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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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Royhman D, Pourzal R, Hall D, Lundberg HJ, Wimmer MA, Jacobs J, Hallab NJ, Mathew MT. Fretting-corrosion in hip taper modular junctions: The influence of topography and pH levels - An in-vitro study. J Mech Behav Biomed Mater 2021; 118:104443. [PMID: 33752094 DOI: 10.1016/j.jmbbm.2021.104443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/03/2020] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
Contemporary hip implants feature a modular design. Increased reported failure rates associated with the utilization of modular junctions have raised many clinical concerns. Typically, these modular interfaces contain circumferential machining marks (threads or microgrooves), but the effect of the machining marks on the fretting-corrosion behavior of total hip implant materials is unknown. This study reports the effects of microgrooves on the fretting-corrosion behavior of hip implant materials. The flat portions of two cylindrical, polished, CrCrMo alloy pins were loaded horizontally against one rectangular Ti alloy rod. Two surface preparation groups were used for the Ti6Al4V rod (polished and machined). The polished group was prepared using the same methods as the CoCrMo pins. The machined samples were prepared by creating parallel lines on the rod surfaces to represent microgrooves present on the stem tapers of head-neck modular junctions. Newborn calf serum (30 g/L protein content; 37 °C) at pH of levels of 7.6 and 3.0 were used to simulate the normal joint fluid and a lowered pH within a crevice, respectively. The samples were tested in a fretting corrosion apparatus under a 200N normal force and a 1Hz sinusoidal fretting motion with a displacement amplitude of 25 μm. All electrochemical measurements were performed with a potentiostat in a three-electrode configuration. The results show significant differences between machined samples and polished samples in both electrochemical and mechanical responses. In all cases, the magnitude of the drop in potential was greater in the machined group compared to the polished group. The machined group showed a lower total dissipated friction energy for the entire test compared to the polished group. Additionally, the potentiostatic test measurements revealed a higher evolved charge in the machined group compared to the polished group at both pH conditions (pH 7.6 and 3.0). The machined surfaces lowered the overall dissipated friction energy at pH 7.6 compared to pH 3.0, but also compromised electrochemical performance in the tested conditions. Therefore, the role of synergistic interaction of wear and corrosion with surface topographical changes is evident from the outcome of the study. Despite the shift towards higher electrochemical destabilization in the machined group, both polished and machined groups still exhibited a mechanically dominated degradation.
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Affiliation(s)
- Dmitry Royhman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; Department of Biomedical Science, UIC School of Medicine, Rockford, IL, USA
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Deborah Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hannah J Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Markus A Wimmer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joshua Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nadim J Hallab
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mathew T Mathew
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; Department of Biomedical Science, UIC School of Medicine, Rockford, IL, USA.
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Sidhu GAS, Kaur H, Singh H, Hind J, Ashwood N. Prospective Study Showing Results of Large-Diameter Femoral Heads After Cementless Total Hip Replacement. Cureus 2021; 13:e12610. [PMID: 33585100 PMCID: PMC7877256 DOI: 10.7759/cureus.12610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction Large-diameter femoral heads (≥36 mm) were introduced to decrease instability and improve the range of motion of the hip. We hypothesized regarding the clinical outcome and complications (dislocation, implant survivorship, and functional scores) following total hip replacement (THR) surgery in an Indian population who have smaller acetabulum compared to the western population. Methodology A prospective study was conducted at a tertiary hospital from November 2011 to July 2013. A total of 70 patients with hip pathology were operated by a senior surgeon for THR using the anterolateral approach. The Harris Hip Scores were recorded pre and postoperatively in all patients. Postoperatively, radiographs were taken to check for evidence of implant loosening or osteolysis. The patients were followed up till a mean follow-up of 86.52 months (range: 74 to 108 months) in our cohort. Detailed clinical and radiographic results were available for 59 patients, while six died (three died of myocardial infarction (MI), two had cerebrovascular accident (CVA), and one patient died of pulmonary embolism) and five patients were lost to follow-up. Results Of the 59 hips, majority (76%) had acetabular inclination of 46-55 degrees. Ninety percent of the stems were in the central position and 10% were in the varus position. The average preoperative Harris Hip Score was 38.8 ± 5.7 (range: 24-46), which increased to 90.4 ± 7.3 (range: 78-94) at the last follow-up. A total of six patients died (four died of MI and two of CVA) and two patients had infection which was treated with antibiotics. Three cases of dislocation were observed; one following a fall one year after surgery and revision total hip arthroplasty was done and two cases while getting up from the bed which were managed with closed reduction and abduction brace for six weeks. Two cases of periprosthetic fracture were observed which were managed with plating. Conclusion Lower dislocation rate and better range of movement reinforces the advantage of large-diameter femoral head during THR in the Indian population.
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Affiliation(s)
- Gur Aziz Singh Sidhu
- Trauma and Orthopaedics, University Hospitals of Derby and Burton, Burton, GBR
- Trauma and Orthopaedics, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Harjot Kaur
- Anesthesia, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Hakam Singh
- Trauma and Orthopaedics, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Jamie Hind
- Trauma and Orthopaedics, University Hospitals of Derby and Burton, Burton, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, University Hospitals of Derby and Burton, Burton, GBR
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Stavrakis AI, Khoshbin A, Joseph A, Lee LY, Bostrom MP, Westrich GH, McLawhorn AS. Dual Mobility Total Hip Arthroplasty Is Not Associated with a Greater Incidence of Groin Pain in Comparison with Conventional Total Hip Arthroplasty and Hip Resurfacing:A Retrospective Comparative Study. HSS J 2020; 16:394-399. [PMID: 33380972 PMCID: PMC7749877 DOI: 10.1007/s11420-020-09764-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Groin pain is a common long-term complication of total hip arthroplasty (THA). Femoral head size has been proposed as one of the primary causes. The implants used in dual mobility (DM) THA have large outer-bearing articulations, which could increase the risk of post-operative groin pain. Hip resurfacing (HR), too, has been shown to be associated with a risk of groin pain. QUESTIONS/PURPOSES The goals of this study were to compare the incidence of groin pain at 1 year after hip arthroplasty in patients with different femoral head diameters and in patients undergoing conventional THA, DM THA, and HR. METHODS After combing an institutional registry for all patients who had undergone THA or HR for primary hip osteoarthritis, we included 3193 patients in the analysis; 2008 underwent conventional THA, 416 underwent DM THA, and 769 underwent HR. We used logistic regression modeling to analyze the relation of groin pain at 1 year after surgery to patient demographics and clinical characteristics, including age, sex, body mass index (BMI), University of California at Los Angeles activity score at 1 year after surgery, bearing couple, and the ratio of acetabular diameter to femoral head diameter. We also measured cup inclination and anteversion in a subset of patients with and without groin pain at 1 year to assess whether pain could be related to implant position. RESULTS Overall, 8.7% of patients reported groin pain at 1 year. Patients with groin pain were younger and had lower BMIs. There were increased odds of groin pain with a greater cup-to-head ratio, although DM implants, interestingly, were not significantly associated with groin pain; this may be attributable to so much of their movement taking place inside the implant. Subgroup analysis measuring cup inclination and anteversion showed no difference in cup position between patients with and without pain. CONCLUSION In this population of hip arthroplasty patients, the incidence of groin pain 1 year after surgery did not differ among patients undergoing DM and conventional THA; DM THA in particular was not associated with a higher risk of groin pain, despite its comparatively larger femoral head sizes. HR, on the other hand, was associated with a higher risk of pain. Appropriate implant sizing and bearing couple choice may optimize the functional benefit of THA.
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Affiliation(s)
- Alexandra I. Stavrakis
- grid.19006.3e0000 0000 9632 6718Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Amir Khoshbin
- grid.17063.330000 0001 2157 2938Division of Orthopaedic Surgery, University of Toronto, Toronto, ON Canada
| | - Amethia Joseph
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Lily Y. Lee
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Mathias P. Bostrom
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Geoffrey H. Westrich
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Alexander S. McLawhorn
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
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Head-Neck Taper Corrosion in Metal-on-Polyethylene Total Hip Arthroplasty: Risk Factors, Clinical Evaluation, and Treatment of Adverse Local Tissue Reactions. J Am Acad Orthop Surg 2020; 28:907-913. [PMID: 32694319 DOI: 10.5435/jaaos-d-20-00475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Adverse local tissue reaction (ALTR) associated with mechanically assisted crevice corrosion of metal-on-polyethylene (MoP) head-neck modular total hip arthroplasty (THA), similarly observed in the metal-on-metal bearing, is a growing concern in MoP THA patients. Given the complex pathogenesis as well as variable clinical presentation, the diagnosis can be challenging. This article focuses on providing surgeons with an evidence-based update on (1) implant, surgical, and patient risk factors associated with ALTRs; (2) clinical systematic evaluation; and (3) surgical management options for ALTRs in MoP THA patients based on the currently available evidence.
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Abstract
Aims To report our experience with trunnion corrosion following metal-on-polyethylene total hip arthroplasty, in particular to report the spectrum of presentation and determine the mean time to presentation. Patients and Methods We report the presenting symptoms and signs, intraoperative findings, and early results and complications of operative treatment in nine patients with a mean age of 74 years (60 to 86). The onset of symptoms was at a mean of seven years (3 to 18) after index surgery. Results Patients presented with a variety of symptoms including pain, limp and rash. The preoperative mean serum cobalt level was 7.1 ppb (2.2 to 12.8) and mean serum chromium level was 2.2 ppb (0.5 to 5.2). Metal artifact reduction sequence (MARS) MRI showed fluid collection and possible pseudotumour formation in five hips, fluid collection in two hips, and synovitis/debris in one hip, with no MRI in one patient. Acetabular revision was performed in three patients, six patients underwent liner and head exchange only. The postoperative metal levels decreased in all patients: mean cobalt 0.5 ppb (0 to 1.8) and mean chromium 0.9 ppb (0 to 2.6) at a mean of five months (3 to 8) postoperatively. Seven patients had good pain relief and no complications at one year. There were two major complications requiring reoperation: acute infection at six weeks, for which the patient required two-stage reimplantation; and recurrent dislocation, for which the patient was revised to a dual mobility component. Conclusion Trunnion corrosion in metal-on-polyethylene THA has a range of presenting symptoms, and may present later than previously described. A high index of suspicion is warranted, and serum cobalt and chromium levels are recommended for diagnosis. Patients should be counselled about possible postoperative complications. Cite this article: Bone Joint J 2018;100-B:898–902.
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Affiliation(s)
- P. F. Lachiewicz
- Chapel Hill Orthopedics Surgery and Sports
Medicine, North Carolina, USA
and Department of Orthopaedic Surgery, Duke
University, Durham, North
Carolina, USA
| | - J. A. O’Dell
- Chapel Hill Orthopedics Surgery and Sports
Medicine, North Carolina, USA
and Department of Family Medicine, Duke University, Durham, North
Carolina, USA
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7
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Buente D, Bryant M, Ward M, Neville A, Morlock M, Huber G. The taper corrosion pattern observed for one bi-modular stem design is related to geometry-determined taper mechanics. Med Eng Phys 2017. [PMID: 28647286 DOI: 10.1016/j.medengphy.2017.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bi-modular primary hip stems exhibit high revision rates owing to corrosion at the stem-neck taper, and are associated with local adverse tissue reactions. The aim of this study was to relate the wear patterns observed for one bi-modular design to its design-specific stem-neck taper geometry. Wear patterns and initial geometry of the taper junctions were determined for 27 retrieved bi-modular primary hip arthroplasty stems (Rejuvenate, Stryker Orthopaedics) using a tactile coordinate-measuring device. Regions of high-gradient wear patterns were additionally analyzed via optical and electron microscopy. The determined geometry of the taper junction revealed design-related engagement at its opening (angle mismatch), concentrated at the medial and lateral apexes (axes mismatch). A patch of retained topography on the proximal medial neck-piece taper apex was observed, surrounded by regions of high wear. On the patch, a deposit from the opposing female stem taper-containing Ti, Mo, Zr, and O-was observed. High stress concentrations were focused at the taper apexes owing to the specific geometry. A medial canting of the components may have augmented the inhomogeneous stress distributions in vivo. In the regions with high normal loads interfacial slip and consequently fretting was inhibited, which explains the observed pattern of wear.
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Affiliation(s)
- Dennis Buente
- TUHH Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany.
| | - Michael Bryant
- University of Leeds, Faculty of Engineering Institute of Materials and Research/Functional Surfaces, Leeds LS2 9JT, UK.
| | - Michael Ward
- University of Leeds, Faculty of Engineering Institute of Materials and Research/Functional Surfaces, Leeds LS2 9JT, UK.
| | - Anne Neville
- University of Leeds, Faculty of Engineering Institute of Materials and Research/Functional Surfaces, Leeds LS2 9JT, UK.
| | - Michael Morlock
- TUHH Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany.
| | - Gerd Huber
- TUHH Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany.
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Abstract
As the number of primary total hip arthroplasties increases, so does the burden of revision procedures. The decision to revise well-fixed components in the setting of polyethylene wear and osteolysis is controversial. Modular head and liner exchange offers the advantages of reduced invasiveness, faster recovery, and bone preservation. These advantages come at the expense of higher rates of revision surgery for instability. Using the native locking mechanism for securing the new liner is preferred; however, cementing a liner into a well-fixed acetabular component is a practical alternative. The use of bone allograft or bone graft substitute for areas of osteolysis is controversial. In the setting of osteolysis, outcomes associated with the use of highly cross-linked polyethylene liners have been better than those associated with the use of conventional polyethylene; therefore, thinner liners and larger femoral heads can be used and reduce the risk of instability.
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Cooper HJ. Diagnosis and Treatment of Adverse Local Tissue Reactions at the Head-Neck Junction. J Arthroplasty 2016; 31:1381-4. [PMID: 27113943 DOI: 10.1016/j.arth.2016.02.082] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 02/01/2023] Open
Abstract
Modular junctions in total hip arthroplasty are susceptible to mechanically assisted crevice corrosion, leading to the release of metal wear debris. Adverse local tissue reactions result from an immune-mediated biological reaction to this debris and can have a profound effect on the surrounding periarticular soft tissue envelope. Patients often present with pain or muscle weakness and demonstrate elevated serum cobalt and chromium levels. Serum inflammatory markers and synovial fluid tests help distinguish these reactions from deep infection in the majority of cases; however, the presence of amorphous material or fragmented cells can lead to difficulty in some cases. Advanced cross-sectional imaging is essential in establishing the diagnosis. Early revision surgery is generally the treatment of choice for symptomatic adverse local tissue reaction from corrosion at the modular head-neck junction. The existing stem is retained, and a new ceramic head is placed on the existing trunnion whenever possible. This strategy generally leads to short-term improvement of symptoms with reliable clinical outcomes; however, longer term results are presently lacking.
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Affiliation(s)
- Herbert J Cooper
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
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10
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[Histopathological particle algorithm. Particle identification in the synovia and the SLIM]. Z Rheumatol 2015; 73:639-49. [PMID: 24821089 DOI: 10.1007/s00393-013-1315-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In the histopathological diagnostics of synovitis and the synovium-like interface membrane (SLIM) the identification of crystals and crystal-like deposits and the associated inflammatory reactions play an important role. The multitude of endogenous crystals, the range of implant materials and material combinations, and the variability in the formation process of different particles explain the high morphological particle heterogeneity which complicates the diagnostic identification of diagnostic particles. STUDY DESIGN AND METHODS A simple histopathological particle algorithm has been designed which allows methodological particle identification based on (1) conventional transmitted light microscopy with a guide to particle size, shape and color, (2) optical polarization criteria and (3) enzyme histochemical properties (oil red staining and Prussian blue reaction). These methods, the importance for particle identification and the differential diagnostics from non-prosthetic materials are summarized in the so-called histopathological particle algorithm. RESULTS A total of 35 cases of synovitis and SLIM were analyzed and validated according to these criteria. Based on these criteria and a dichotomous differentiation the complete spectrum of particles in the SLIM and synovia can be defined histopathologically. CONCLUSION For histopathological diagnosis a particle score for synovitis and SLIM is recommended to evaluate (1) the predominant type of prothetic wear debris with differentiation between microparticles, and macroparticles, (2) the presence of non-prosthesis material particles and (3) the quantification of particle-association necrosis and lymphocytosis. An open, continuously updated web-based particle algorithm would be helpful to address the issue of particle heterogeneity and include all new particle materials generated in a rapidly changing field.
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11
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Trunnionosis: the latest culprit in adverse reactions to metal debris following hip arthroplasty. Skeletal Radiol 2015; 44:433-40. [PMID: 25109382 DOI: 10.1007/s00256-014-1978-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/27/2014] [Accepted: 07/30/2014] [Indexed: 02/02/2023]
Abstract
The imaging findings of periprosthetic soft tissue lesions (pseudotumours) have been typically defined in the context of newer second-generation metal-on-metal hip arthroplasty. More recently, similar findings have been described in the setting of non-metal-on-metal prostheses. Although uncommon, wear and corrosion between the metal surfaces at the head-neck ('trunnionosis') and neck-stem interfaces are the potential culprits. With modular junctions containing at least one cobalt chromium component frequently present in hip arthroplasty prostheses, the incidence of this mode of adverse wear may be higher than previously thought (irrespective of the specific bearing couple used). In the present report, we described a case of a severe adverse local tissue reaction secondary to suspected corrosion at the head-neck taper in a metal-on-polyethylene total hip arthroplasty and reviewed the literature. Knowledge of this topical entity should help radiologists facilitate early diagnosis and ensure early management of this potentially serious complication.
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12
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Abstract
Dislocation remains among the most common complications of, and reasons for, revision of both primary and revision total hip replacements (THR). Hence, there is great interest in maximising stability to prevent this complication. Head size has been recognised to have a strong influence on the risk of dislocation post-operatively. As femoral head size increases, stability is augmented, secondary to an increase in impingement-free range of movement. Larger head sizes also greatly increase the 'jump distance' required for the head to dislocate in an appropriately positioned cup. Level-one studies support the use of larger diameter heads as they decrease the risk of dislocation following primary and revision THR. Highly cross-linked polyethylene has allowed us to increase femoral head size, without a marked increase in wear. However, the thin polyethylene liners necessary to accommodate larger heads may increase the risk of liner fracture and larger heads have also been implicated in causing soft-tissue impingement resulting in groin pain. Larger diameter heads also impart larger forces on the femoral trunnion, which may contribute to corrosion, metal release, and adverse local tissue reactions. Alternative large bearings including large ceramic heads and dual mobility bearings may mitigate some of these risks, and several of these devices have been used with clinical success.
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Affiliation(s)
- H J Cooper
- Lenox Hill Hospital, Department of Orthopaedic Surgery, 130 East 77th Street, New York, 10075, USA
| | - C J Della Valle
- Rush University Medical Center, Department of Orthopaedic Surgery, 1611 West Harrison Street, Chicago, Illinois, 60612, USA
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13
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Porter DA, Urban RM, Jacobs JJ, Gilbert JL, Rodriguez JA, Cooper HJ. Modern trunnions are more flexible: a mechanical analysis of THA taper designs. Clin Orthop Relat Res 2014; 472:3963-70. [PMID: 25267272 PMCID: PMC4397791 DOI: 10.1007/s11999-014-3965-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 09/16/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is renewed concern surrounding the potential for corrosion at the modular head-neck junction to cause early failure in contemporary THAs. Although taper corrosion involves a complex interplay of many factors, a previous study suggested that a decrease in flexural rigidity of the femoral trunnion may be associated with an increased likelihood of corrosion at retrieval. QUESTIONS/PURPOSES By analyzing a large revision retrieval database of femoral stems released during a span of three decades, we asked: (1) how much does flexural rigidity vary among different taper designs; (2) what is the contribution of taper geometry alone to flexural rigidity of the femoral trunnion; and (3) how have flexural rigidity and taper length changed with time in this group of revised retrievals? METHODS A dual-center retrieval analysis of 85 modular femoral stems released between 1983 and 2012 was performed, and the flexural rigidity and length of the femoral trunnions were determined. These stems were implanted between 1991 and 2012 and retrieved at revision or removal surgery between 2004 and 2012. There were 10 different taper designs made from five different metal alloys from 16 manufacturers. Digital calipers were used to measure taper geometries by two independent observers. RESULTS Median flexural rigidity was 228 N-m(2); however, there was a wide range of values among the various stems spanning nearly an order of magnitude between the most flexible (80 N-m(2)) and most rigid (623 N-m(2)) trunnions, which was partly attributable to the taper geometry and to the material properties of the base alloy. There was a negative correlation between flexural rigidity and length of the trunnion and release date of the stem. CONCLUSIONS There is wide variability in flexural rigidity of various taper designs, with a trend toward trunnions becoming shorter and less rigid with time. CLINICAL RELEVANCE This temporal trend may partly explain why taper corrosion is being seen with increasing frequency in modern THAs.
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Affiliation(s)
- David A. Porter
- />Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10024 USA
| | - Robert M. Urban
- />Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Joshua J. Jacobs
- />Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Jeremy L. Gilbert
- />Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, NY USA
| | - José A. Rodriguez
- />Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10024 USA
| | - H. John Cooper
- />Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10024 USA
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14
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Abstract
Large ceramic femoral heads offer several advantages that are potentially advantageous to patients undergoing both primary and revision total hip replacement. Many high-quality studies have demonstrated the benefit of large femoral heads in reducing post-operative instability. Ceramic femoral heads may also offer an advantage in reducing polyethylene wear that has been reported in vitro and is starting to become clinically apparent in mid-term clinical outcome studies. Additionally, the risk of taper corrosion at a ceramic femoral head-neck junction is clearly lower than when using a metal femoral head. With improvements in the material properties of both modern ceramic femoral heads and polyethylene acetabular liners that have reduced the risk of mechanical complications, large ceramic heads have gained popularity in recent years.
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Affiliation(s)
- J A Rodriguez
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, New York 10075, USA
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15
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Abstract
Corrosion has long been recognized to occur in total hip arthroplasty, but the local effects of this process have only recently become better understood. This article provides an overview of corrosion at modular junctions, and discusses the various etiologic factors for corrosion and the biologic response to metal debris released from this junction. Algorithms are provided for diagnosis and treatment, in accordance with the best available data.
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16
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Krenn V, Kretzer JP, Thomas P, Thomsen M, Usbeck S, Scheuber L, Boettner F, Rüther W, Schulz S, Zustin J, Huber M. Update on endoprosthesis pathology: Particle algorithm for particle identification in the SLIM. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.sart.2014.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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