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Smoljanić T, Milović L, Sedmak S, Milovanović A, Čolić K, Radaković Z, Sedmak A. Numerical Investigation of Fatigue Behavior in Ti-6Al-4V Orthopedic Hip Implants Subjected to Different Environments. MATERIALS (BASEL, SWITZERLAND) 2024; 17:3796. [PMID: 39124458 PMCID: PMC11312728 DOI: 10.3390/ma17153796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/16/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
In this paper, hip implants made of Ti-6Al-4V titanium alloy are analyzed numerically using Extended Finite Element Method XFEM. The combined effect of corrosion and fatigue was considered here since this is a common cause of failure of hip implants. Experimental testing of Ti-6Al-4V alloy was performed to determine its mechanical properties under different working environments, including normal, salty, and humid conditions. The integrity and life of the hip implant were assessed using the Linear Elastic Fracture Mechanics (LEFM) approach. For this purpose, the conditional fracture toughness Kq using CT specimens from all three groups (normal, humid, salty conditions) were determined. This provided insight into how different aggressive environments affect the behavior of Ti-6Al-4V alloy; i.e., how much its resistance to crack growth would degrade depending on conditions corresponding to the real exploitation of hip implants. Next, analytical and XFEM analyses of fatigue behavior in terms of the number of cycles were performed for all three groups, and the obtained results showed good agreement, confirming the validity of the integrity assessment approach shown in this work, which also represented a novel approach since fatigue and corrosion effects were investigated simultaneously.
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Affiliation(s)
- Tamara Smoljanić
- Innovation Centre of the Faculty of Mechanical Engineering, Kraljice Marije 16 Street, 11120 Belgrade, Serbia; (T.S.); (A.M.); (K.Č.)
| | - Ljubica Milović
- Faculty of Technology and Metallurgy, University of Belgrade, Karnegijeva 4 Street, 11120 Belgrade, Serbia;
| | - Simon Sedmak
- Innovation Centre of the Faculty of Mechanical Engineering, Kraljice Marije 16 Street, 11120 Belgrade, Serbia; (T.S.); (A.M.); (K.Č.)
| | - Aleksa Milovanović
- Innovation Centre of the Faculty of Mechanical Engineering, Kraljice Marije 16 Street, 11120 Belgrade, Serbia; (T.S.); (A.M.); (K.Č.)
| | - Katarina Čolić
- Innovation Centre of the Faculty of Mechanical Engineering, Kraljice Marije 16 Street, 11120 Belgrade, Serbia; (T.S.); (A.M.); (K.Č.)
| | - Zoran Radaković
- Faculty of Mechanical Engineering, University of Belgrade, Kraljice Marije 16 Street, 11120 Belgrade, Serbia; (Z.R.); (A.S.)
| | - Aleksandar Sedmak
- Faculty of Mechanical Engineering, University of Belgrade, Kraljice Marije 16 Street, 11120 Belgrade, Serbia; (Z.R.); (A.S.)
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Gaillard-Campbell D, Gross T. Magnum metal-on-metal uncemented total hip replacement: 8- to 18-year outcomes of 211 cases. Musculoskelet Surg 2024:10.1007/s12306-024-00831-3. [PMID: 38833069 DOI: 10.1007/s12306-024-00831-3] [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: 05/22/2023] [Accepted: 05/17/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Reports of adverse reactions to metal debris contributed in part to a decline in use of large-bearing metal-on-metal total hip devices. We hypothesize an optimal trunnion design may reduce risk of this failure mode in large-bearing total hip arthroplasty systems. The purpose of this study is to report mid- to long-term outcomes for a single-surgeon series of 211 total hip arthroplasties using the large-bearing Biomet Magnum metal-on-metal system. MATERIALS AND METHODS Between December 2004 and January 2016, the primary surgeon performed 211 uncemented Magnum total hip arthroplasties in 181 patients. The average length of follow-up was 10.1 ± 3.5 years (range 8-18 years). RESULTS Using failure of any component as the endpoint, the overall survivorship rate was 98.1% at 10 years and 97.4% at 18 years. These eight failures (3.8% of cohort) included one case of adverse wear-related failure (0.5%), two cases of acetabular ingrowth failure (0.9%), three cases of trunnion corrosion (1.4%), one failure of late infection (0.5%), and one inappropriate revision of components for trochanteric nonunion without instability (0.5%). Excluding failed cases, all components were radiographically stable with no radiolucencies. Except for the one wear failure, ion testing revealed that 97.2% of cases were within optimal whole blood metal ion levels with the remaining ion test results within acceptable levels. CONCLUSIONS With the uncemented Magnum metal-on-metal total hip, we achieved 97.4% 18-year implant survivorship, exceeding the NICE criteria and registry benchmarks for implant survivorship. We observed a trunnion corrosion rate of 1.4% and no cases of instability. The single case of adverse wear-related failure was caused by acetabular component malposition.
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Affiliation(s)
- D Gaillard-Campbell
- Midlands Orthopaedics and Neurosurgery, PA, 1910 Blanding Street, Columbia, SC, 29201, USA.
| | - T Gross
- Midlands Orthopaedics and Neurosurgery, PA, 1910 Blanding Street, Columbia, SC, 29201, USA
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Kanniyappan H, Cheng KY, Badhe RV, Neto M, Bijukumar D, Barba M, Pourzal R, Mathew M. Investigation of cell-accelerated corrosion (CAC) on the CoCrMo alloy with segregation banding: Hip implant applications. J Mech Behav Biomed Mater 2024; 152:106449. [PMID: 38387118 DOI: 10.1016/j.jmbbm.2024.106449] [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: 07/19/2023] [Revised: 12/07/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
Metal alloy microstructure plays a crucial role in corrosion associated with total hip replacement (THR). THR is a prominent strategy that uses metal implants such as cobalt-chromium-molybdenum (CoCrMo) alloys due to their advantageous biological and mechanical properties. Despite all benefits, these implants undergo corrosion and wear processes in-vivo in a synergistic manner called tribocorrosion. Also, the implant retrieval findings reported that fretting corrosion occurred in-vivo, evidenced by the damage patterns that appeared on the THR junction interfaces. There is no scientific data on the studies reporting the fretting corrosion patterns of CoCrMo microstructures in the presence of specific biological treatments to date. In the current study, Flat-on-flat fretting corrosion set-up was customized and used to study the tribocorrosion patterns of fretting corrosion to understand the role of alloy microstructure. Alloy microstructural differences were created with the implant stock metal's longitudinal and transverse cutting orientations. As a result, the transverse created the non-banded, homogenous microstructure, whereas the longitudinal cut resulted in the banded, non-homogenous microstructure on the surface of the alloy (in this manuscript, the terms homogenous and banded were used). The induced currents were monitored using a three-electrode system. Three different types of electrolytes were utilized to study the fretting corrosion patterns with both homogeneous and banded microstructures: 1. Control media 2. Spent media (the macrophage cell cultured media) 3. Challenged media (media collected after the macrophage was treated with CoCrMo particles). From the electrochemical results, in the potentiostat conditions, the banded group exhibited a higher induced current in both challenged and spent electrolyte environments than in control due to the synergistic activity of CoCrMo particles and macrophage demonstrating more corrosion loss. Additionally, both Bode and Nyquist plots reported a clear difference between the banded and homogeneous microstructure, especially with challenged electrolytes becoming more corrosion-resistant post-fretting than pre-fretting results. The banded microstructure showed a unique shape of the fretting loop, which may be due to tribochemical reactions. Therefore, from the electrochemical, mechanical, and surface analysis data results, the transverse/homogenous/non-banded alloy microstructure groups show a higher resistance to fretting-corrosion damage.
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Affiliation(s)
- Hemalatha Kanniyappan
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UICOM, Rockford, IL, USA
| | - Kai-Yuan Cheng
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UICOM, Rockford, IL, USA
| | - Ravindra V Badhe
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UICOM, Rockford, IL, USA; Marathwada Mitra Mandal's College of Pharmacy, Pune, India
| | | | - Divya Bijukumar
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UICOM, Rockford, IL, USA
| | - Mark Barba
- Dept of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | | | - Mathew Mathew
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UICOM, Rockford, IL, USA.
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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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Osan J, Pabbruwe M, Kop A, Joyce A, Vlaskovsky P, Salasi M, Kuster M. The effect of trunnionosis on the risk of re-revision following femoral head exchange in hip arthroplasty. Hip Int 2023; 33:1072-1078. [PMID: 36357353 DOI: 10.1177/11207000221136204] [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: 11/12/2022]
Abstract
BACKGROUND Fretting corrosion at modular junctions contributes to arthroplasty failure. Currently, no evidence-based guidelines are available regarding the acceptable level of trunnion corrosion that can occur in vivo. We aimed to examine the relationship between trunnion corrosion and risk of re-revision to assist surgeons with intraoperative decision making. METHOD Grading by 3 independent examiners of revised and re-revised head components was performed using a modified Goldberg corrosion scale. Samples were separated into low-grade (LG) and high-grade (HG) corrosion. Mechanical testing determined the relationship between corrosion severity and pull-off strength at the head-stem junction. RESULTS 529 retrieved femoral heads were analysed. A positive association was detected between males and HG corrosion (OR 2.07; 95% CI, 1.45-2.94; p < 0.001). No difference between the survivorship of LG and HG heads was detected (p-value = 0.247). In the re-revised sample, the first implant had a time in situ that was on average 7.97 years longer (95% CI, 5.4-10.6) than that of the subsequent re-revised femoral head. Severe corrosion on the first head was associated with a 37.5 (95% CI, 4.00-1944) fold increase of HG on the subsequent head (p < 0.001). Femoral disassembly force had a positive correlation with stem taper corrosion grade (p = 0.001). CONCLUSIONS A well-fixed stem with corrosion may remain in situ.
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Affiliation(s)
- Jessica Osan
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Moreica Pabbruwe
- Centre for Implant Retrieval and Analysis, Royal Perth Hospital, Perth, WA, Australia
| | - Alan Kop
- Centre for Implant Retrieval and Analysis, Royal Perth Hospital, Perth, WA, Australia
| | - Alex Joyce
- Curtin Corrosion Centre, Curtin University, Bentley, WA, Australia
| | - Phil Vlaskovsky
- Medical School, University of Western Australia, Nedlands, WA, Australia
| | - Mobin Salasi
- Curtin Corrosion Centre, Curtin University, Bentley, WA, Australia
| | - Markus Kuster
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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Codirenzi AM, Lanting BA, Teeter MG. A convolutional neural network for high throughput screening of femoral stem taper corrosion. Proc Inst Mech Eng H 2023:9544119231177834. [PMID: 37300244 DOI: 10.1177/09544119231177834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Corrosion at the modular head-neck taper interface of total and hemiarthroplasty hip implants (trunnionosis) is a cause of implant failure and clinical concern. The Goldberg corrosion scoring method is considered the gold standard for observing trunnionosis, but it is labor-intensive to perform. This limits the quantity of implants retrieval studies typically analyze. Machine learning, particularly convolutional neural networks, have been used in various medical imaging applications and corrosion detection applications to help reduce repetitive and tedious image identification tasks. 725 retrieved modular femoral stem arthroplasty devices had their trunnion imaged in four positions and scored by an observer. A convolutional neural network was designed and trained from scratch using the images. There were four classes, each representing one of the established Goldberg corrosion classes. The composition of the classes were as follows: class 1 (n = 1228), class 2 (n = 1225), class 3 (n = 335), and class 4 (n = 102). The convolutional neural network utilized a single convolutional layer and RGB coloring. The convolutional neural network was able to distinguish no and mild corrosion (classes 1 and 2) from moderate and severe corrosion (classes 3 and 4) with an accuracy of 98.32%, a class 1 and 2 sensitivity of 0.9881, a class 3 and 4 sensitivity of 0.9556 and an area under the curve of 0.9740. This convolutional neural network may be used as a screening tool to identify retrieved modular hip arthroplasty device trunnions for further study and the presence of moderate and severe corrosion with high reliability, reducing the burden on skilled observers.
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Affiliation(s)
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Matthew G Teeter
- School of Biomedical Engineering, Western University, London, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Trunnions and Modularity in Total Hip Arthroplasty: A Historical Review With Current Clinical Implications. J Am Acad Orthop Surg 2023; 31:189-197. [PMID: 36728328 DOI: 10.5435/jaaos-d-22-00498] [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] [Received: 06/07/2022] [Accepted: 11/27/2022] [Indexed: 02/03/2023] Open
Abstract
Trunnion in total hip arthroplasty refers to the interface between the neck of a femoral stem and the femoral head. Clinical complications arising from damage to this junction, whether it be due to mechanical wear, corrosion, or a combination, are referred to as mechanically assisted crevice corrosion (MACC), also commonly known as trunnionosis. With the use of modular hip prostheses, which help customize offset and leg length to an individual patient's anatomy, the incidence of MACC and revision due to MACC has increased in recent years. Although the cause of MACC is multifactorial, with patient factors and technique factors contributing to this condition, taper design and geometry, metallurgical properties of implants, and size mismatch of the bearing couple are some of the implant factors that have also been implicated in this clinical phenomenon. Understanding the history of taper design and geometry, the track record of older implants, and the rationale behind the development of current prostheses can help surgeons choose the right implants for their patients and accurately assess the pros and cons of new implants being introduced to the market each year.
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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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Codirenzi AM, Lanting BA, Teeter MG. What Patient and Implant Factors Affect Trunnionosis Severity? An Implant Retrieval Analysis of 664 Femoral Stems. J Arthroplasty 2023; 38:376-382. [PMID: 36084756 DOI: 10.1016/j.arth.2022.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Corrosion at the modular head-neck taper interface of total and hemiarthroplasty hip implants (trunnionosis) is a cause of implant failure and thus a clinical concern. Patient and device factors contributing to the occurrence of trunnionosis have been investigated in prior implant retrieval studies but generally with limited sample sizes and a narrow range of models. The purpose of the present investigation was to determine which patient and device factors were associated with corrosion damage on the femoral stem taper across a large collection of different implant models retrieved following revision hip arthroplasty. METHODS A retrieval study of 664 hip arthroplasty modular stem components was performed. Patient and device information was collected. Trunnions were imaged under digital microscopy and scored for corrosion damage using a scaling system. Damage was related to patient and device factors using regression analyses. RESULTS Greater duration of implantation (P = .005) and larger head size (P < .001) were associated with an elevated corrosion class. Older age at index surgery (P = .035), stainless steel stem material (P = .022), indication for revision as bone or periprosthetic fracture (P = .017), and infection (P = .018) and certain larger taper geometries were associated with a decreased corrosion class. CONCLUSION Factors identified as contributing to a higher or lower risk of more severe corrosion are consistent with most prior smaller retrieval studies. Surgeons should be aware of these risk factors when selecting implants for their patients and when diagnosing trunnionosis in symptomatic hip arthroplasty patients.
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Affiliation(s)
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Matthew G Teeter
- School of Biomedical Engineering, Western University, London, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Nafi MA, Jahan MP. Functional Surface Generation by EDM-A Review. MICROMACHINES 2022; 14:115. [PMID: 36677180 PMCID: PMC9865250 DOI: 10.3390/mi14010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Electro-discharge machining (EDM) removes electrically conductive materials by high frequency spark discharges between the tool electrode and the workpiece in the presence of a dielectric liquid. Being an electrothermal process and with melting and evaporation being the mechanisms of material removal, EDM suffers from migration of materials between the tool and the workpiece. Although unwanted surface modification was considered a challenge in the past for many applications, this inherent nature of the EDM process has recently become of interest to the scientific community. As a result, researchers have been focusing on using the EDM process for surface modification and coating by targeted surface engineering. In order to engineer a surface or generate functional coatings using the electro-discharge process, proper knowledge of the EDM process and science of electro-discharge surface modification must be understood. This paper aims to provide an overview of the electro-discharge surface modification and coating processes, thus assisting the readers on exploring potential applications of EDM-based techniques of surface engineering and coating generation. This review starts with a brief introduction to the EDM process, the physics behind the EDM process, and the science of the surface modification process in EDM. The paper then discusses the reasons and purposes of surface modification and coating practices. The common EDM-based techniques reported in the literature for producing coatings on the surface are discussed with their process mechanisms, important parameters, and design considerations. The characterization techniques used for the analysis of modified surfaces and coating layers, as well as the tribological and surface properties of modified surfaces or coatings are discussed. Some of the important applications of EDM-based surface modification and coating processes are generating surfaces for protective coating, for aesthetic purposes, for enhancing the biocompatibility of implants, for improving corrosion resistance, for improving wear resistance, and for improving tribological performance. The current state of the research in these application areas is discussed with examples. Finally, suggestions are provided on future research directions and innovative potential new applications of the electro-discharge-based surface engineering and coating processes.
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Affiliation(s)
| | - Muhammad Pervej Jahan
- Department of Mechanical and Manufacturing Engineering, Miami University, Oxford, OH 45056, USA
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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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Fallahnezhad K, Feyzi M, Hashemi R, Taylor M. The Role of the Assembly Force in the Tribocorrosion Behaviour of Hip Implant Head-Neck Junctions: An Adaptive Finite Element Approach. Bioengineering (Basel) 2022; 9:629. [PMID: 36354540 PMCID: PMC9687484 DOI: 10.3390/bioengineering9110629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 09/13/2023] Open
Abstract
The cyclic loading, in the corrosive medium of the human body, results in tribocorrosion at the interface of the head-neck taper junction of hip implants. The resulting metal ions and wear debris adversely affect the local tissues. The force applied by surgeons to assemble the junction has proven to play a major role in the mechanics of the taper junction which, in turn, can influence the tribocorrosion damage. Recently, finite element method has been used to predict the material loss at the head-neck interface. However, in most finite element studies, the contribution of electrochemical corrosion has been ignored. Therefore, a detailed study to investigate the influence of the assembly force on the tribocorrosive behaviour of the head-neck junction, which considers both the mechanical and chemical material removal, is of paramount interest. In this study, a finite-element-based algorithm was used to investigate the effect of assembly force on the tribocorrosion damage at the junction interface, for over four million cycles of simulated level gait. The patterns of the material removal in the modelling results were compared with the damage patterns observed in a group of retrieved modular hip implants. The results of this study showed that for different cases, chemical wear was in the range of 25-50% of the total material loss, after four million cycles. A minimum assembly force (4 kN for the studied cases) was needed to maintain the interlock in the junction. The computational model was able to predict the damage pattern at the retrieved head-neck interface.
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Affiliation(s)
- Khosro Fallahnezhad
- Medical Device Research Institute, College of Science and Engineering, Flinders University, 1284 South Road, Clovelly Park, SA 5042, Australia
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13
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Matsushita Y, Otani T, Hayama T, Fujii H, Kawaguchi Y, Saito M. A Modified Modular Stem in Primary Total Hip Arthroplasty for Developmental Dysplasia of the Hip: Average 11-year Follow-Up in Cases With Previously Reported 3-year Clinical Results. J Arthroplasty 2022; 37:1832-1838. [PMID: 35469988 DOI: 10.1016/j.arth.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Modular stems require careful follow-up, especially after any design modification. This study investigated the mid- to long-term outcomes of total hip arthroplasty in patients with developmental dysplasia of the hip using the S-ROM-A stem, a modified S-ROM stem for Asians. METHODS We previously reported short-term outcomes for all 220 dysplastic hips that underwent primary total hip arthroplasty with the S-ROM-A stem. Here, we followed the clinical and radiological outcomes of 201 of the 220 hips (91%) for a mean 11.4 years postoperatively. We also performed multivariate analysis to determine whether large anteversion angle adjustment was associated with increased osteolysis. RESULTS The cumulative survival rate of the stem at 168 months postoperatively was 97.4%. Two hips underwent revision surgery, including 1 due to neck trunnionosis. Characteristic distal stem fracture occurred in 3 hips (1.5%). Most partial radiolucent lines observed around the sleeve early postoperatively disappeared by 7 years, postoperatively. Mild osteolysis occurred relatively frequently (20%), but a multivariate model adjusted for polyethylene type showed no significant association between the occurrence of osteolysis and anteversion adjustment of the modular stem (stem anteversion decreased ≤-20°, P = .829; stem anteversion increased ≥+20°, P = .619). CONCLUSION Partial radiolucent lines early postoperatively do not affect long-term outcomes. The clinical benefits of actively adjusting the stem anteversion angle outweigh the mechanical risks. Mild osteolysis, stem fracture, and trunnionosis were relatively frequent complications. Analysis with longer follow-up and more cases are necessary to clearly determine if these complications are associated with the design modification.
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Affiliation(s)
- Yohei Matsushita
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takuya Otani
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuo Hayama
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Fujii
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiko Kawaguchi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Abe T, Otani T, Hayama T, Fujii H, Kawaguchi Y, Saito M. Revision Total Hip Arthroplasty Using the Modular Proximal Stem Modified for Asians: Medium-Term Clinical Results and Perioperative Complications. J Arthroplasty 2022; 37:770-776. [PMID: 34990756 DOI: 10.1016/j.arth.2021.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/22/2021] [Accepted: 12/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to examine the medium-term clinical and radiological outcomes of revision THA using the S-ROM-A stem, a modification of the S-ROM stem intended for Asians. METHODS Femoral reconstruction using the S-ROM-A stem was performed in 126 hips that underwent revision THA. All patients were followed for perioperative complications. In addition, clinical and radiographic outcomes at a mean of 8 (range 5-14) years postoperatively were evaluated in 96 hips of 86 patients (76%). RESULTS The most common perioperative complication was a femoral fracture, occurring in 16 hips (13%), including 11 intraoperative and 5 postoperative fractures. Dislocation occurred in five hips (4.0%), infection in three hips (2.4%), and trunnionosis in two hips (1.6%), including late complications. The total second stem revision was performed in two hips while stem only second revision preserving the bone ingrown sleeve was performed in four hips. With a second revision for aseptic loosening as the endpoint, the 13-year stem survival rate was 100%. Hip function as assessed by the Japanese Orthopedic Association score improved from a mean of 48 points preoperatively to 87 points 8 years postoperatively (P < .05). Radiological evaluation at the final follow-up showed that 95 hips (99%) achieved bone ingrowth fixation and one hip (1%) achieved fibrous stable status. CONCLUSION Revision THA using the S-ROM-A stem resulted in good medium-term outcomes. Although modifications of the stem length and shape may be effective in preventing fractures in Asians with relatively small body sizes, attention should be paid to the occurrence of trunnionosis, which may be associated with the decreased taper size.
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Affiliation(s)
- Toshiomi Abe
- Department of Orthopaedic Surgery, The Jikei University KASHIWA Hospital, Chiba, Japan
| | - Takuya Otani
- Department of Orthopaedic Surgery, The Jikei University DAISAN Hospital, Tokyo, Japan
| | - Tetsuo Hayama
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Fujii
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiko Kawaguchi
- Department of Orthopaedic Surgery, The Jikei University DAISAN Hospital, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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15
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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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16
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Tucker K, Günther KP, Kjaersgaard-Andersen P, Lützner J, Kretzer JP, Nelissen RGHH, Lange T, Zagra L. EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty. EFORT Open Rev 2021; 6:982-1005. [PMID: 34909220 PMCID: PMC8631244 DOI: 10.1302/2058-5241.6.210080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended. Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced). Within the EFORT ‘Implant and Patient Safety Initiative’, evidence- and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty. Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately. Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake. Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results. Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures.
Cite this article: EFORT Open Rev 2021;6:982-1005. DOI: 10.1302/2058-5241.6.210080
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Affiliation(s)
- Keith Tucker
- Orthopaedic Data Evaluation Panel (ODEP), Norwich, UK
| | - Klaus-Peter Günther
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | | | - Jörg Lützner
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Toni Lange
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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17
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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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18
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Chethan KN, Shyamasunder Bhat N, Zuber M, Satish Shenoy B. Finite element analysis of hip implant with varying in taper neck lengths under static loading conditions. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106273. [PMID: 34284197 DOI: 10.1016/j.cmpb.2021.106273] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Total hip arthroplasty is known as one of the best advancements in orthopedics in the 20th century. Due to age or trauma hip joint has to replace by an artificial implant. After the hip arthroplasty, the patients can return to normal day-to-day activities with a normal range of motion. There are several types and designs are currently available. These designs usually depend upon the anatomy of the patients. There is a need for revision surgery due to dislocation and aseptic loosening in these joints over time in actively younger patients. Minor changes in the design stage can certainly improve the life expectancy of the implant and will also further reduce the revision rate. METHODS In this current work, finite element analysis is carried out by varying the neck length with a change in femoral head size for a circular-shaped stem. The effects of using a shorter neck are analyzed. A total of nine combinations are considered for analysis. Modeling is carried out in CATIA V-6 and analysis is performed in ANSYS R-19. A femoral head of 36, 40, and 44 mm and taper neck length of 18, 16, and 14 mm is considered. CoPE is considered as the material combination for all the models. RESULTS It was observed that the von Mises stresses in the complete implant tend to decrease with an increase in the femoral head size. Maximum 5% variation in stress values when 36 mm femoral head is compared with 44 mm. The stresses in the taper neck region tend to decrease with a decrease in the neck length. Minimum von Mises stress of 161.83 MPa was found for the complete implant and in the head-neck region, a minimum von Mises stress found 91.9 MPa. CONCLUSIONS Performance evaluation of hip implant under static loading conditions gives a clear idea about the behavior of implant. It was found that a decrease in the von Mises stresses with a decrease in the taper length. However, these variations won't affect much in the performance of the hip implant. Also, a reduction in taper length can significantly increase the dislocation in the implant. So it is advised to consider the optimal taper length with an increase in the femoral head size.
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Affiliation(s)
- K N Chethan
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - N Shyamasunder Bhat
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Mohammad Zuber
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - B Satish Shenoy
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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19
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Stockhausen KE, Riedel C, Belinski AV, Rothe D, Gehrke T, Klebig F, Gebauer M, Amling M, Citak M, Busse B. Variability in stem taper surface topography affects the degree of corrosion and fretting in total hip arthroplasty. Sci Rep 2021; 11:9348. [PMID: 33931680 PMCID: PMC8087796 DOI: 10.1038/s41598-021-88234-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 03/19/2021] [Indexed: 12/29/2022] Open
Abstract
Degradation at the modular head-neck interface in total hip arthroplasty (THA) is predominately expressed in the form of corrosion and fretting, potentially causing peri-prosthetic failure by adverse reactions to metal debris. This retrieval study aimed to quantify variations in stem taper surface topographies and to assess the influence on the formation of corrosion and/or fretting in titanium alloy stem tapers combined with metal and ceramic heads. Four hip stem designs (Alloclassic, CLS, Bicontact and SL-Plus) were characterized using high-resolution 3D microscopy, and corrosion and fretting were rated using the Goldberg scoring scheme. Quantification of the taper surface topographies revealed a high variability in surface characteristics between threaded stem tapers: Alloclassic and CLS tapers feature deeply threaded trapezoid-shaped profiles with thread heights over 65 µm. The sawtooth-shaped Bicontact and triangular SL-Plus taper are characterized by low thread heights below 14 µm. Significantly lower corrosion and fretting scores were observed in lightly threaded compared to deeply threaded tapers in ceramic head combinations. No significant differences in corrosion or fretting scores with thread height were found in pairings with metal heads. Understanding the relationship between stem taper surface topography and the formation of corrosion and fretting could help to improve the performance of modern THAs and lead to longer-lasting clinical results.
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Affiliation(s)
- Kilian Elia Stockhausen
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Christoph Riedel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Alex Victoria Belinski
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany.,Department of Mechanical Engineering, University of California, 6141 Etcheverry Hall, Berkeley, CA, USA
| | - Dorothea Rothe
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Felix Klebig
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Matthias Gebauer
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany. .,Interdisciplinary Competence Center for Interface Research (ICCIR), Martinistr. 52, 20251, Hamburg, Germany. .,Forum Medical Technology Health Hamburg (FMTHH), Butenfeld 34, 22529, Hamburg, Germany.
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20
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Denduluri SK, Koltsov JCB, Ziino C, Segovia N, McMains C, Falakassa J, Ratliff J, Wood KB, Alamin T, Cheng I, Hu SS. Rod-Screw Constructs Composed of Dissimilar Metals Do Not Affect Complication Rates in Posterior Fusion Surgery Performed for Adult Spinal Deformity. Clin Spine Surg 2021; 34:E121-E125. [PMID: 33633069 DOI: 10.1097/bsd.0000000000001058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to compare implant-related complications between mixed-metal and same-metal rod-screw constructs in patients who underwent posterior fusion for adult spinal deformity. SUMMARY OF BACKGROUND DATA Contact between dissimilar metals is discouraged due to potential for galvanic corrosion, increasing the risk for metal toxicity, infection, and implant failure. In spine surgery, titanium (Ti) screws are most commonly used, but Ti rods are notch sensitive and likely more susceptible to fracture after contouring for deformity constructs. Cobalt chrome (CC) and stainless steel (SS) rods may be suitable alternatives. No studies have yet evaluated implant-related complications among mixed-metal constructs (SS or CC rods with Ti screws). METHODS Adults with spinal deformity who underwent at least 5-level thoracic and/or lumbar posterior fusion or 3-column osteotomy between January 2013 and May 2015 were reviewed, excluding neuromuscular deformity, tumor, acute trauma or infection. Implant-related complications included pseudarthrosis, proximal junctional kyphosis, hardware failure (rod fracture, screw pullout or haloing), symptomatic hardware, and infection. RESULTS A total of 61 cases met inclusion criteria: 24 patients received Ti rods with Ti screws (Ti-Ti, 39%), 31 SS rods (SS-Ti, 51%), and 6 CC rods (CC-Ti, 9.8%). Median follow-up was 37-42 months for all groups. Because of the limited number of cases, the CC-Ti group was not included in statistical analyses. There were no differences between Ti-Ti and SS-Ti groups with regard to age, body mass index, or smokers. Implant-related complications did not differ between the Ti-Ti and SS-Ti groups (P=0.080). Among the Ti-Ti group, there were 15 implant-related complications (63%). In the SS-Ti group, there were 12 implant-related complications (39%). There were 3 implant-related complications in the CC-Ti group (50%). CONCLUSION We found no evidence that combining Ti screws with SS rods increases the risk for implant-related complications.
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Affiliation(s)
| | - Jayme C B Koltsov
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Chason Ziino
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Nicole Segovia
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | | | | | - John Ratliff
- Department of Neurosurgery, Stanford University, Stanford, CA
| | - Kirkham B Wood
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Todd Alamin
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Ivan Cheng
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Serena S Hu
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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21
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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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22
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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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Lee HE, Wu JH, Chao CY, Chang YH, Du JK, Chen KK, Chen HM. A Study of Low Young's Modulus Ti-15Ta-15Nb Alloy Using TEM Analysis. MATERIALS 2020; 13:ma13245694. [PMID: 33327375 PMCID: PMC7764856 DOI: 10.3390/ma13245694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022]
Abstract
The microstructural characteristics and Young’s modulus of the as-cast Ti–15Ta–15Nb alloy are reported in this study. On the basis of the examined XRD and TEM results, the microstructure of the current alloy is essentially a mixture (α + β+ α′ + α″ + ω + H) phase. The new H phase has not previously been identified as a known phase in the Ti–Ta–Nb alloy system. On the basis of examination of the Kikuchi maps, the new H phase belongs to a tetragonal structural class with lattice parameters of a = b = 0.328 nm and c = 0.343 nm, denoting an optimal presentation of the atomic arrangement. The relationships of orientation between these phases would be {0001}α//{110}β//{1¯21¯0}ω//{101¯}H and (011¯0)α//(11¯2)β//(1¯010)ω//(121)H. Moreover, the Young’s modulus of the as-cast Ti–15Ta–15Nb alloy is approximately E = 80.2 ± 10.66 GPa. It is implied that the Young’s modulus can be decreased by the mixing of phases, especially with the presence of the H phase.
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Affiliation(s)
- Huey-Er Lee
- Department of Dentistry, Yuan’s General Hospital, Kaohsiung 80249, Taiwan;
| | - Ju-Hui Wu
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan;
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chih-Yeh Chao
- Department of Mechanical Engineering, National Pintung University of Science and Technology, Pingtung 91201, Taiwan; (C.-Y.C.); (H.-M.C.)
| | - Yen-Hao Chang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Je-Kang Du
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan;
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Correspondence: (J.-K.D.); (K.-K.C.); Tel.: +886-7-3121-101 (ext. 7003) (J.-K.D.)
| | - Ker-Kong Chen
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan;
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Correspondence: (J.-K.D.); (K.-K.C.); Tel.: +886-7-3121-101 (ext. 7003) (J.-K.D.)
| | - Huey-Ming Chen
- Department of Mechanical Engineering, National Pintung University of Science and Technology, Pingtung 91201, Taiwan; (C.-Y.C.); (H.-M.C.)
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Mahon J, McCarthy CJ, Sheridan GA, Cashman JP, O'Byrne JM, Kenny P. Outcomes of the Exeter V40 cemented femoral stem at a minimum of ten years in a non-designer centre. Bone Jt Open 2020; 1:743-748. [PMID: 33367281 PMCID: PMC7750737 DOI: 10.1302/2633-1462.112.bjo-2020-0163.r1] [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] [Indexed: 11/23/2022] Open
Abstract
Aims The Exeter V40 cemented femoral stem was first introduced in 2000. The largest single-centre analysis of this implant to date was published in 2018 by Westerman et al. Excellent results were reported at a minimum of ten years for the first 540 cases performed at the designer centre in the Exeter NHS Trust, with stem survivorship of 96.8%. The aim of this current study is to report long-term outcomes and survivorship for the Exeter V40 stem in a non-designer centre. Methods All patients undergoing primary total hip arthroplasty using the Exeter V40 femoral stem between 1 January 2005 and 31 January 2010 were eligible for inclusion. Data were collected prospectively, with routine follow-up at six to 12 months, two years, five years, and ten years. Functional outcomes were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Outcome measures included data on all components in situ beyond ten years, death occurring within ten years with components in situ, and all-cause revision surgery. Results A total of 829 stems in 745 patients were included in the dataset; 155 patients (20.8%) died within ten years, and of the remaining 664 stems, 648 stems (97.6%) remained in situ beyond ten years. For the 21 patients (2.5%) undergoing revision surgery, 16 femoral stems (1.9%) were revised and 18 acetabular components (2.2%) were revised. Indications for revision in order of decreasing frequency were infection (n = 6), pain (n = 6), aseptic component loosening (n = 3), periprosthetic fracture (n = 3), recurrent dislocation (n = 2), and noise production (ceramic-on-ceramic squeak) (n = 1). One patient was revised for aseptic stem loosening. The mean preoperative WOMAC score was 61 (SD 15.9) with a mean postoperative score of 20.4 (SD 19.3) (n = 732; 88.3%). Conclusion The Exeter V40 cemented femoral stem demonstrates excellent functional outcomes and survival when used in a high volume non-designer centre. Outcomes are comparable to those of its serially validated predecessor, the Exeter Universal stem. Cite this article: Bone Jt Open 2020;1-12:743–748.
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Affiliation(s)
- John Mahon
- Cappagh National Orthopaedic Hospital, Dublin, Ireland
| | | | | | - James P Cashman
- Cappagh National Orthopaedic Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - John M O'Byrne
- Cappagh National Orthopaedic Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paddy Kenny
- Cappagh National Orthopaedic Hospital, Dublin, Ireland.,Connolly Hospital Blanchardstown, Dublin, Ireland
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25
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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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26
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Dawson-Amoah KG, Waddell BS, Prakash R, Alexiades MM. Adverse Reaction to Zirconia in a Modern Total Hip Arthroplasty with Ceramic Head. Arthroplast Today 2020; 6:612-616.e1. [PMID: 32995410 PMCID: PMC7502561 DOI: 10.1016/j.artd.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/27/2020] [Accepted: 03/08/2020] [Indexed: 12/28/2022] Open
Abstract
Hypersensitivity reactions to zirconia (ZrO2) or similar ceramics is highly unusual. Owing to the stable oxide formed between the base metal and oxygen, ceramics are considered relatively biologically inert. We report the case of an otherwise healthy 50-year-old woman with a 5-year history of progressively worsening right hip pain who underwent a ceramic-on-polyethylene total hip replacement and subsequently developed hypersensitivity reaction. After metal allergy testing showed her to be highly reactive to zirconium, the femoral head was revised to a custom titanium implant and her symptoms resolved.
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Affiliation(s)
| | - Bradford S. Waddell
- Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Corresponding author. Hospital for Special Surgery LLC, 1 Blachley Road, Stamford, CT 06902, USA. Tel.: +1 404 352 1015.
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27
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Rieker CB, Wahl P. What the Surgeon Can Do to Reduce the Risk of Trunnionosis in Hip Arthroplasty: Recommendations from the Literature. MATERIALS 2020; 13:ma13081950. [PMID: 32326259 PMCID: PMC7215371 DOI: 10.3390/ma13081950] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/24/2023]
Abstract
Trunnionosis, defined as wear and corrosion at the head–neck taper connection, is a cause of failure in hip arthroplasty. Trunnionosis is linked to a synergistic combination of factors related to the prosthesis, the patient, and the surgeon. This review presents analytical models that allow for the quantification of the impact of these factors, with the aim of providing practical recommendations to help surgeons minimize the occurrence of this failure mode. A tighter fit reduces micromotion and, consequently, fretting of the taper connection. The paramount parameters controlling the fixation force are the coefficient of friction and the impaction force. The influence of the head diameter, as well as of the diameter and angle of the taper, is comparatively small, but varus alignment of the taper and heads with longer necks are unfavourable under physiologic loads. The trunnion should be rinsed, cleaned, and dried carefully, while avoiding any contamination of the bore—the female counterpart within the head—prior to assembly. Biological debris, and even residual water, might critically reduce the fixation of the taper connection between the head and the neck. The impaction force applied to the components should correspond to at least two strong blows with a 500 g hammer, striking the head with an ad hoc impactor aligned with the axis of the taper. These strong blows should correspond to a minimum impaction force of 4000 N.
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Affiliation(s)
- Claude B. Rieker
- Scientific Affairs, Zimmer Biomet EMEA (Europa, Middle East and Africa), Sulzerallee 8, 8404 Winterthur, Switzerland
- Correspondence:
| | - Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland;
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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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Midterm Outcomes and Frequency of Osteolysis of Total Hip Arthroplasty Using Cementless Modular Stem for Asian Patients. J Arthroplasty 2020; 35:811-817. [PMID: 31685396 DOI: 10.1016/j.arth.2019.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/06/2019] [Accepted: 10/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Modular stems are useful for total hip arthroplasty (THA) in anatomically difficult dysplasia. Here, we present mean 6.8-year outcomes of cementless primary THA using S-ROM-A (modified modular stem for Asian patients) femoral prosthesis in anatomically difficult cases. METHODS Charts of 373 patients (461 hips) undergoing THA (mean age, 58 years) were reviewed for clinical evaluation of modified Merle d'Aubigné-Postel score and Kaplan-Meier survivorship with revision for any reason as the end point. For radiographic analysis, 331 patients (412 hips) followed up for ≥5 years were included. Bearing couples were metal-on-metal (n = 145), metal-on-polyethylene (n = 120), and ceramic-on-polyethylene (n = 147). Radiography and multiplanar computed tomography were performed. RESULTS No postoperative dislocation or deep infection occurred. Mean modified Merle d'Aubigné-Postel score improved significantly (10.9 points preoperatively, 16.7 points at last follow-up; P < .001). Cumulative 5- and 10-year stem survival rates were 100% and 84%, respectively (95% confidence interval, 75%-93%). All stems were classified as bone ingrown fixation. Osteolysis occurred in metal-on-metal (42.8%) and metal-on-polyethylene (15.8%) groups. Mean time to osteolysis was ~3 years, with no significant difference between 3 groups (P = .264). In logistic regression, lower cup inclination angle was significantly associated with osteolysis (odds ratio, 0.914; 95% confidence interval, 0.84-0.99; P = .029). CONCLUSION S-ROM-A femoral prosthesis achieved excellent midterm fixation, and the modular system was useful in primary THA with severe deformity. Bearing couples are potentially associated with adverse reactions to metal debris. S-ROM-A with ceramic-on-polyethylene bearing couples may be an option for anatomically difficult THA.
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Faizan A, Longaray J, Nevelos JE, Westrich GH. Effects of corrosion and cleaning method on taper dimensions: an in vitro investigation. Hip Int 2020; 30:87-92. [PMID: 30698029 DOI: 10.1177/1120700018825448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Taper corrosion related revisions have recently been reported in the orthopaedic literature. Cleaning procedure of the trunnions during hip revision is not standardised. The purpose of this bench top investigation was to understand the alterations in the trunnion dimensions and surface roughness characteristics as a result of corrosion product build-up. METHODS 8 titanium alloy trunnions and CoCr femoral heads assemblies were cyclically tested in a mechanical simulator. Following disassembly of the tested constructs, the trunnions were cleaned using 2 methods. The trunnion dimensions were measured using coordinate measuring machine, and surface roughness was measured using white light interferometry. The trunnions were reassembled with ceramic femoral heads and titanium sleeves following cleaning. Head/sleeve pull-off testing was conducted to understand the effects of cleaning methods on the pull-off strength. RESULTS Grade 4 corrosion was observed on all trunnions after mechanical testing. The aggressive cleaning methods had a larger impact on the surface roughness when compared to the light cleaning method. The aggressive cleaning method also decreased the taper cone angle. The pull-off strength was not affected by the cleaning method and the pull-off values were approximately 50% of the assembly loads. CONCLUSIONS The study suggests that trunnion cleaning method may alter the surface roughness and taper cone angle of the existing trunnion. However, the effects of these changes on the pull-off strength did not reach statistical significance. Complex corrosion testing under cyclic loading conditions are warranted to understand the long-term effects of these changes.
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31
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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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Jonitz-Heincke A, Sellin ML, Seyfarth A, Peters K, Mueller-Hilke B, Fiedler T, Bader R, Klinder A. Analysis of Cellular Activity Short-Term Exposure to Cobalt and Chromium Ions in Mature Human Osteoblasts. MATERIALS 2019; 12:ma12172771. [PMID: 31466377 PMCID: PMC6747798 DOI: 10.3390/ma12172771] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 01/19/2023]
Abstract
In aseptic loosening of endoprosthetic implants, metal particles, as well as their corrosion products, have been shown to elicit a biological response. Due to different metal alloy components, the response may vary depending on the nature of the released corrosion product. Our study aimed to compare the biological effects of different ions released from metal alloys. In order to mimic the corrosion products, different metal salts (CoCl2, NiCl2 and CrCl3 × 6H2O) were dissolved and allowed to equilibrate. Human osteoblasts were incubated with concentrations of 10 µM to 500 µM metal salt solutions under cell culture conditions, whereas untreated cells served as negative controls. Cells exposed to CoCr28Mo6 particles served as positive controls. The cell activity and expression of osteogenic differentiation and pro-osteolytic mediators were determined. Osteoblastic activity revealed concentration- and material-dependent influences. Collagen 1 synthesis was reduced after treatment with Co(2+) and Ni(2+). Additionally, exposure to these ions (500 µM) resulted in significantly reduced OPG protein synthesis, whereas RANKL as well as IL-6 and IL-8 secretion were increased. TLR4 mRNA was significantly induced by Co(2+) and CoCr28Mo6 particles. The results demonstrate the pro-osteolytic capacity of metal ions in osteoblasts. Compared to CoCr28Mo6 particles, the results indicated that metal ions intervene much earlier in inflammatory processes.
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Affiliation(s)
- Anika Jonitz-Heincke
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Doberaner Strasse 142, 18057 Rostock, Germany.
| | - Marie-Luise Sellin
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Doberaner Strasse 142, 18057 Rostock, Germany
| | - Anika Seyfarth
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Doberaner Strasse 142, 18057 Rostock, Germany
| | - Kirsten Peters
- Department of Cell Biology, Rostock University Medical Center, Schillingallee 69, 18057 Rostock, Germany
| | - Brigitte Mueller-Hilke
- Institute for Immunology, Rostock University Medical Center, Schillingallee 70, 18057 Rostock, Germany
| | - Tomas Fiedler
- Institute for Medical Microbiology, Virology and Hygiene, Rostock University Medical Center, Schillingallee 70, 18057 Rostock, Germany
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Doberaner Strasse 142, 18057 Rostock, Germany
| | - Annett Klinder
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Doberaner Strasse 142, 18057 Rostock, Germany
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33
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On the Corrosion Behaviour of Low Modulus Titanium Alloys for Medical Implant Applications: A Review. METALS 2019. [DOI: 10.3390/met9080878] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The corrosion behaviour of new generation titanium alloys (β-type with low modulus) for medical implant applications is of paramount importance due to their possible detrimental effects in the human body such as release of toxic metal ions and corrosion products. In spite of remarkable advances in improving the mechanical properties and reducing the elastic modulus, limited studies have been done on the electrochemical corrosion behaviour of various types of low modulus titanium alloys including the effect of different beta-stabilizer alloying elements. This development should aim for a good balance between mechanical properties, design features, metallurgical aspects and, importantly, corrosion resistance. In this article, we review several significant factors that can influence the corrosion resistance of new-generation titanium alloys such as fabrication process, body electrolyte properties, mechanical treatments, alloying composition, surface passive layer, and constituent phases. The essential factors and their critical features are discussed. The impact of various amounts of α and β phases in the microstructure, their interactions, and their dissolution rates on the surface passive layer and bulk corrosion behaviour are reviewed and discussed in detail. In addition, the importance of different corrosion types for various medical implant applications is addressed in order to specify the significance of every corrosion phenomenon in medical implants.
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Tan MHC, Baghi AD, Ghomashchi R, Xiao W, Oskouei RH. Effect of niobium content on the microstructure and Young's modulus of Ti-xNb-7Zr alloys for medical implants. J Mech Behav Biomed Mater 2019; 99:78-85. [PMID: 31344525 DOI: 10.1016/j.jmbbm.2019.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/16/2019] [Accepted: 07/18/2019] [Indexed: 12/26/2022]
Abstract
New generation titanium alloys with low elastic moduli are promising materials for medical implants, particularly load-bearing orthopaedic implants. In this paper, the effect of niobium content on the microstructure and mechanical properties of new Ti alloys including Ti-23Nb-7Zr, Ti-28Nb-7Zr and Ti-33Nb-7Zr (wt%) is studied. Ti-23Nb-7Zr was found to mainly form α΄ and α″- phases, while both the Ti-28Nb-7Zr and Ti-33Nb-7Zr consisted of α″ and β-phases with an increased amount of β-phase in the alloy with 33 wt% of Nb. X-ray diffraction and microstructural analyses showed that the addition of Nb stabilises the β-phase in the solution treated condition with the depleting amount of α΄ and α″- phases. The hardness and Young's modulus values were highest in Ti-23Nb-7Zr which is attributed to the high fraction of α΄- phase in this alloy. The Young's moduli achieved for the three alloys through nanoindentation were 35.9, 29.1 and 29.0 GPa, respectively. The new alloys are encouraging candidates for orthopaedic implants due to their low elastic modulus which can help inhibit stress shielding, although biocompatibility tests (in-vitro and in-vivo) are suggested for future work.
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Affiliation(s)
- Magdalen H C Tan
- College of Science and Engineering, Flinders University, Clovelly Park, SA, 5042, Australia
| | - Alireza Dareh Baghi
- School of Mechanical Engineering, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Reza Ghomashchi
- School of Mechanical Engineering, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Wenlong Xiao
- School of Materials Science and Engineering, Beihang University, Beijing, 100191, China
| | - Reza H Oskouei
- College of Science and Engineering, Flinders University, Clovelly Park, SA, 5042, Australia.
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Lanting BA, Wood TJ, Young S, Van Citters DW, MacDonald SJ, Howard JL, Teeter MG. The effect of altering head length on corrosion using a material loss method. Hip Int 2019; 29:368-372. [PMID: 29808723 DOI: 10.1177/1120700018779886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Corrosion at head neck taper junctions in total hip arthroplasty has increasingly been reported in the literature. Debate persists as to the exact causes and clinical significance of corrosion. Increased offset and head length has been correlated with an increased risk of tribocorrosion due to an adverse mechanical environment. The purpose of this study is to assess the effect of head length on corrosion of a metal-on-polyethylene articulation. METHODS Retrievals from a single institution of 28-mm cobalt chromium alloy heads with a 12/14 taper from a single manufacturer were studied. Corrosion of femoral head bores were studied utilising a material loss method. Testing was performed using co-ordinate measuring for maximum linear wear depth. RESULTS 56 heads were examined with lengths of either -3, 0, +4 or +8 mm and all had been in situ for a minimum of 2 years. There were no significant differences in mean maximum linear wear depth (MLWD) (p = 0.6545). There was no correlation found between MLWD and the time implants were in situ (Spearman coefficient -0.1157) and no significant difference seen between high or standard offset stems (p = 0.1336). CONCLUSION In contrast to studies using qualitative methodologies, there was no correlation between head length and material loss when confined to a 28-mm head. Broad application of this outcome should be cautioned against as this study examined 1 taper construct and a metal-on-polyethylene articulation.
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Affiliation(s)
- Brent A Lanting
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Thomas J Wood
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Sam Young
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Douglas W Van Citters
- 2 Department of Surgery, Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Steven J MacDonald
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - James L Howard
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Matthew G Teeter
- 3 Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
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Does Taper Design Affect Taper Fretting Corrosion in Ceramic-on-Polyethylene Total Hip Arthroplasty? A Retrieval Analysis. J Arthroplasty 2019; 34:S366-S372.e2. [PMID: 31000401 DOI: 10.1016/j.arth.2019.02.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/23/2019] [Accepted: 02/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ceramic-on-polyethylene (CoP) implants have exhibited lower fretting and corrosion scores than metal-on-polyethylene implants. This study aims at investigating the effect of taper design on taper corrosion and fretting in modular CoP total hip arthroplasty (THA) systems. METHODS Under an institutional review board--approved protocol, a query of an implant retrieval library from 2002 to 2017 identified 120 retrieved CoP THA systems with zirconia toughened alumina femoral heads. Femoral stem trunnions were visually evaluated and graded for fretting, corrosion, and damage at the taper interface. Medical records were reviewed for patient demographics and implant characteristics. Data were statistically analyzed using Spearman correlation and rank-sum tests with a Dunn's post hoc test, with a significance level of α = 0.05. RESULTS Four different taper designs were evaluated: 11/13 (n = 18), 12/14 (n = 53), 16/18 (n = 21), and V40 (n = 28). There were no statistically significant demographic differences between taper groups for duration of implantation, laterality, patient age, and patient sex, but patients with 16/18 tapers had a higher body mass index than V40 tapers (P = .012). Duration of implantation had a weak positive correlation with both trunnion fretting (ρ = 0.224, P = .016) and corrosion (ρ = 0.253, P = .006). Summed fretting and corrosion scores were significantly greater on the V40 and 16/18 tapers compared with the 12/14 tapers (all P ≤ .001). CONCLUSION Taper fretting and corrosion were observed in CoP THA implants and were greatest with V40 and 16/18 tapers and lowest with 12/14 tapers. Differences in taper design characteristics may lead to greater micromotion at the taper-head interface, leading to increased fretting and corrosion.
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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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Gross trunnion failure after a metal-on-polyethylene total hip arthroplasty leading to dissociation at the femoral head-trunnion interface. Arthroplast Today 2019; 5:5-10. [PMID: 31020013 PMCID: PMC6475645 DOI: 10.1016/j.artd.2019.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 01/04/2019] [Accepted: 02/04/2019] [Indexed: 11/24/2022] Open
Abstract
Gross trunnion failure (GTF) leading to dissociation at the femoral head-trunnion interface is an uncommon complication after total hip arthroplasty (THA). The incidence of this complication is currently unknown due to the limited number of reported cases but it is significantly more common in the context of a recalled femoral head. This report details the case of a gross trunnion failure and secondary polyethylene failure of a non-recalled metal-on-polyethylene primary THA from a taper type previously reported to be associated with an increased prevalence of mechanically assisted crevice corrosion (MACC). This case describes a 77-year-old man who was 10 years status post right THA presenting with acute-onset right hip pain after trying to rise from a seated position. Radiographs showed that the right femoral head was dissociated from the femoral component. At the time of surgical revision, there was extensive dark metallic debris in the hip joint. A revision THA was performed using a modular revision system. Clinicians must be aware that MACC can eventually lead to GTF, which can result in dissociation at the femoral head-trunnion interface in metal-on-polyethylene primary THA. Further research is needed to determine patient and implant factors that make patients susceptible to MACC/GTF so that adequate screening and patient counseling can be performed.
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A R, Das M, Balla VK, D D, Sen D, Manivasagam G. Surface engineering of LENS-Ti-6Al-4V to obtain nano- and micro-surface topography for orthopedic application. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 18:157-168. [PMID: 30844575 DOI: 10.1016/j.nano.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
Two distinct surface topographies consisting of micro- and nano-surface were developed using laser texturing (LT) and anodization process respectively and their effect on the surface-related properties of Ti-6Al-4V fabricated using Laser Engineered Net Shaping (LENS) were determined. The topographies developed using laser texturing (25, 50 and 75% overlap) were examined using 3D profilometer, whereas, Field Emission Scanning Electron Microscopy (FE-SEM) was used to analyze Titania NanoTubes (TNT) formed using anodization. Though all the surface modified specimens exhibited hydrophilic behavior, least contact angle values were observed for the specimen surface modified with TNT. 25LT and 50LT specimens offered about 8 fold higher corrosion resistance than TNT specimens. All the surface modified samples exhibited non-toxicity to blood cells as well as to the mesenchymal stem cells (hMSCs) with a higher rate of proliferation and differentiation hMSCs observed on 75LT specimens and TNT specimen.
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Affiliation(s)
- Revathi A
- School of Biosciences and Technology (SBST), VIT University, Vellore, TN, India
| | - Mitun Das
- CSIR-Central Glass and Research Institute, Kolkata, WB, India; School of Mechanical Engineering (SMEC), VIT University, Vellore, TN, India
| | - Vamsi K Balla
- CSIR-Central Glass and Research Institute, Kolkata, WB, India; School of Mechanical Engineering (SMEC), VIT University, Vellore, TN, India
| | - Devika D
- Department of Mechanical Engineering, Velammal Engineering College, Chennai, TN, India
| | - Dwaipayan Sen
- Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT), VIT University, Vellore, TN, India
| | - Geetha Manivasagam
- Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT), VIT University, Vellore, TN, India.
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40
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The Distribution and Severity of Corrosion Damage at Eight Distinct Zones of Metallic Femoral Stem Implants. METALS 2018. [DOI: 10.3390/met8100840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Metallic taper junctions of modular total hip replacement implants are analysed for corrosion damage using visual scoring based on different granularity levels that span from analysing the taper holistically to dividing the taper into several distinct zones. This study aims to objectively explore the spatial distribution and the severity of corrosion damage onto the surface of metallic stem tapers. An ordinal logistic regression model was developed to find the odds of receiving a higher score at eight distinct zones of 137 retrieved stem tapers. A method to find the order of damage severity across the eight zones is introduced based on an overall test of statistical significance. The findings show that corrosion at the stem tapers occurred more commonly in the distal region in comparison with the proximal region. Also, the medial distal zone was found to possess the most severe corrosion damage among all the studied eight zones.
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41
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Abstract
BACKGROUND Our understanding of fretting and corrosion at head-neck junctions in modular THAs in vivo is based largely on the analysis of retrieved implants removed for various diagnoses. Little is known about the condition of head-neck tapers in well-functioning THAs. QUESTIONS/PURPOSES Regarding a cohort of well-functioning autopsy-retrieved modular THAs, we asked: (1) Does trunnion geometry or femoral head material affect the pull-off force of the femoral head? (2) Is there a relationship between trunnion damage and length of implantation time, head diameter, and neck length? (3) Does visual damage scoring accurately determine the presence or absence of corrosion on cobalt-chrome trunnions? METHODS Sixty-six femoral stems and engaged femoral heads were retrieved at autopsy from 53 patients at Anderson Orthopaedic Research Institute from 1998 to 2014. Ten stems were excluded for low stem design group size or insufficient head-stem clearance for pull-off testing, leaving a cohort of 56 THAs with a median implantation time of 10 years (range, 1-24 years). The femoral stems included three cobalt-chrome (CoCr) designs from a single manufacturer with either a 12/14 or 14/16 trunnion design (N = 36 and 20, respectively) mated with alumina or CoCr heads (N = 13 and 43, respectively). The force required to pull off the femoral heads was measured using a uniaxial load frame according to ASTM F2009-00. Mating surfaces were visually examined to assess the presence and severity of fretting and corrosion using a modified Goldberg scoring system. Three 12/14 trunnions of similar implantation lengths and varied damage scores were selected for imaging with a scanning electron microscope (SEM) and energy dispersive x-ray analysis (EDAX) to confirm the absence or presence of corrosion damage. RESULTS No difference was seen in pull-off force between groups based on trunnion geometry and head material (median [range], alumina-12/14: 3127 [2320-6992] N, alumina-14/16: 2670 [1095-7919] N, CoCr-12/14: 2255 [1332-5939] N, CoCr-14/16: 2812 [1655-4246] N; p = 0.132). A positive correlation was found between damage score and length of implantation (ρ = 0.543, p < 0.001). However, no correlation between damage score and either head diameter or neck length was found (ρ = -0.012, p = 0.930 and ρ < 0.001, p = 0.995, respectively). In all, 39 of 56 specimens demonstrated no fretting or corrosion, and 16 specimens had mild damage scores. One specimen demonstrated severe corrosion without visual evidence of fretting. The presence of intergranular corrosion on this trunnion was determined by SEM imaging and EDAX. The absence of corrosion products on two trunnions with no observed damage was confirmed. CONCLUSIONS This study found little evidence of fretting and corrosion in a cohort of well-functioning CoCr-CoCr and alumina-CoCr head-neck couples. Further studies are necessary to characterize fretting and corrosion at head-neck junctions of well-functioning implants of other designs and manufacturers. CLINICAL RELEVANCE The results from this study suggest that patients with well-functioning THAs using polyethylene bearing surfaces with alumina or CoCr heads appear to be at low risk for trunnion corrosion for the specific CoCr alloy stems and trunnion geometries analyzed here.
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42
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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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43
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Bolognesi MP. Management of the Implant With Taper Corrosion: What to Change and What to Change It to? J Arthroplasty 2018; 33:2716-2719. [PMID: 30033065 DOI: 10.1016/j.arth.2018.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/09/2018] [Indexed: 02/01/2023] Open
Abstract
Management of implant corrosion remains a challenge for the revision arthroplasty surgeon. Our field continues to gain insight in to how to manage this clinical scenario but there are still gaps in what is known to be considered to be the standard of care. There is a significant amount of effort going in to determining the best means of managing this issue but more work is needed. There is no doubt more studies are needed to further delineate the appropriate treatment algorithms for this clinical problem.
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Affiliation(s)
- Michael P Bolognesi
- Division of Orthopaedics, Duke University Medical Center, Durham, North Carolina
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44
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Westerman RW, Whitehouse SL, Hubble MJW, Timperley AJ, Howell JR, Wilson MJ. The Exeter V40 cemented femoral component at a minimum 10-year follow-up: the first 540 cases. Bone Joint J 2018; 100-B:1002-1009. [PMID: 30062940 DOI: 10.1302/0301-620x.100b8.bjj-2017-1535.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to report the initial results of the Exeter V40 stem, which became available in 2000. Patients and Methods A total of 540 total hip arthroplasties (THAs) were performed in our unit using this stem between December 2000 and May 2002. Our routine protocol is to review patients postoperatively and at one, five, and ten years following surgery. Results A total of 145 patients (26.9%) died before ten years and of the remaining 395 stems, 374 (94.7%) remain in situ. A total of 21 well-fixed stems (5.3%) were revised. Ten were exchanged using a cement-in-cement technique to facilitate acetabular revision. Three were revised for infection, one for instability, one for fracture of the stem, and six following a periprosthetic fracture. An additional 16 acetabular components (4.1%) were revised; five for aseptic loosening and 11 for instability. There were no revisions for aseptic loosening of the stem, and no evidence of aseptic loosening in any hip. The fate of every stem is known and all patients remain under review. Survivorship, with revision of the stem for aseptic loosening as the endpoint, was 100%. At 13.5 years, the Kaplan-Meier survival rate for all-cause revision of the stem was 96.8% (95% confidence interval (CI) 94.8 to 98.8) and all-cause revision (including acetabular revision, infection, and instability) was 91.2% (95% CI 88.3 to 94.1). Conclusion Conclusion No stem was revised for aseptic loosening in this series. The contemporary Exeter V40 stem continues to perform well, and survival has remained comparable with that of the Exeter Universal stem. Cite this article: Bone Joint J 2018;100-B:1002-9.
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Affiliation(s)
- R W Westerman
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S L Whitehouse
- Queensland University of Technology (QUT), Brisbane, Australia
| | - M J W Hubble
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - A J Timperley
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - J R Howell
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - M J Wilson
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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45
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Marinier M, Edmiston TA, Kearns S, Hannon CP, Levine BR. A Survey of the Prevalence of and Techniques to Prevent Trunnionosis. Orthopedics 2018; 41:e557-e562. [PMID: 29813167 DOI: 10.3928/01477447-20180524-03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/08/2018] [Indexed: 02/03/2023]
Abstract
Trunnionosis of total hip arthroplasty (THA) components has been an increasingly reported complication. Consensus is lacking regarding preventive practices and the overall incidence of trunnionosis. In this study, fellowship-trained adult reconstruction orthopedic surgeons were surveyed to identify expert opinions. A 25-question, web-based survey regarding trunnionosis incidence, prevention, and biomaterials was sent to 345 fellowship-trained adult reconstruction orthopedic surgeons in North America. The survey yielded 151 (43.8%) responses from surgeons with a mean of 11.97±9.49 years of experience. These surgeons believe that the material composite of the head-neck junction is the most important contributor to trunnionosis. They often choose a ceramic head with a metal alloy stem to reduce trunnionosis. They more commonly impact the femoral head 3 times than once. Fifty-one percent believe that trunnionosis leads to THA failure for between 0% and 2% of all THA revisions, whereas 48.3% believe that the failure rate is greater than 2%. More than half (53.6%) of these surgeons recommend a revision THA if a patient's serum cobalt level is greater than 10 µg/L, regardless of symptom presence. The incidence of trunnionosis appears to be increasing due to changes in implants and/or an increased awareness of the problem, with 48.3% of these surgeons believing that trunnionosis is the primary cause of THA failure for more than 1 in 50 patients. Some suggested preventive measures include cleaning and drying the trunnion, using ceramic femoral heads, matching THA components, and adding titanium sleeves on well-fixed stems that are retained during revision surgery. [Orthopedics. 2018; 41(4):e557-e562.].
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46
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Waterson HB, Whitehouse MR, Greidanus NV, Garbuz DS, Masri BA, Duncan CP. Revision for adverse local tissue reaction following metal-on-polyethylene total hip arthroplasty is associated with a high risk of early major complications. Bone Joint J 2018; 100-B:720-724. [PMID: 29855241 DOI: 10.1302/0301-620x.100b6.bjj-2017-1466.r1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims Fretting and corrosion at the modular head/neck junction, known as trunnionosis, in total hip arthroplasty (THA) is a cause of adverse reaction to metal debris (ARMD). We describe the outcome of revision of metal-on-polyethylene (MoP) THA for ARMD due to trunnionosis with emphasis on the risk of major complications. Patients and Methods A total of 36 patients with a MoP THA who underwent revision for ARMD due to trunnionosis were identified. Three were excluded as their revision had been to another metal head. The remaining 33 were revised to a ceramic head with a titanium sleeve. We describe the presentation, revision findings, and risk of complications in these patients. Results The patients presented with pain, swelling, stiffness, or instability and an inflammatory mass was confirmed radiologically. Macroscopic material deposition on the trunnion was seen in all patients, associated with ARMD. Following revision, six (18.2%) dislocated, requiring further revision in four. Three (9.1%) developed a deep infection and six (18.2%) had significant persistent pain without an obvious cause. One developed a femoral artery thrombosis after excision of an iliofemoral pseudotumor, requiring a thrombectomy. Conclusion The risk of serious complications following revision MoP THA for ARMD associated with trunnionosis is high. In the presence of extensive tissue damage, a constrained liner or dual mobility construct is recommended in these patients. Cite this article: Bone Joint J 2018;100-B:720-4.
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Affiliation(s)
- H B Waterson
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | | | - N V Greidanus
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - D S Garbuz
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - B A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - C P Duncan
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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47
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Persson A, Eisler T, Bodén H, Krupic F, Sköldenberg O, Muren O. Revision for Symptomatic Pseudotumor After Primary Metal-on-Polyethylene Total Hip Arthroplasty with a Standard Femoral Stem. J Bone Joint Surg Am 2018; 100:942-949. [PMID: 29870445 DOI: 10.2106/jbjs.17.00616] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pseudotumor formation following total hip arthroplasty (THA) is a well-known complication mainly associated with metal-on-metal (MoM) bearings and taper corrosion on modular-neck femoral stems. The purpose of this study was to determine the prevalence of revision surgery for symptomatic pseudotumors in a large cohort of patients treated with primary THA with a standard stem and a non-MoM articulation. METHODS We included 2,102 patients treated with a total of 2,446 THAs from 1999 until May 2016 in a prospective, observational cohort study. All patients underwent THA with the same uncemented, non-modular-neck femoral stem and metal-on-polyethylene (MoP) (n = 2,409) or ceramic-on-polyethylene (n = 37) articulation. All patients were followed by means of a combination of surgical and medical chart review, follow-up visits, and the Swedish Hip Arthroplasty Register. Metal artifact reduction sequence magnetic resonance imaging (MARS MRI) was used for diagnosis of the pseudotumors, and serum metal ion levels and inflammatory marker levels were measured for all patients who underwent a revision due to pseudotumor. RESULTS The prevalence of revision for symptomatic pseudotumor formation was 0.5% (13 cases) at a mean follow-up time of 7 years. The incidence rate was 0.9 case per 1,000 person-years. All 13 revisions were done in patients with an MoP articulation. CONCLUSIONS This study demonstrated a 0.5% prevalence of revision due to symptomatic pseudotumor formation in a cohort of patients who underwent THA with a non-MoM construct. Surgeons should be aware that symptomatic pseudotumor formation requiring revision surgery is a tangible complication even after standard MoP THA. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anders Persson
- Department of Orthopaedics, Danderyd University Hospital, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden
| | - Thomas Eisler
- Department of Orthopaedics, Danderyd University Hospital, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden
| | - Henrik Bodén
- Department of Orthopaedics, Danderyd University Hospital, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden
| | - Ferid Krupic
- Department of Orthopaedics and Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olof Sköldenberg
- Department of Orthopaedics, Danderyd University Hospital, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden
| | - Olav Muren
- Department of Orthopaedics, Danderyd University Hospital, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden
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48
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Raji HY, Shelton JC. Prediction of taper performance using quasi static FE models: The influence of loading, taper clearance and trunnion length. J Biomed Mater Res B Appl Biomater 2018; 107:138-148. [DOI: 10.1002/jbm.b.34104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/19/2018] [Accepted: 02/18/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Halimat Y. Raji
- School of Engineering and Materials Science; Queen Mary University of London; London E1 4NS UK
| | - Julia C. Shelton
- School of Engineering and Materials Science; Queen Mary University of London; London E1 4NS UK
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49
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Siddiqi A, Talmo CT, Bono JV. Intraoperative femoral head dislodgement during total hip arthroplasty: a report of four cases. Arthroplast Today 2018; 4:44-50. [PMID: 29560395 PMCID: PMC5859736 DOI: 10.1016/j.artd.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 11/28/2022] Open
Abstract
Dislodgment of trial femoral heads and migration into the pelvis during total hip arthroplasty is a rarely reported complication with limited published cases. There are three primary mechanisms of femoral head separation: dislodgement during reduction attempt, disassociation from anterior dislocation while assessing anterior stability, and during dislocation after implant trialing. If the trial femoral migrates beyond the pelvic brim, it is safer to finish the total hip arthroplasty and address the retained object after repositioning or in a planned second procedure with a general surgeon. We recommend operative retrieval since long-term complications from retention or clinical results are lacking.
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Affiliation(s)
- Ahmed Siddiqi
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
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50
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Krull A, Morlock MM, Bishop NE. Factors influencing taper failure of modular revision hip stems. Med Eng Phys 2018; 54:65-73. [PMID: 29500122 DOI: 10.1016/j.medengphy.2018.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/19/2018] [Accepted: 02/11/2018] [Indexed: 10/17/2022]
Abstract
Stem modularity of revision hip implant systems offers the advantage of the restoration of individual patient geometry but introduces additional interfaces, which are subjected to repetitive bending loading and have a propensity for fretting corrosion. The male stem taper is the weakest part of the modular junction due to its reduced cross section compared to the outside diameter of the stem. Taper fractures can be the consequence of overloading in combination with corrosion. The purpose of this study was to assess the influence of implant design factors, patient factors, and surgical factors on the risk of taper failure of the modular junction of revision stems. An analytical bending model was used to estimate the strength of the taper connection for pristine, fatigued and corroded conditions. Additionally, a finite element contact model of the taper connection was developed to assess the relative motion and potential for surface damage at the taper interface under physiological loading for varyied assembly and design parameters. Increasing the male taper diameter was shown to be the most effective means for increasing taper strength but would require a concurrent increase in the outer implant diameter to limit a greater risk of total surface damage for a thinner female taper wall. Increasing the assembly force decreases the total surface damage but not local magnitudes, which are probably responsible for crack initiation. It is suggested that in unfavourable loading conditions a monobloc implant system will reduce the risk of failure.
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Affiliation(s)
- A Krull
- TUHH - Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany.
| | - M M Morlock
- TUHH - Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany
| | - N E Bishop
- HAW - Hamburg University of Applied Science, Fakulty of Life Sciences, Department of Biomedical Engineering, Ulmenliet 20, 21033 Hamburg, Germany
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