHODS The search criteria "(corrosion) AND (hip arthroplasty) AND (taper OR trunnion)" and "(hip arthroplasty) AND ((pseudotumor) OR (pseudo-tumor))" in PubMed and the JAAOS were used for the literature search. In addition, the arthroplasty registers were considered. RESULTS Most studies acknowledge the multifactorial nature of the problem but concentrate their analysis on taper and implant design aspects, since this is the only factor that can be easily quantified. The sometimes conflicting results in the literature could be due to the fact that the other two decisive factors are not sufficiently considered: the loading situation in the patient and the assembly situation by the surgeon. All three factors together determine the fate of a taper junction in THA. There is no single reason as a main cause for taper corrosion. The combined "outcome" of these three factors has to be in a "safe range" to achieve a successful long-term taper fixation. CONCLUSION No, this is not the beginning of an epidemic. It is rather the consequence of disregarding known mechanical and electrochemical relationships, which in combination have recently caused a more frequent occurrence-and mainly reporting-of corrosion issues.
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Affiliation(s)
- Michael Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, 21073 Hamburg, Germany
| | - Dennis Bünte
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, 21073 Hamburg, Germany
| | - Julian Gührs
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, 21073 Hamburg, Germany
| | - Nicholas Bishop
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, 21073 Hamburg, Germany
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14
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An Analytical Calculation of Frictional and Bending Moments at the Head-Neck Interface of Hip Joint Implants during Different Physiological Activities. MATERIALS 2016; 9:ma9120982. [PMID: 28774104 PMCID: PMC5456991 DOI: 10.3390/ma9120982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 01/20/2023]
Abstract
This study predicts the frictional moments at the head-cup interface and frictional torques and bending moments acting on the head-neck interface of a modular total hip replacement across a range of activities of daily living. The predicted moment and torque profiles are based on the kinematics of four patients and the implant characteristics of a metal-on-metal implant. Depending on the body weight and type of activity, the moments and torques had significant variations in both magnitude and direction over the activity cycles. For the nine investigated activities, the maximum magnitude of the frictional moment ranged from 2.6 to 7.1 Nm. The maximum magnitude of the torque acting on the head-neck interface ranged from 2.3 to 5.7 Nm. The bending moment acting on the head-neck interface varied from 7 to 21.6 Nm. One-leg-standing had the widest range of frictional torque on the head-neck interface (11 Nm) while normal walking had the smallest range (6.1 Nm). The widest range, together with the maximum magnitude of torque, bending moment, and frictional moment, occurred during one-leg-standing of the lightest patient. Most of the simulated activities resulted in frictional torques that were near the previously reported oxide layer depassivation threshold torque. The predicted bending moments were also found at a level believed to contribute to the oxide layer depassivation. The calculated magnitudes and directions of the moments, applied directly to the head-neck taper junction, provide realistic mechanical loading data for in vitro and computational studies on the mechanical behaviour and multi-axial fretting at the head-neck interface.
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15
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Jauch-Matt SY, Miles AW, Gill HS. Effect of trunnion roughness and length on the modular taper junction strength under typical intraoperative assembly forces. Med Eng Phys 2016; 39:94-101. [PMID: 27913177 DOI: 10.1016/j.medengphy.2016.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 10/15/2016] [Accepted: 11/13/2016] [Indexed: 01/24/2023]
Abstract
Modular hip implants are at risk of fretting-induced postoperative complications most likely initiated by micromotion between adjacent implant components. A stable fixation between ball head and stem-neck taper is critical to avoid excessive interface motions. Therefore, the aim of this study was to identify the effect of trunnion roughness and length on the modular taper strength under typical intraoperative assembly forces. Custom-made Titanium trunnions (standard/mini taper, smooth/grooved surface finish) were assembled with modular Cobalt-chromium heads by impaction with peak forces ranging from 2kN to 6kN. After each assembly process these were disassembled with a materials testing machine to detect the pull-off force as a measure for the taper strength. As expected, the pull-off forces increased with rising peak assembly force (p < 0.001). For low and moderate assembly forces, smooth standard tapers offered higher pull-off forces compared to grooved tapers (p < 0.038). In the case of an assembly force of 2kN, mini tapers showed a higher taper strength than standard ones (p=0.037). The results of this study showed that smooth tapers provided a higher strength for taper junctions. This higher taper strength may reduce the risk of fretting-related complications especially in the most common range of intraoperative assembly forces.
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Affiliation(s)
- S Y Jauch-Matt
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, United Kingdom.
| | - A W Miles
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, United Kingdom.
| | - H S Gill
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, United Kingdom.
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16
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MacLeod AR, Sullivan NPT, Whitehouse MR, Gill HS. Large-diameter total hip arthroplasty modular heads require greater assembly forces for initial stability. Bone Joint Res 2016; 5:338-46. [PMID: 27496914 PMCID: PMC5013896 DOI: 10.1302/2046-3758.58.bjr-2016-0044.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/06/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives Modular junctions are ubiquitous in contemporary hip arthroplasty. The head-trunnion junction is implicated in the failure of large diameter metal-on-metal (MoM) hips which are the currently the topic of one the largest legal actions in the history of orthopaedics (estimated costs are stated to exceed $4 billion). Several factors are known to influence the strength of these press-fit modular connections. However, the influence of different head sizes has not previously been investigated. The aim of the study was to establish whether the choice of head size influences the initial strength of the trunnion-head connection. Materials and Methods Ti-6Al-4V trunnions (n = 60) and two different sizes of cobalt-chromium (Co-Cr) heads (28 mm and 36 mm; 30 of each size) were used in the study. Three different levels of assembly force were considered: 4 kN; 5 kN; and 6 kN (n = 10 each). The strength of the press-fit connection was subsequently evaluated by measuring the pull-off force required to break the connection. The statistical differences in pull-off force were examined using a Kruskal–Wallis test and two-sample Mann–Whitney U test. Finite element and analytical models were developed to understand the reasons for the experimentally observed differences. Results 36 mm diameter heads had significantly lower pull-off forces than 28 mm heads when impacted at 4 kN and 5 kN (p < 0.001; p < 0.001), but not at 6 kN (p = 0.21). Mean pull-off forces at 4 kN and 5 kN impaction forces were approximately 20% larger for 28 mm heads compared with 36 mm heads. Finite element and analytical models demonstrate that the differences in pull-off strength can be explained by differences in structural rigidity and the resulting interface pressures. Conclusion This is the first study to show that 36 mm Co-Cr heads have up to 20% lower pull-off connection strength compared with 28 mm heads for equivalent assembly forces. This effect is likely to play a role in the high failure rates of large diameter MoM hips. Cite this article: A. R. MacLeod, N. P. T. Sullivan, M. R. Whitehouse, H. S. Gill. Large-diameter total hip arthroplasty modular heads require greater assembly forces for initial stability. Bone Joint Res 2016;5:338–346. DOI: 10.1302/2046-3758.58.BJR-2016-0044.R1.
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Affiliation(s)
- A R MacLeod
- University of Bath, Claverton Down Rd, Bath, North East Somerset BA2 7AY, UK
| | - N P T Sullivan
- Southmead Hospital, Department of Trauma and Orthopaedics, North Bristol NHS Trust, Southmead Way, Bristol, BS10 5NB, UK
| | - M R Whitehouse
- University of Bristol, Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK, BS10 5NB, UK
| | - H S Gill
- University of Bath, Claverton Down Rd, Bath, North East Somerset BA2 7AY, UK
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17
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Influence of geometry and materials on the axial and torsional strength of the head–neck taper junction in modular hip replacements: A finite element study. J Mech Behav Biomed Mater 2016; 60:118-126. [DOI: 10.1016/j.jmbbm.2015.12.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/26/2015] [Accepted: 12/29/2015] [Indexed: 11/23/2022]
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18
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Haschke H, Jauch-Matt SY, Sellenschloh K, Huber G, Morlock MM. Assembly force and taper angle difference influence the relative motion at the stem–neck interface of bi-modular hip prostheses. Proc Inst Mech Eng H 2016; 230:690-9. [DOI: 10.1177/0954411916648717] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 04/15/2016] [Indexed: 11/15/2022]
Abstract
Bi-modular hip arthroplasty prostheses allow adaptation to the individual patient anatomy and the combination of different materials but introduce an additional interface, which was related lately to current clinical issues. Relative motion at the additional taper interface might increase the overall risk of fretting, corrosion, metallic debris and early failure. The aim of this study was to investigate whether the assembly force influences the relative motion and seating behaviour at the stem–neck interface of a bi-modular hip prosthesis (Metha®; Aesculap AG, Tuttlingen, Germany) and whether this relation is influenced by the taper angle difference between male and female taper angles. Neck adapters made of titanium (Ti6Al4V) and CoCr (CoCr29Mo) were assembled with a titanium stem using varying assembly forces and mechanically loaded. A contactless eddy current measurement system was used to record the relative motion between prosthesis stem and neck adapter. Higher relative motion was observed for Ti neck adapters compared to the CoCr ones (p < 0.001). Higher assembly forces caused increased seating distances (p < 0.001) and led to significantly reduced relative motion (p = 0.019). Independent of neck material type, prostheses with larger taper angle difference between male and female taper angles exhibited decreased relative motion (p < 0.001). Surgeons should carefully use assembly forces above 4 kN to decrease the amount of relative motion within the taper interface. Maximum assembly forces, however, should be limited to prevent periprosthetic fractures. Manufacturers should optimize taper angle differences to increase the resistance against relative motion.
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Affiliation(s)
- Henning Haschke
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
| | - Sabrina Y Jauch-Matt
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Kay Sellenschloh
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
| | - Gerd Huber
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
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19
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Osman K, Panagiotidou AP, Khan M, Blunn G, Haddad FS. Corrosion at the head-neck interface of current designs of modular femoral components. Bone Joint J 2016; 98-B:579-84. [DOI: 10.1302/0301-620x.98b5.35592] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 12/10/2015] [Indexed: 11/05/2022]
Abstract
There is increasing global awareness of adverse reactions to metal debris and elevated serum metal ion concentrations following the use of second generation metal-on-metal total hip arthroplasties. The high incidence of these complications can be largely attributed to corrosion at the head-neck interface. Severe corrosion of the taper is identified most commonly in association with larger diameter femoral heads. However, there is emerging evidence of varying levels of corrosion observed in retrieved components with smaller diameter femoral heads. This same mechanism of galvanic and mechanically-assisted crevice corrosion has been observed in metal-on-polyethylene and ceramic components, suggesting an inherent biomechanical problem with current designs of the head-neck interface. We provide a review of the fundamental questions and answers clinicians and researchers must understand regarding corrosion of the taper, and its relevance to current orthopaedic practice. Cite this article: Bone Joint J 2016;98-B:579–84.
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Affiliation(s)
- K. Osman
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore HA7 4LP, UK
| | - A. P. Panagiotidou
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore HA7 4LP, UK
| | - M. Khan
- University College London, 170 Tottenham
Court Road, London W1T 7HA, UK
| | - G. Blunn
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore HA7 4LP, UK
| | - F. S. Haddad
- University College London Hospitals, 235
Euston Road, London, NW1
2BU, UK
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20
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Tan SC, Teeter MG, Del Balso C, Howard JL, Lanting BA. Effect of Taper Design on Trunnionosis in Metal on Polyethylene Total Hip Arthroplasty. J Arthroplasty 2015; 30:1269-72. [PMID: 25773576 DOI: 10.1016/j.arth.2015.02.031] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/07/2015] [Accepted: 02/21/2015] [Indexed: 02/01/2023] Open
Abstract
This study examines how taper design affects corrosion and fretting at the head trunnion surface. All hip prostheses retrieved between 1999 and 2013 with 28mm/+0 heads were selected, resulting in 44 cobalt-chrome-on-polyethylene implants, representing six taper designs. Mean implantation time: 8.9±3.7years. The femoral head tapers were scored for fretting and corrosion using the Goldberg scale as both a combined score and by three zones (apex, central and base). There was no difference in age (P=0.34), BMI (P=0.29), or implantation time (P=0.19) between taper groups. The 11/13 taper had the highest combined corrosion and fretting score, but no difference (P=0.22) between groups for combined scores (P=0.22 for corrosion, P=0.19 for fretting). In a zone-specific analysis, the 11/13 taper had highest corrosion score at base zone (P=0.02). Taper design had a significant effect on corrosion at base of trunnion.
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Affiliation(s)
- Sok Chuen Tan
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Matthew G Teeter
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Christopher Del Balso
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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21
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Farhoudi H, Oskouei RH, Jones CF, Taylor M. A novel analytical approach for determining the frictional moments and torques acting on modular femoral components in total hip replacements. J Biomech 2015; 48:976-83. [PMID: 25721768 DOI: 10.1016/j.jbiomech.2015.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/31/2015] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
Abstract
A three dimensional analytical approach was developed to determine the frictional moment vector generated by the relative sliding of the head-cup bearing couple of a total hip replacement. The frictional moment projection onto the femoral neck was also determined over the loading cycle. Predicted frictional moments for nine combinations of bearing materials and diameters were in close agreement with existing in vitro data. The analytical method was then applied to simplified gait (lubrication conditions of dry and serum), ISO standard gait and physiological level gait loading cycles. ISO standard gait had a total contact force of about two fold of physiological level gait and there was a corresponding increase in the maximum frictional torque on neck from 0.66×BW%m to 0.88×BW%m. For the ISO standard gait, the maximum frictional torque occurred at the same instance of maximum frictional moment and the maximum contact force. In contrast, for the physiological level gait, the frictional torque did not occur at the same instance as the peak load. This suggests that the neck frictional torque is a function of other parameters, such as angle between neck axis and frictional moment vector, as well as the magnitude of the contact force and frictional moment. The developed methodology was able to predict the maximum magnitude and change of directions of moments and the variation of torque at the head neck interface. The data will be useful for experimental studies assessing the fretting behaviour of the head neck junction, by providing appropriate loading data.
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Affiliation(s)
- H Farhoudi
- Discipline of Mechanical Engineering, School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, Australia
| | - R H Oskouei
- Discipline of Mechanical Engineering, School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, Australia.
| | - C F Jones
- Adelaide Centre for Spinal Research, SA Pathology, Adelaide, Australia; School of Mechanical Engineering, University of Adelaide, Adelaide, Australia; Centre for Orthopaedic and Trauma Research, School of Medicine, University of Adelaide, Adelaide, Australia
| | - M Taylor
- Medical Device Research Institute, School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, Australia
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