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Döring J, Bormann T, Buchholz A, Hembus J, Rothammer B, Uhler M. [Tribology in arthroplasty : Friction and wear, a key to a long lifetime]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:479-486. [PMID: 38833160 DOI: 10.1007/s00132-024-04520-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/06/2024]
Abstract
This article is intended to highlight one of the key roles in endoprosthetic treatment with artificial implants and the extension of service life. Like every joint, artificial joints are subject to the physical laws of friction and wear-in short, tribology. Material pairings, surfaces and mechanisms of action in particular play a decisive role here. The special features and current findings relating to the three largest synovial joints (hip, knee and shoulder) will be discussed in detail and suggestions will be made for future developments. Continuous developments in the field of the tribology of artificial joints can massively improve care for patients. The revision figures and reasons already show the success of individual improvements in recent years.
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Affiliation(s)
- Joachim Döring
- Orthopädische Universitätsklinik, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Therese Bormann
- Sektion für Biomechanik und Implantatforschung, Klinik für Orthopädie, Universitätsklinikums Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Adrian Buchholz
- Orthopädische Universitätsklinik, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Jessica Hembus
- Forschungslabor für Biomechanik und Implantattechnologie, Orthopädische Klinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
| | - Benedict Rothammer
- Lehrstuhl für Konstruktionstechnik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Maximilian Uhler
- Sektion für Biomechanik und Implantatforschung, Klinik für Orthopädie, Universitätsklinikums Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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Ekweariri N, White R, Brown N, Schmitt D. A rare case of taper junction corrosion in semi-constrained total knee arthroplasty. Knee 2024; 48:46-51. [PMID: 38507890 DOI: 10.1016/j.knee.2024.02.010] [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: 06/03/2023] [Revised: 12/19/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
Metallosis is a known yet rare late complication of unicompartmental and total knee arthroplasty (TKA), usually secondary to either metal-backed patellar component failure, mobile-bearing polyethylene dislocation, or catastrophic polyethylene failure and wear through. The majority of literature surrounding metallosis has been published in relation to total hip arthroplasty (THA) metal on metal bearing wear or mechanically assisted crevice corrosion.This case report describes the development of metallosis in a 77-year-old male patient with advanced (Kellgren-Lawrence Grade 4) osteoarthritis with associated valgus deformity, who underwent index TKA with a semiconstrained revision knee system due to intraoperative medial collateral ligament laxity. The taper junction between the titanium alloy stem and cobalt chromium femoral component was the source of diffuse intra-articular metallosis.
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Affiliation(s)
- Nnadozie Ekweariri
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Ryan White
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Nicholas Brown
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Daniel Schmitt
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA
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Pagani NR, Coden GS, Ramsden DM, Zink TM, Ward DM, Bono JV, Talmo CT. Failure Following Revision Total Hip Arthroplasty After Cobalt-Chrome Femoral Heads are Placed on a Retained Femoral Stem. J Arthroplasty 2024:S0883-5403(24)00437-6. [PMID: 38754707 DOI: 10.1016/j.arth.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Failure due to trunnionosis with adverse local tissue reaction (ALTR) has been reported with cobalt-chrome (CoCr) heads in total hip arthroplasty (THA); however, there are limited data on the use of these heads in the revision setting. The purpose of this study was to analyze the outcomes of patients who underwent revision THA with a retained femoral component and received a CoCr femoral head on a used trunnion. METHODS In this retrospective review, we identified all patients who underwent revision THA with a retained femoral component and received a CoCr femoral head between February 2006 and March 2014. Demographic factors, implant details, and postoperative complications, including the need for repeat revisions, were recorded. In total, 107 patients were included (mean age 67 years, 74.0% women). Of the 107 patients, 24 (22.4%) required repeat revisions. RESULTS Patients who required repeat revision were younger than those who did not (mean age: 62.9 versus 69, P = .03). The most common indications for repeat revision were instability (8 of 24, 33.3%), ALTR (5 of 24, 20.8%), and infection (4 of 18, 16.7%). Evidence of ALTR or metallosis was identified at the time of reoperation in 10 of the 24 patients who underwent re-revision (41.7%). CONCLUSIONS The placement of a new CoCr femoral head on a used trunnion during revision THA with a retained femoral component carries a significant risk of complication (22.4%) and should be avoided when possible.
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Affiliation(s)
- Nicholas R Pagani
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Gloria S Coden
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - David M Ramsden
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Thomas M Zink
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Daniel M Ward
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - James V Bono
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Carl T Talmo
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
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Lanting BA, Sogbein OA, MacDonald SJ, Shah N, Kok TL, Willing R, Teeter MG. Quantification of trunnion damage in a series of intact total hip arthroplasty femoral stems previously identified to be at risk of catastrophic failure. Hip Int 2024; 34:363-371. [PMID: 37786293 DOI: 10.1177/11207000231199941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Corrosion at the head-neck junction of femoral stems is a rare complication of total hip arthroplasty (THA) with manifestations ranging from subclinical wear to failure. Prior studies have identified a single femoral component design with an increased propensity for catastrophic trunnion failure. The purpose of the present study was to quantify trunnion damage of this femoral component retrieved from patients undergoing revision THA for non-trunnionosis indications. METHODS 24 femoral components from a single manufacturer were identified for study inclusion. Each prosthesis underwent stereomicroscopic inspection. Corrosion and fretting scores were assigned per the Goldberg criteria to quadrants of the trunnion. Material loss was calculated based on cone angles across trunnion quadrants. This was carried out using a coordinate measuring machine that digitised each trunnion surface. Stems were compared to a series of femoral stems with the same trunnion design. RESULTS 20 of the 24 (83%) trunnions demonstrated corrosion, all 24 trunnions demonstrated fretting. Corrosion scores did not statistically differ with respect to trunnion zone (p = 0.53), while fretting scores were higher in the inferior compared to the superior zones (p < 0.001). There was no significant difference in cone angles assessing material loss between stems (p = 0.25). CONCLUSIONS Evidence of trunnion damage was observed in each stem retrieved for non-trunnionosis revision. Fretting occurred more frequently about the inferior quadrants. However, digitised trunnion shapes were similar between compared stems exhibiting no material loss. Therefore, it is possible that previous reports of trunnion failures for this implant are not a systemic issue, and that further investigation is required.
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Affiliation(s)
- Brent A Lanting
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
| | - Olawale A Sogbein
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
| | - Steven J MacDonald
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
| | - Nirmit Shah
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Tea-Lyn Kok
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Ryan Willing
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Matthew G Teeter
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
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Bruggink C, Gerards R, Nijs A. Gross trunnion failure in an elderly obese patient presenting 10 years after total hip arthroplasty with a cobalt chromium femoral head: A case report. Int J Surg Case Rep 2024; 118:109525. [PMID: 38555830 PMCID: PMC10987315 DOI: 10.1016/j.ijscr.2024.109525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Trunnionosis of total hip prosthesis is defined as corrosion at the head-neck taper junction combined with local tissue reaction. Trunnionosis is a rare complication of total hip arthroplasty (THA) that is often missed in diagnosis. Severe trunnionosis can result in head-neck dissociation, which is called gross trunnion failure (GTF). CASE PRESENTATION We describe a case of GTF in a 70-year-old male patient 10 years after right total hip arthroplasty with a cobalt chromium (CoCr) femoral head and a titanium alloy stem. A revision of the stem, cup and femoral head was performed. Six months after surgery, the patient is recovering well and walking. DISCUSSION Trunnionosis is associated with hip prostheses with a CoCr femoral head and a titanium alloy stem. Metal Artefact Reduction Sequence (MARS) and serum cobalt and chromium levels are diagnostic tools that can be useful when trunnionosis is suspected. CONCLUSION Trunnionosis remains hard to diagnose in an early stage when gross trunnion failure is not present. This case of a 70-year-old patient with gross trunnion failure 10 years after right total hip arthroplasty supports the literature suggesting that a CoCr femoral head, a high body mass index (BMI), and a longer implantation time are risk factors for developing trunnionosis. When conventional X ray and C-reactive protein are inconclusive, serum cobalt and chromium levels should be determined. When serum cobalt and chromium levels are elevated, a MARS MRI should be performed to confirm trunnionosis.
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Affiliation(s)
- Chiara Bruggink
- Department of Orthopedic Surgery, Amphia Hospital, Breda, Netherlands.
| | - Rogier Gerards
- Department of Orthopedic Surgery, Amphia Hospital, Breda, Netherlands.
| | - Anouk Nijs
- Foundation for Orthopedic Research, Care and Education, Amphia Hospital, Breda, Netherlands
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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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Park CW, Cho K, Jeong SJ, Jung IG, Lim SJ, Park YS. Mean 23-Year Outcomes of Total Hip Arthroplasty Using a Modular Femoral Stem With Metaphyseal Fixation Sleeve. J Arthroplasty 2024; 39:1007-1012. [PMID: 37852443 DOI: 10.1016/j.arth.2023.10.019] [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: 05/18/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Although the modular sleeve concept for femoral implants has several advantages, studies reporting on greater than 20-year outcomes are limited. This study aimed to report the mean 23-year results of total hip arthroplasty (THA) using a modular stem with metaphyseal fixation sleeve. METHODS This study reviewed primary THAs performed using a modular stem between October 1994 and April 1998. Of the 272 hips (221 patients) identified, 220 hips (177 patients) satisfying the minimum 20-year follow-up were included. The Harris Hip Score was used for clinical evaluation. Final hip radiographs were analyzed to evaluate the implant stability and the extent of femoral osteolysis. The mean follow-up duration was 23 years (range, 20 to 28). RESULTS The mean Harris Hip Score improved from 38 points (range, 26 to 67) preoperatively to 90 points (range, 71 to 100) at the final follow-up (P < .001). Femoral osteolysis was observed in 146 hips (67.1%), but 145 were located proximal to the osseo-integrated sleeve. Overall, 4 femoral revisions were performed; 2 for chronic infection, one for aseptic loosening, and one for periprosthetic femoral fracture. Of the 19 (8.6%) periprosthetic femoral fractures, the most common type was Vancouver AG (13 hips). One (0.5%) asymptomatic distal stem fracture occurred, while no complications were identified at the stem-sleeve junction. Implant survivorship free of any femoral revision was 98.3% at 23 years. CONCLUSIONS A THA using a modular stem with metaphyseal fixation sleeve demonstrated 98.3% stem survivorship with excellent clinical outcomes at a mean follow-up of 23 years in non-obese patients.
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Affiliation(s)
- Chan-Woo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungjun Cho
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Jin Jeong
- Department of Orthopedic Surgery, Myongji hospital, Hanyang University School of Medicine, Goyang, Korea
| | - In Geol Jung
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Fokter SK, Ledinek Ž, Kljaić Dujić M, Novak I. Extreme Serum Titanium Concentration Induced by Acetabular Cup Failure: Unveiling a Unique Scenario of Titanium Alloy Debris Accumulation. Bioengineering (Basel) 2024; 11:235. [PMID: 38534509 DOI: 10.3390/bioengineering11030235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
The majority of contemporary total hip arthroplasty (THA) implants are constructed from Ti alloys, which are generally believed to generate fewer adverse local tissue reactions (ALTRs) compared to CoCr alloys. This study presents a case of unusual primary THA failure where a substantial release of Ti alloy debris was observed. A 52-year-old active male underwent THA after post-traumatic aseptic necrosis of the femoral head in 2006. Seventeen years after the procedure, the patient presented with groin pain and a restricted range of motion. X-rays revealed the protrusion of the alumina ceramic head through the Ti6Al4V acetabular cup. Trace element analysis indicated significantly elevated levels of serum Ti, Al, and V. CT and MRI confirmed Ti alloy cup failure and a severe ALTR. During revision surgery, it was found that the worn-out ceramic head was in direct contact with the acetabular cup, having protruded through a central hole it had created over time. No acetabular liner was found. Histological analysis of his tissue samples showed wear-induced synovitis with areas of multinucleated foreign body giant cells and the accumulation of numerous metal particles but no acute inflammatory response. Six months after the revision THA, the patient has experienced favourable outcomes. This case provides an instructive illustration for studying the consequences of the substantial release of Ti alloy debris from orthopedic implants.
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Affiliation(s)
- Samo K Fokter
- Clinical Department of Orthopedic Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Slomškov trg 15, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
| | - Živa Ledinek
- Department of Pathology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Milka Kljaić Dujić
- Department of Radiology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Igor Novak
- Clinical Department of Orthopedic Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
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Diaz-Lopez RA, Wen PH, Shelton JC. Influence of Taper surface topographies on contact deformation and stresses. J Mech Behav Biomed Mater 2023; 148:106213. [PMID: 37952504 DOI: 10.1016/j.jmbbm.2023.106213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
The role of bore and trunnion surface topography on the failure rate of total hip joint replacements due to trunnionosis is not clear despite significant variations in the design of taper components between manufacturers. Taper surface topography, along with other taper design parameters such as clearance, diameter, and assembly force, determine the initial interlock of the contacting surfaces after assembly; this has been related to relative motions that can cause fretting and corrosion at the taper interface. However, in most in-silico parametrical taper studies associated with taper micromotions, the bore and trunnion surfaces have been simplified using a flat surface and/or sinusoidal functions to mimic the surface roughness. The current study tests the hypothesis that the use of simple geometrical functions for the taper surface topography can predict the surface mechanics developed in assembled tapers. Measured and simulated surfaces of bores and trunnions were characterised using common roughness parameters and spectral density estimations. Using the same characterised surface profiles, 2D Finite Element (FE) models of CoCr alloy femoral heads and Ti alloy trunnions were developed. Models simulated assembly conditions at different resultant forces ranging from 0.5 to 4.0 kN, contact conditions were determined and associated with their topographical characteristics. Measured surfaces of bore and trunnion components comprise up to seven dominant spatial frequencies. Flattening of the trunnion microgrooved peaks was observed during the assembly of the taper. When the femoral head bore and trunnion topography were both considered a reduced number of microgrooved peaks were in contact, from 51 in an idealised taper surfaces to 35 in measured surfaces using an assembly reaction force of 4 kN. The contact points in the models developed high plastic strains, which were greater than that associated with failure of the material. Results showed that line and sine wave functions over estimate contact points at the taper interface compared to those surfaces that consider roughness and peak variation. These findings highlight the important role of modelling the full surface topography on the taper contact mechanics, as surface variations in the roughness and waviness change the performance of tapers.
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Affiliation(s)
- R A Diaz-Lopez
- School of Engineering and Materials Science, Queen Mary University of London, UK
| | - P H Wen
- School of Engineering and Materials Science, Queen Mary University of London, UK
| | - J C Shelton
- School of Engineering and Materials Science, Queen Mary University of London, UK.
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Olšovská E, Čabanová K, Motyka O, Kryštofová HB, Matějková P, Voves J, Židlík V, Madeja R, Demel J, Halfar J, Kukutschová J. Simple method for quantification of metal-based particles in biopsy samples of patients with long bone implants - Pilot study. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2023; 103:104282. [PMID: 37769889 DOI: 10.1016/j.etap.2023.104282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
The presence of particles fixed in tissue samples due to implant degradation or disintegration plays an important role in post-operative complications. The ability to determine the size, shape, chemical composition and, above all, the number of these particles can be used in many areas of medicine. This study presents a novel, simple metal-based particle detection method using scanning electron microscopy with energy dispersive spectrometer (SEM-EDS). The presence of metal particles in biopsy specimens from long bone nail-fixated implants (10 patients with titanium steel nails and 10 patients with stainless steel nails) was studied. The samples were analysed using automated area analysis based on image binarization and brightness to 255 grayscale. The results were supplemented with histological data and statistically analysed. The method based on the software used was found to be accurate and easy to use and, thus, appears to be very suitable for particle detection in similar samples.
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Affiliation(s)
- Eva Olšovská
- Nanotechnology Centre, CEET, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic.
| | - Kristina Čabanová
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Mining and Geology, VSB-Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Oldřich Motyka
- Nanotechnology Centre, CEET, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Mining and Geology, VSB-Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Hana Bielniková Kryštofová
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava and Faculty of Medicine, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Petra Matějková
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Jiří Voves
- Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Vladimír Židlík
- Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava and Faculty of Medicine, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Roman Madeja
- Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Jiří Demel
- Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic; Faculty of Medicine, Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic
| | - Jan Halfar
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Mining and Geology, VSB-Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Jana Kukutschová
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
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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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Zhang G, Yang S, Cui W, Huang Z, Zhang X, Zhang Y, Li J, Jin Z. Decomposition of micromotion at the head-neck interface in total hip arthroplasty during walking. Comput Methods Biomech Biomed Engin 2023; 26:548-558. [PMID: 35549565 DOI: 10.1080/10255842.2022.2073788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Fretting corrosion as one of the leading causes for failure of modular hip prostheses has been associated with micromotion at head-neck taper junction. Decomposition of micromotion is helpful to promote the development of more realistic experiments investigating failure mechanisms of the head-neck junction in total hip arthroplasty. The aim of this study was to decompose the complex three-dimensional micromotion at the head-neck junction into multiple fundamental modes, including three translational and three rotational components. A three-dimensional finite element model composed of head-neck junction, liner and acetabular cup with a typical 12/14 taper size, as well as the taper mismatch of -4', was developed during walking. The analysis was divided into three procedures: a) the assembly simulation of the head and neck during surgery, b) verification with a simplified axisymmetric model, and c) three-dimensional modelling under normal walking. This study revealed that the main forms of micromotion contained circumferential, longitudinal micromotion and longitudinal rolling toggling, and were closely related to the state of motion. The maximum translational micromotion was predicted to be 10.9 μm during the walking gait, with the predominant modes of the circumferential translation of 9.6 μm, the longitudinal translation of 5.5 μm and the longitudinal rotation of 0.29° along the taper junction. These findings may provide design considerations for further experimental testing about fretting and facilitate the understanding of the fretting mechanisms in hip prostheses.
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Affiliation(s)
- Guoxian Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Shu Yang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Wen Cui
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Zhi Huang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Xiaogang Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Yali Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Junyan Li
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Zhongmin Jin
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
- School of Mechanical Engineering, University of Leeds, Leeds, UK
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A Modular Head-Neck Adapter System and Ceramic Heads in Revision Hip Arthroplasty: A Registry Study on 354 Implants. J Arthroplasty 2023:S0883-5403(23)00075-X. [PMID: 36764407 DOI: 10.1016/j.arth.2023.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Five- to 10-year outcomes of a modular head-neck adapter system with ceramic heads in revision hip arthroplasty on large populations are still lacking. A registry study about modular adapter system with Delta ceramic head in revisions was designed, aiming to assess (1) the survival rates of the device, (2) the reasons for re-revisions of the device, and (3) a comparison to factory assembled titanium sleeve and Delta head cohort in revision hips. METHODS Using a regional arthroplasty registry, we investigated the modular adapter system with a ceramic head in revision hips. Demographics, implant features, and reasons for revision were recorded. Survival rates and reasons for re-revision were assessed. The modular adapter system with the ceramic ball was compared to a factory-assembled ceramic titanium-sleeved head in revisions, acting as a control group. There were 354 revisions included at a mean follow-up of 5 years (range, 0 to 13). RESULTS The 5- and 7-year survival rates were 87.9% and 86.9%, respectively. Dislocations (2.8%) and cup aseptic loosening (4.2%) were the 2 most frequent reasons for re-revision. No breakage of the adapter system or the ceramic head occurred. A femoral neck failed (0.3%). No implant features, offset (P = .088) or skirted (P = .870) tapers, impacted on failures. No differences between the 2 cohorts were found regarding survival rates (P = .696) and reasons for re-revision (dislocations, P = .983; cup aseptic loosening, P = .296). CONCLUSION The modular head neck adapter system with a ceramic head seems to be a valid option in revisions at 5 and 7 years, without additional risk of implant breakage in this registry.
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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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Martelli A, Erani P, Pazzagli N, Cannillo V, Baleani M. Surface Analysis of Ti-Alloy Micro-Grooved 12/14 Tapers Assembled to Non-Sleeved and Sleeved Ceramic Heads: A Comparative Study of Retrieved Hip Prostheses. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1067. [PMID: 36770073 PMCID: PMC9920329 DOI: 10.3390/ma16031067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Ti6Al4V titanium alloy (Ti-alloy) sleeved ceramic heads have become widely used in revision surgery when the hip stem is left in situ. This solution guarantees a new junction between the bore of the ceramic head and the Ti-alloy sleeve, regardless of any possible, slight surface damage to the Ti-alloy taper of the stem. However, this solution introduces an additional Ti-alloy/Ti-alloy interface pairing, which is potentially susceptible to mechanically assisted crevice corrosion. This study evaluated both qualitatively and quantitatively the damage that occurred in vivo on Ti-alloy micro-grooved 12/14 tapers of (i) primary implants with non-sleeved ceramic heads (Group 1), (ii) secondary implants with non-sleeved ceramic heads (Group 2), and (iii) secondary implants with sleeved ceramic heads (Group 3). A total of 45 explants-15 for each group, including short-, medium- and long-neck heads-underwent optical evaluation for surface damage (Goldberg scoring), surface roughness analysis, and SEM/EDX analysis. The Goldberg scores did not reveal different patterns in the tapers' surface damage; surface damage was classified as absent or mild (surface damage score ≤2) in 94%, another 94%, and 92% of the analysed regions for Group 1, Group 2, and Group 3, respectively. Small but significant differences in morphological changes occurred in the tapers of the three groups: reductions no greater than a few percentage points in median values of roughness parameters were found in Group 1 and Group 2, while negligible changes were found in Group 3. SEM/EDX analysis revealed little (i.e., a slight increase in the oxygen content) to undetectable changes in the chemical composition on the Ti-alloy surface independently of the group. These results suggest that the Ti-alloy/Ti-alloy sleeve/taper junction is only mildly susceptible to mechanically assisted crevice corrosion. Assembling a sleeved ceramic head, with variable neck lengths up to a "long-neck", to a Ti-alloy micro-grooved 12/14 taper of a stem left in situ does not seem to increase the risk of revision due to trunnionosis, as long as junction stability (i.e., the proper seating of the sleeved ceramic head on the 12/14 taper) is achieved intraoperatively.
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Affiliation(s)
- Andrea Martelli
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Ingegneria Enzo Ferrari, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
| | - Paolo Erani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Nicola Pazzagli
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Valeria Cannillo
- Dipartimento di Ingegneria Enzo Ferrari, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
| | - Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Technical Considerations and Avoiding Complications in Total Hip Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202211000-00011. [PMID: 36733988 PMCID: PMC9668563 DOI: 10.5435/jaaosglobal-d-22-00234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/25/2022] [Indexed: 11/22/2022]
Abstract
Total hip arthroplasty (THA) is considered to be the surgical procedure of the 20th century. Current projections show that by 2030, primary THA is expected to grow by 171%, with revision THA expected to increase by 142% in the same time frame. Although complications are not common, when they occur, they can cause notable morbidity to the patient. Understanding the unique anatomy and needs of each patient will prepare the surgeon to avoid soft-tissue or bony injury, optimize prosthesis placement, and decrease the risk of infection. This article aims to highlight common causes of early revision THA and provide specific technical strategies to avoid these complications. Following a systematic approach to the primary THA and using these techniques will assist the surgeon in avoiding complications to revision hip arthroplasty.
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Wight C, Phillips DM, Whyne C. Wear reduction of orthopaedic implants through Cryogenic Thermal Cycling. J Mech Behav Biomed Mater 2022; 135:105420. [DOI: 10.1016/j.jmbbm.2022.105420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/22/2022] [Accepted: 08/17/2022] [Indexed: 10/31/2022]
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Vick HP, Domingue GA, Richburg K, Dean R, Khan F, Thakral R. Unusual Case of a Trunnion Fracture Following a Revision Hip Arthroplasty Surgery: A Brief Review of the Literature and Discussion About Causes of Failure. Arthroplast Today 2022; 18:103-106. [PMID: 36304696 PMCID: PMC9593279 DOI: 10.1016/j.artd.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 11/07/2022] Open
Abstract
Trunnion fracture is an incredibly rare complication of total hip arthroplasty. Of the few reported cases, all involve implants with faulty designs, a small neck taper, or an extended neck length or offset. Most also report corrosion and an adverse soft-tissue reaction. We present a review of the literature and report on the first case, to our knowledge, of trunnion fracture in a well-fixed, cemented cobalt-chromium femoral component with a standard neck length and offset with no evidence of corrosion. This failure was likely related to scratching of the metal during previous procedures which led to crack propagation and catastrophic failure. The patient was treated with revision hip arthroplasty to an uncemented, distal-fit femoral component and insertion of new bearing surfaces.
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Affiliation(s)
| | - Grayson A. Domingue
- Corresponding author. University of Oklahoma Health Sciences Center, 13221 Englewood Ln, Edmond, OK 73013, USA. Tel.: +1 225 620 3384.
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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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Bormann T, Müller U, Gibmeier J, Mai PT, Renkawitz T, Kretzer JP. Insights into Imprinting: How Is the Phenomenon of Tribocorrosion at Head-Neck Taper Interfaces Related to Corrosion, Fretting, and Implant Design Parameters? Clin Orthop Relat Res 2022; 480:1585-1600. [PMID: 35383614 PMCID: PMC9278900 DOI: 10.1097/corr.0000000000002202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/15/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Wear and corrosion at modular neck tapers in THA can lead to major clinical implications such as periprosthetic osteolysis, adverse local tissue reactions, or implant failure. The material degradation processes at the taper interface are complex and involve fretting corrosion, third-body abrasion, as well as electrochemical and crevice corrosion. One phenomenon in this context is imprinting of the head taper, where the initially smooth surface develops a topography that reflects the rougher neck taper profile. The formation mechanism of this specific phenomenon, and its relation to other observed damage features, is unclear. An analysis of retrieved implants may offer some insights into this process. QUESTIONS/PURPOSES (1) Is imprinting related to time in situ of the implants and to the taper damage modes of corrosion and fretting? (2) Are implant design parameters like neck taper profile, stem material, or head seating associated with the formation of imprinting? (3) Is imprinting created by an impression of the neck taper profile or can a different mechanistic explanation for imprinting be derived? METHODS Thirty-one THAs with cobalt-chromium-molybdenum-alloy (CoCrMo) heads retrieved between 2013 and 2019 at revision surgery from an institutional registry were investigated. Inclusion criteria were: 12/14 tapers, a head size of 36 mm or smaller, time in situ more than 1 year, and intact nonmodular stems without sleeve adaptors. After grouping the residual THAs according to stem type, stem material, and manufacturer, all groups of three or more were included. Of the resulting subset of 31 retrievals, nine THAs exhibited a still assembled head-neck taper connection. The median (range) time in situ was 5 years (1 to 23). Two stem materials (21 titanium-alloy and 10 stainless steel), three kinds of bearing couples (11 metal-on-metal, 13 metal-on-polyethylene, and seven dual-mobility heads), and two different neck taper profiles (six wavy profile and 25 fluted profile) were present in the collection. Four THAs exhibited signs of eccentric head seating. The 31 investigated THAs represented 21% of the retrieved THAs with a CoCrMo alloy head during the specified period.At the head tapers, the damage modes of corrosion, fretting, and imprinting were semiquantitatively rated on a scale between 0 (no corrosion/fretting/imprinting) and 3 (severe corrosion/fretting/imprinting). Corrosion and fretting were assessed applying the Goldberg score, with the modification that the scale started at 0 and not at 1. Imprinting was assessed with a custom scoring system. Rating was done individually at the proximal and distal head taper half and summed to one total damage score for each retrieval and damage mode. Correlations between the damage modes and time in situ and between the damage modes among each other, were assessed using the Spearman rank order correlation coefficient (ρ). Associations between imprinting and implant design parameters were investigated by comparing the total imprinting score distributions with the Mann-Whitney U-test. Metallographically prepared cross-sections of assembled head-neck taper connections were examined by optical microscopy and disassembled head and neck taper surfaces were assessed by scanning electron microscopy (SEM). RESULTS The imprinting damage score increased with time in-situ (ρ = 0.72; p < 0.001) and the corrosion damage score (ρ = 0.63; p < 0.001) but not with the fretting damage score (ρ = 0.35; p = 0.05). There was no difference in total imprinting score comparing neck taper profiles or stem materials, with the numbers available. Eccentric head seating had elevated total imprinting score (median 6 [interquartile range 0]) compared with centric seating (median 1 [2]; p = 0.001). Light optical investigations showed that imprinting can be present on the head taper surfaces even if the depth of abraded material exceeds the neck taper profile height. SEM investigations showed bands of pitting corrosion in the imprinted grooves. CONCLUSION The microscopic investigations suggest that imprinting is not an independent phenomenon but a process that accompanies the continuous material degradation of the head taper surface because of circular damage on the passive layer induced by grooved neck tapers. CLINICAL RELEVANCE Material loss from head-neck taper connections involving CoCrMo alloy heads is a source of metal ions and could potentially be reduced if hip stems with smooth neck tapers were used. Surgeons should pay attention to the exact centric seating of the femoral head onto the stem taper during joining of the parts.
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Affiliation(s)
- Therese Bormann
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike Müller
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jens Gibmeier
- Institute for Applied Materials, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Phuong Thao Mai
- Institute for Applied Materials, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Tobias Renkawitz
- Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Metal Articulations as a Source of Total Hip Arthroplasty Pain. J Arthroplasty 2022; 37:1483-1487. [PMID: 35101592 DOI: 10.1016/j.arth.2022.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/03/2022] [Accepted: 01/20/2022] [Indexed: 02/02/2023] Open
Abstract
The consensus systematic risk stratification algorithm from the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and The Hip Society summarizes clinical challenges in evaluation and treatment of metal-on-polyethylene total hip arthroplasty (THA) patients with adverse local tissue reaction (ALTR) due to mechanically assisted crevice corrosion (MACC), reviews up-to-date evidence, and identifies the areas for future research in order to provide a useful resource for orthopedic surgeons providing care to these patients. A painful THA has various intrinsic and extrinsic causes. ALTR is one of the intrinsic causes in patients with painful THA. The occurrence of ALTR due to MACC at modular junctions is likely to be multifactorial, including implant, surgical, and patient factors. Therefore, a systematic evaluation needs to involve a focused clinical history, detailed physical examination, laboratory tests, and imaging in order to identify potential differential diagnoses. There should be a low threshold to perform a systematic evaluation of patients with painful non-metal-on-metal THA, including patients with metal-on-polyethylene THA, and modular dual-mobility THA with the CoCr metal acetabular insert, as early recognition and diagnosis of ALTR due to MACC will facilitate initiation of appropriate treatment prior to significant adverse biological reactions. Specialized tests such as blood metal analysis and metal artifact reduction sequence magnetic resonance imaging are important modalities in evaluation and management of ALTR in patients with painful THA.
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22
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Fernandez-Fairen M. CORR Insights®: Insights into Imprinting: How Is the Phenomenon of Tribocorrosion at Head-Neck Taper Interfaces Related to Corrosion, Fretting, and Implant Design Parameters? Clin Orthop Relat Res 2022; 480:1601-1603. [PMID: 35638900 PMCID: PMC9278905 DOI: 10.1097/corr.0000000000002267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/12/2022] [Indexed: 01/31/2023]
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23
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Grothe T, Günther KP, Hartmann A, Blum S, Haselhoff R, Goronzy J. The incidence of adverse local tissue reaction due to head taper corrosion after total hip arthroplasty using V40 taper and 36 mm CoCr head. Bone Joint J 2022; 104-B:852-858. [PMID: 35775169 DOI: 10.1302/0301-620x.104b7.bjj-2021-1769.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Head-taper corrosion is a cause of failure in total hip arthroplasty (THA). Recent reports have described an increasing number of V40 taper failures with adverse local tissue reaction (ALTR). However, the real incidence of V40 taper damage and its cause remain unknown. The aim of this study was to evaluate the long-term incidence of ALTR in a consecutive series of THAs using a V40 taper and identify potentially related factors. METHODS Between January 2006 and June 2007, a total of 121 patients underwent THA using either an uncemented (Accolade I, made of Ti12Mo6Zr2Fe; Stryker, USA) or a cemented (ABG II, made of cobalt-chrome-molybdenum (CoCrMo); Stryker) femoral component, both with a V40 taper (Stryker). Uncemented acetabular components (Trident; Stryker) with crosslinked polyethylene liners and CoCr femoral heads of 36 mm diameter were used in all patients. At a mean folllow-up of 10.8 years (SD 1.1), 94 patients (79%) were eligible for follow-up (six patients had already undergone a revision, 15 had died, and six were lost to follow-up). A total of 85 THAs in 80 patients (mean age 61 years (24 to 75); 47 (56%) were female) underwent clinical and radiological evaluation, including the measurement of whole blood levels of cobalt and chrome. Metal artifact reduction sequence MRI scans of the hip were performed in 71 patients. RESULTS A total of 20 ALTRs were identified on MRI, with an incidence of 26%. Patients with ALTR had significantly higher median Co levels compared with those without ALTR (2.96 μg/l (interquartile range (IQR) 1.35 to 4.98) vs 1.44 μg/l (IQR 0.79 to 2.5); p = 0.019). Radiological evidence of osteolysis was also significantly associated with ALTR (p = 0.014). Median Cr levels were not significantly higher in those with ALTR compared with those without one (0.97 μg/l (IQR 0.72 to 1.9) v 0.67 μg/l (IQR 0.5 to 1.19; p = 0.080). BMI, sex, age, type of femoral component, head length, the inclination of the acetabular component, and heterotopic ossification formation showed no significant relationship with ALTR. CONCLUSION Due to the high incidence of local ALTR in our cohort after more than ten years postoperatively, we recommend regular follow-up investigation even in asymptomatic patients with V40 taper and metal heads. As cobalt levels correlate with ALTR occurrence, routine metal ion screening and consecutive MRI investigation upon elevation could be discussed. Cite this article: Bone Joint J 2022;104-B(7):852-858.
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Affiliation(s)
- Tim Grothe
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Albrecht Hartmann
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Sophia Blum
- Department of Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Richard Haselhoff
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jens Goronzy
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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Kayani B, Baawa-Ameyaw J, Fontalis A, Tahmassebi J, Wardle N, Middleton R, Stephen A, Hutchinson J, Haddad FS. Oxidized zirconium versus cobalt-chrome femoral heads in total hip arthroplasty: a multicentre prospective randomized controlled trial with ten years' follow-up. Bone Joint J 2022; 104-B:833-843. [PMID: 35775177 DOI: 10.1302/0301-620x.104b7.bjj-2021-1673.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study reports the ten-year wear rates, incidence of osteolysis, clinical outcomes, and complications of a multicentre randomized controlled trial comparing oxidized zirconium (OxZr) versus cobalt-chrome (CoCr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) and highly cross-linked polyethylene (XLPE) liners in total hip arthroplasty (THA). METHODS Patients undergoing primary THA were recruited from four institutions and prospectively allocated to the following treatment groups: Group A, CoCr femoral head with XLPE liner; Group B, OxZr femoral head with XLPE liner; and Group C, OxZr femoral head with UHMWPE liner. All study patients and assessors recording outcomes were blinded to the treatment groups. The outcomes of 262 study patients were analyzed at ten years' follow-up. RESULTS Patients in Group C were associated with increased mean liner wear rates compared to patients in Group A (0.133 mm/yr (SD 0.21) vs 0.031 mm/yr (SD 0.07), respectively; p < 0.001) and Group B (0.133 mm/yr (SD 0.21) vs 0.022 mm/yr (SD 0.05), respectively; p < 0.001) at ten years' follow-up. Patients in Group C were also associated with increased risk of osteolysis and aseptic loosening requiring revision surgery, compared with patients in Group A (7/133 vs 0/133, respectively; p = 0.007) and Group B (7/133 vs 0/135, respectively; p = 0.007). There was a non-statistically significant trend towards increased mean liner wear rates in Group A compared with Group B (0.031 mm/yr (SD 0.07) vs 0.022 mm/yr (SD 0.05), respectively; p = 0.128). All three groups were statistically comparable preoperatively and at ten years' follow-up when measuring normalized Western Ontario and McMaster Universities Osteoarthritis Index (p = 0.410), 36-Item Short Form Health Survey (p = 0.465 mental, p = 0.713 physical), and pain scale scores (p = 0.451). CONCLUSION The use of UHMWPE was associated with progressively increased annual liner wear rates after THA compared to XLPE. At ten years' follow-up, the group receiving UHMWPE demonstrated an increased incidence of osteolysis and aseptic loosening requiring revision surgery compared to XLPE. Femoral heads composed of OxZr were associated with trend towards reduced wear rates compared to CoCr, but this did not reach statistical significance and did not translate to any differences in osteolysis, functional outcomes, or revision surgery between the two femoral head components. Cite this article: Bone Joint J 2022;104-B(7):833-843.
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Affiliation(s)
- Babar Kayani
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Joanna Baawa-Ameyaw
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Jenni Tahmassebi
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Nick Wardle
- Colchester Hospital University Foundation Trust, Colchester, UK
| | - Robert Middleton
- Department of Trauma and Orthopaedics, Bournemouth University, Bournemouth, UK
| | | | | | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
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Movassaghi K, Patel A, Miller I, Levine BR. An Atypical Adverse Local Tissue Reaction After Ceramic-on-Ceramic Primary Total Hip Arthroplasty. Arthroplast Today 2022; 14:71-75. [PMID: 35252509 PMCID: PMC8889265 DOI: 10.1016/j.artd.2022.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/11/2021] [Accepted: 01/15/2022] [Indexed: 11/14/2022] Open
Abstract
Adverse local tissue reaction is an uncommon but frequently described complication after total hip arthroplasty (THA). It is most often associated with metal-on-metal hips and less frequently with metal-on-polyethylene implants as part of a mechanically assisted crevice corrosion process. In this report, we describe a rare case of an atypical adverse local tissue reaction in a patient with a ceramic-on-ceramic THA. Abrasive backside liner wear from a prominent screw head, failure of the liner locking mechanism, and liner fragmentation secondary to component-component impingement created an atypical mass and fluid collection leading to THA failure. This case demonstrates the importance of appropriate cup-liner positioning, thorough workup of pain after THA, and the ability of ceramic debris to cause an associated, atypical adverse local tissue reaction.
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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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Personalized Hip Joint Replacement with Large Diameter Head: Current Concepts. J Clin Med 2022; 11:jcm11071918. [PMID: 35407525 PMCID: PMC9000212 DOI: 10.3390/jcm11071918] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 02/05/2023] Open
Abstract
Hip arthroplasty is a common procedure in elective orthopaedic surgery that has excellent outcomes. Hip replacement surgery aims to create a “forgotten” joint, i.e., a pain-free joint akin to a native articulation. To achieve such goals, hip arthroplasty must be personalised. This is achieved by restoring: the centre of rotation of the native hip; leg length equality; femoral offset; femoral orientation; soft tissue tension; joint stability with an unrestricted hip range of motion; and having appropriate stress transfer to the bone. In addition, the whole pathway should provide an uneventful and swift postoperative recovery and lifetime implant survivorship with unrestricted activities. At our institution, the preferred option is a personalized total hip arthroplasty (THA) with a large diameter head (LDH) using either monobloc or dual-mobility configuration for the acetabular component. LDH THA offers an impingement-free range of motion and a reduced risk of dislocation. The larger head-neck offset allows for a supraphysiologic range of motion (ROM). This can compensate for a patient’s abnormal spinopelvic mobility and surgical imprecision. Additionally, LDH bearing with a small clearance exerts a high suction force, which provides greater hip micro-stability. With appropriate biomechanical reconstruction, LDH THA can restore normal gait parameters. This results in unrestricted activities and higher patient satisfaction scores. We use LDH ceramic on ceramic for our patients with a life expectancy of more than 20 years and use LDH dual mobility bearings for all others.
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Snyder MJ, Weber MA, Kromka JJ, Sims MM, Smith CN, Daji AV, Kumar D, Borrero CG, Cordle AC, DiGioia AM, Hamlin BR, Plakseychuk AY, Urish KL. Predictors of Adverse Local Tissue Reaction in a High-Risk Population. Arthroplast Today 2022; 13:125-129. [PMID: 35106348 PMCID: PMC8784296 DOI: 10.1016/j.artd.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/30/2021] [Accepted: 12/15/2021] [Indexed: 11/08/2022] Open
Abstract
Background Adverse local tissue reaction (ALTR) is a recognized complication of total hip arthroplasty (THA) with metal-on-polyethylene (MoP) bearing surface implants. Specific models of THA implants have been identified as having a higher incidence of ALTR. The purpose of this study is to determine if serum metal levels, patient symptoms, implant factors, and imaging findings can be predictive of ALTR within this high-risk population. Methods We retrospectively reviewed an observational cohort of 474 patients who underwent MoP THA and were at increased risk of having ALTR. Patients were stratified based on the presence or absence of ALTR. Patient symptoms, serum metal ions, implant head offset, and imaging findings were compared. Results Patients with ALTR were more likely to be symptomatic (52.9% vs 9.9%, P < .0001). The presence of ALTR was associated with significantly higher serum cobalt and chromium levels (6.2 ppb vs 3.6 ppb, P < .0001; 2.3 ppb vs 1.2 ppb, P < .0001). Head offsets greater than 4 mm were associated with a higher prevalence of ALTR (53% vs 38%, P = .05). On metal artifact reduction sequence magnetic resonance imaging, patients with ALTR had larger effusions (4.7 cm vs 2.1 cm, P < .001) and a higher incidence of trochanteric bursitis (47% vs 16%, P < .001). Conclusions In high-risk MoP implants, serum cobalt and chromium levels are elevated, even in patients without ALTR. A larger femoral head offset is a risk factor for the development of ALTR. Our study suggests that patients presenting with painful THA and elevated metal ions require risk stratification based on patient symptoms, metal artifact reduction sequence magnetic resonance imaging findings, and implant factors.
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29
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Ishida T, Tateiwa T, Takahashi Y, Nishikawa Y, Shishido T, Masaoka T, Yamamoto K. Adverse Tissue Reactions and Metal Ion Behavior After Small-Head Metasul Hip Arthroplasty: A Long-Term Follow-Up Study. Orthop Surg 2021; 14:264-273. [PMID: 34910382 PMCID: PMC8867442 DOI: 10.1111/os.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/10/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the long‐term survivorship, incidence of adverse reactions to metal debris (ARMD), and metal ion behavior in patients who underwent small‐head Metasul metal‐on‐metal (MoM) total hip arthroplasty (THA). Methods Between February 1998 and September 2003, a retrospective study was performed on 43 consecutive patients (43 hips) who underwent unilateral cementless Metasul MoM THAs at our institution. Of them, 35 patients (nine males and 26 females) who were available for follow‐up more than 15 years after THA were enrolled in this study and underwent metal artifact reduction sequence magnetic resonance imaging (MARS‐MRI) to identify ARMD. The mean age at surgery of the patients was 59.7 years old (range, 31–83). Clinical and radiographic outcomes were evaluated retrospectively. Clinical examinations were conducted using the Harris Hip Score (HHS). Serum cobalt (Co) and chromium (Cr) ion levels and Co/Cr ratio were assessed at different postoperative periods of <5, 5–10, 11–14, and ≥15 years. Results The mean follow‐up period for the 35 patients included was 18.1 years (range, 15–22). The mean HHS significantly improved from 44.6 ± 11.3 points preoperatively to 89.4 ± 7.9 points at the final follow‐up (P < 0.0001). ARMD was found in 20% of the patients using MARS‐MRI. No signs of stem loosening were found clinically or radiographically, whereas cup loosening and ARMD were observed in three patients (9%), for whom revision THAs were performed. The Kaplan–Meier survival rates with revision for any reason as the endpoint were 90.9% at 5 years, 84.8% at 10 years, 84.8% at 15 years (95% CI, 67.1–93.6), and 70.3% at 20 years (95% CI, 43.6–87.0). The survival rates with revision for ARMD as the endpoint were 100% at 5 years, 96.6% at 10 years, 96.6% at 15 years (95% CI, 77.2–99.7), and 80.1% at 20 years (95% CI, 45.3–95.2). Serum Co ion level peaked at 5–10 years after THA, which was significantly higher than that <5 years; however, it decreased to the initial level after 15 years. In contrast, serum Cr ion level significantly increased at 5–10 years and then remained almost constant. Significant differences in Cr ion levels (1.0 vs 2.0 μg/L, P = 0.024) and Co/Cr ratio (1.3 vs 0.9, P = 0.037) were found between non‐ARMD and ARMD patients at >11 years postoperatively. Conclusion Our results suggest that increased Cr ion levels and decreased Co/Cr ratio may be signs of ARMD in patients who underwent small‐head Metasul MoM THA.
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Affiliation(s)
- Tsunehito Ishida
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasuhito Takahashi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.,Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Tokyo, Japan
| | - Yohei Nishikawa
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takaaki Shishido
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshinori Masaoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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Hersnaes PN, Gromov K, Otte KS, Gebuhr PH, Troelsen A. Harris Hip Score and SF-36 following metal-on-metal total hip arthroplasty and hip resurfacing - a randomized controlled trial with 5-years follow up including 75 patients. BMC Musculoskelet Disord 2021; 22:781. [PMID: 34511090 PMCID: PMC8436430 DOI: 10.1186/s12891-021-04671-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background The metal-on-metal large-diameter-head (MoM-LDH) hip replacements increased in popularity during the start of the twenty-first century. Subsequently reports raised concerns regarding adverse reactions due to elevated chromium (Cr) and cobalt (Co) concentrations as well as high rates of other complications and revisions. The purpose was to compare Harris Hip Score and SF-36 at 5-years follow up following MoM-LDH total hip arthroplasty (MoM-LDH-THA) or MoM hip resurfacing (MoM-HR). Methods The study was conducted between November 2006 to January 2012 in a tertiary health care center in Denmark. Patients with primary or secondary osteoarthritis were randomly assigned to receive a Magnum (MoM-LDH-THA) or a Recap (MoM-HR) prosthesis. Randomization was computer generated and allocation was concealed in an opaque envelope. Neither patients nor care provider were blinded. Primary outcome was Harris Hip Score at 5-years follow up. Results Seventy-five were included and allocated to the MoM-LDH-THA (n = 39) and MoM-HR (n = 36) group. The study was prematurely stopped due to numerous reports of adverse events in patients with MoM hip replacements. Thirty-three in the MoM-LDH-THA and 25 in the MoM-HR group were available for primary outcome analysis. Median Harris Hip Score was 100 (IQR: 98–100) for MoM-LDH-THA and 100 (IQR: 93–100) for MoM-HR (p = 0.486). SF-36 score was high in both groups with no significant difference between groups. Conclusion Harris Hip Score and SF-36 score was excellent in both groups with no significant difference at 5-years follow up. Our findings suggest that there is no clinical important difference between the two prostheses implanted 5 years after implantation. Trial registration ClinicalTrials.gov, NCT04585022, Registered 23 September 2020 – Retrospectively registered. This study was not prospectively registered in a clinical trial database since it was not an entirely implemented standard procedure in the international orthopedic society when the study was planned.
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Affiliation(s)
- Peter Nyby Hersnaes
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kristian Stahl Otte
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Peter Henrik Gebuhr
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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McCarthy SM, Hall DJ, Mathew MT, Jacobs JJ, Lundberg HJ, Pourzal R. Are Damage Modes Related to Microstructure and Material Loss in Severely Damaged CoCrMo Femoral Heads? Clin Orthop Relat Res 2021; 479:2083-2096. [PMID: 34019490 PMCID: PMC8373544 DOI: 10.1097/corr.0000000000001819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/19/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fretting and corrosion in metal-on-polyethylene total hip arthoplasty (THA) modular junctions can cause adverse tissue reactions that are responsible for 2% to 5% of revision surgeries. Damage within cobalt-chromium-molybdenum (CoCrMo) alloy femoral heads can progress chemically and mechanically, leading to damage modes such as column damage, imprinting, and uniform fretting damage. At present, it is unclear which of these damage modes are most detrimental and how they may be linked to implant alloy metallurgy. The alloy microstructure exhibits microstructural features such as grain boundaries, hard phases, and segregation bands, which may enable different damage modes, higher material loss, and the potential risk of adverse local tissue reactions. QUESTIONS/PURPOSES In this study, we asked: (1) How prevalent is chemically dominated column damage compared with mechanically dominated damage modes in severely damaged metal-on-polyethylene THA femoral heads made from wrought CoCrMo alloy? (2) Is material loss greater in femoral heads that underwent column damage? (3) Do material loss and the presence of column damage depend on alloy microstructure as characterized by grain size, hard phase content, and/or banding? METHODS Surgically retrieved wrought CoCrMo modular femoral heads removed between June 2004 and June 2019 were scored using a modified version of the Goldberg visually based scoring system. Of the total 1002 heads retrieved over this period, 19% (190 of 1002) were identified as severely damaged, exhibiting large areas of fretting scars, black debris, pits, and/or etch marks. Of these, 43% (81 of 190) were excluded for metal-on-metal articulations, alternate designs (such as bipolar, dual-mobility, hemiarthroplasty, metal adaptor sleeves), or previous sectioning of the implant for past studies. One sample was excluded retroactively as metallurgical analysis revealed that it was made of cast alloy, yielding a total of 108 for further analysis. Information on patient age (57 ± 11 years) and sex (56% [61 of 108] were males), reason for removal, implant time in situ (99 ± 78 months), implant manufacturer, head size, and the CoCrMo or titanium-based stem alloy pairing were collected. Damage modes and volumetric material loss within the head tapers were identified using an optical coordinate measuring machine. Samples were categorized by damage mode groups by column damage, imprinting, a combination of column damage and imprinting, or uniform fretting. Metallurgical samples were processed to identify microstructural characteristics of grain size, hard phase content, and banding. Nonparametric Mann-Whitney U and Kruskal-Wallis statistical tests were used to examine volumetric material loss compared with damage mode and microstructural features, and linear regression was performed to correlate patient- and manufacturer-specific factors with volumetric material loss. RESULTS Chemically driven column damage was seen in 48% (52 of 108) of femoral heads, with 34% (37 of 108) exhibiting a combination of column damage and imprinting, 12% (13 of 108) of heads displaying column damage and uniform fretting, and 2% (2 of 108) exhibiting such widespread column damage that potentially underlying mechanical damage modes could not be verified. Implants with column damage showed greater material loss than those with mechanically driven damage alone, with median (range) values of 1.2 mm3 (0.2 to 11.7) versus 0.6 mm3 (0 to 20.7; p = 0.03). Median (range) volume loss across all femoral heads was 0.9 mm3 (0 to 20.7). Time in situ, contact area, patient age, sex, head size, manufacturer, and stem alloy type were not associated with volumetric material loss. Banding of the alloy microstructure, with a median (range) material loss of 1.1 mm3 (0 to 20.7), was associated with five times higher material loss compared with those with a homogeneous microstructure, which had a volume loss of 0.2 mm3 (0 to 4.1; p = 0.02). Hard phase content and grain size showed no correlation with material loss. CONCLUSION Chemically dominated column damage was a clear indicator of greater volume loss in this study sample of 108 severely damaged heads. Volumetric material loss strongly depended on banding (microstructural segregations) within the alloy. Banding of the wrought CoCrMo microstructure should be avoided during the manufacturing process to reduce volumetric material loss and the release of corrosion products to the periprosthetic tissue. CLINICAL RELEVANCE Approximately 30% of THAs rely on wrought CoCrMo femoral heads. Most femoral heads in this study exhibited a banded microstructure that was associated with larger material loss and the occurrence of chemically dominated column damage. This study suggests that elimination of banding from the alloy could substantially reduce the release of implant debris in vivo, which could potentially also reduce the risk of adverse local tissue reactions to implant debris.
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Affiliation(s)
| | - Deborah J. Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Joshua J. Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hannah J. Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Ishida T, Tateiwa T, Takahashi Y, Takahashi RH, Sano K, Shishido T, Masaoka T, Yamamoto K. IL-17A-Mediated Immune-Inflammatory Periarticular Mass and Osteolysis From Impingement in Ceramic-On-Ceramic Total Hip Arthroplasty. Arthroplast Today 2021; 11:15-19. [PMID: 34409142 PMCID: PMC8361011 DOI: 10.1016/j.artd.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/27/2022] Open
Abstract
We present a rare case of symptomatic adverse local tissue reaction in a 54-year-old female patient who had undergone total hip arthroplasty with ceramic-on-ceramic bearing. Inflammatory periarticular mass and osteolysis developed in the absence of cobalt chrome alloy interfaces and a modular neck component. On the pathologic images, there was no clear evidence of gross metal staining of tissues, metal corrosion, and ceramic or metal wear particles. However, there were impingement scars on the titanium alloy femoral neck and acetabular cup associated with a high combined anteversion angle of 75° (stem: 40° and cup: 35°), suggesting titanium debris release in vivo. Immunohistochemical staining proved a predominant infiltration of CD4+ T cells and the corresponding IL-17A response to metal. We conclude that neck-rim impingement may lead to the development of adverse local tissue reaction (periarticular mass and osteolysis) due to a metal hypersensitivity with the production of proinflammatory cytokines (IL-17A) by CD4+ T cells even in ceramic-on-ceramic total hip arthroplasty.
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Affiliation(s)
- Tsunehito Ishida
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yasuhito Takahashi
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.,Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Reisuke H Takahashi
- Department of Anatomic Pathology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Keiji Sano
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takaaki Shishido
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Toshinori Masaoka
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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Pagani NR, LeRoy TE, Menendez ME, Stoker GE, Lococo DV, Nairus JG. Gross Trunnion Failure of a Type 1 Taper After Metal-on-Polyethylene Total Hip Arthroplasty: A Report of 2 Cases. JBJS Case Connect 2021; 11:01709767-202106000-00133. [PMID: 34166254 DOI: 10.2106/jbjs.cc.21.00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CASE We describe 2 cases of gross trunnion failure (GTF) in males with Centers for Disease Control and Prevention Class 3 obesity 10 years after metal-on-polyethylene total hip arthroplasty (THA) with a titanium-alloy femoral stem and Type 1 taper. One patient received a large diameter cobalt-chromium femoral head, whereas the other received a smaller diameter head, both with high-offset femoral stems. CONCLUSION This is the first report of GTF involving the Echo Bi-Metric femoral stem after metal-on-polyethylene THA, and surgeons should consider the potential complication of GTF when using this specific femoral stem with metal heads in obese male patients.
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Affiliation(s)
- Nicholas R Pagani
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
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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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Radiographic Risk Factors Associated With Adverse Local Tissue Reaction in Head-Neck Taper Corrosion of Primary Metal-on-Polyethylene Total Hip Arthroplasty. J Am Acad Orthop Surg 2021; 29:353-360. [PMID: 32796372 DOI: 10.5435/jaaos-d-20-00473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/05/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adverse local tissue reactions (ALTRs) in metal-on-polyethylene (MoP) total hip arthroplasty (THA) with head-neck taper corrosion are multifactorial, involving implant and patient factors. This study aimed to identify any potential clinical risk factors associated with failed MoP THA due to head-neck taper corrosion. METHODS A series of 146 MoP THA patients was investigated: (1) ALTR (n = 42) on metal artifact sequence MRI and (2) non-ALTR (n = 104). Both cohorts were compared regarding femoral neck shaft angle, acetabular implant orientation, component size, femoral head offset, measurement of medial and vertical femoral offsets, and femoral stem alloy. RESULTS The occurrence of ALTR was associated with increased radiographic femoral stem offset (36.0 ± 7.7 mm versus 40.8 ± 7.3 mm, P = 0.008), increased femoral head offset (0.7 ± 3.4 versus 4.5 ± 3.7, P < 0.001), and the use of Ti-12Mo-6Zr-2Fe alloy stems (P = 0.041). The presence of ALTR was notably associated with higher chromium (2.0 versus 0.5 μg/L) and cobalt (7.4 versus 0.7 μg/L, P < 0.001). DISCUSSION This study identified increased femoral head and stem offset and the use of Ti-12Mo-6Zr-2Fe alloy stems as risk factors for clinically relevant ALTR due to head-neck taper corrosion in MoP THA patients. This provides evidenced-based practical information for surgeons in identifying "at-risk" symptomatic MoP THA patients with head-neck taper corrosion for systematic risk stratification.
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"Off-label" Usage of an Oxidized Zirconium Femoral Head in Revision of a Total Hip Arthroplasty with Mechanically Assisted Crevice Corrosion and a Legacy Taper. Arthroplast Today 2021; 8:69-73. [PMID: 33681438 PMCID: PMC7930501 DOI: 10.1016/j.artd.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 11/22/2022] Open
Abstract
We present a case of a 72-year-old male with a history of a late 1980s metal-on-polyethylene total hip arthroplasty who presented with unilateral leg vascular compromise, joint pain, and stiffness and subsequently underwent revision for adverse local tissue reaction secondary to mechanically assisted crevice corrosion. His stable and extensively porous coated femoral implant had a legacy taper with no currently manufactured option for a non–Co-alloy femoral head. After shared decision-making with the patient, we opted to use an oxidized zirconium femoral head from another manufacturer with a similar taper during his revision surgery and documented that his vascular compromise resolved and his serum Co was undetectable 3 years after the revision.
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Baker E, French C, Brian P, Thomas J, Davis CM. Impending Trunnion Failure: An Uncommon Radiographic Presentation of Total Hip Arthroplasty Failure. Arthroplast Today 2021; 7:230-234. [PMID: 33614874 PMCID: PMC7878964 DOI: 10.1016/j.artd.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/17/2023] Open
Abstract
Trunnionosis is emerging as an early mode of failure in conventional metal-on-polyethylene total hip arthroplasty. It is defined as wear or corrosion at the trunnion, the taper at the femoral head-neck interface. Trunnion wear can result in a variety of negative sequelae and, in severe cases, necessitate revision arthroplasty. We describe a 64-year-old man with a metal-on-polyethylene total hip arthroplasty who presented with a sensation of clunking in the hip. Initial imaging and laboratory studies were inconclusive, and the decision was made to monitor. Two years later, trunnion wear was detected on radiographs, presenting as an abnormal alignment of the femoral neck relative to the femoral head. Several case reports and series describe catastrophic total hip arthroplasty failure due to trunnionosis. However, few describe the radiographic signs of wear at the trunnion before gross failure. This early presentation is important to recognize to minimize patient morbidity and aid surgical planning.
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Affiliation(s)
- Emma Baker
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Corresponding author. 500 University Dr, Hershey, PA 17033, USA. Tel.: +1 240 620 6937.
| | - Cristy French
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Pamela Brian
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jonelle Thomas
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Charles M. Davis
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Tsai CE, Hung J, Hu Y, Wang DY, Pilliar RM, Wang R. Improving fretting corrosion resistance of CoCrMo alloy with TiSiN and ZrN coatings for orthopedic applications. J Mech Behav Biomed Mater 2020; 114:104233. [PMID: 33302168 DOI: 10.1016/j.jmbbm.2020.104233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
Total hip replacement is the most effective treatment for late stage osteoarthritis. However, adverse local tissue reactions (ALTRs) have been observed in patients with modular total hip implants. Although the detailed mechanisms of ALTRs are still unknown, fretting corrosion and the associated metal ion release from the CoCrMo femoral head at the modular junction has been reported to be a major factor. The purpose of this study is to increase the fretting corrosion resistance of the CoCrMo alloy and the associated metal ion release by applying hard coatings to the surface. Cathodic arc evaporation technique (arc-PVD) was used to deposit TiSiN and ZrN hard coatings on CoCrMo substrates. The morphology, chemical composition, crystal structures and residual stress of the coatings were characterized by scanning electron microscopy, energy dispersive X-ray spectroscopy, and X-ray diffractometry. Hardness, elastic modulus, and adhesion of the coatings were measured by nano-indentation, nano-scratch test, and the Rockwell C test. Fretting corrosion resistance tests of coated and uncoated CoCrMo discs against Ti6Al4V spheres were conducted on a four-station fretting testing machine in simulated body fluid at 1Hz for 1 million cycles. Post-fretting samples were analyzed for morphological changes, volume loss and metal ion release. Our analyses showed better surface finish and lower residual stress for ZrN coating, but higher hardness and better scratch resistance for TiSiN coating. Fretting results demonstrated substantial improvement in fretting corrosion resistance of CoCrMo with both coatings. ZrN and TiSiN decreased fretting volume loss by more than 10 times and 1000 times, respectively. Both coatings showed close to 90% decrease of Co ion release during fretting corrosion tests. Our results suggest that hard coating deposition on CoCrMo alloy can significantly improve its fretting corrosion resistance and could thus potentially alleviate ALTRs in metal hip implants.
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Affiliation(s)
- Chen-En Tsai
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - James Hung
- Aurora Scientific Corp., Richmond BC, Canada
| | - Youxin Hu
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | - Robert M Pilliar
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Rizhi Wang
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada.
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Gosling OB, Ferreri TG, Khoshbin A, Whitehouse MR, Atrey A. A systematic review and meta-analysis of survivorship and wear rates of metal and ceramic heads articulating with polyethylene liners in total hip arthroplasty. Hip Int 2020; 30:761-774. [PMID: 32933331 DOI: 10.1177/1120700019866428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The major joint registries report better survivorship for ceramic on polyethylene over metal on polyethylene bearings in total hip arthroplasty and it is generally accepted that this is due to a lower polyethylene wear rate. We used evidence synthesis to compare survivorship, polyethylene wear rates and metal ion levels for metal-on-polyethylene (MoP) and ceramic-on-polyethylene (CoP) bearings. If wear rates are not dissimilar in vivo this difference in revision rate may have another cause. Modular junctions are a potential source of corrosion and it is postulated that this may result in higher revision rates. METHODS We performed a systematic review and meta-analysis comparing the survivorship of MoP and CoP bearings. Odds ratio (95% CI) of revision was calculated. Mean difference (MD) and 95% confidence intervals (CI) were used to compare secondary outcomes of polyethylene wear and metal ion levels. Meta-analysis was performed with a Mantel-Haenszel Random-Effects Model. RESULTS 6 randomised controlled trials were included. There was no statistically significant difference between MoP and CoP revision rate (OR 1.04; 95% CI, 0.37-2.90, I2 = 0%, p = 0.94), linear bearing wear (MD 0.00 mm; 95% CI, -0.05 -0.05, I2 = 98%, p = 0.90), nor volumetric bearing wear (MD 33.57 mm3; 95% CI, -215.56-282.70, I2 = 98%, p = 0.79). No studies evaluated metal ion levels. CONCLUSIONS We found no evidence of a difference in revision rates nor linear and volumetric wear between MoP and CoP bearings in the randomised controlled trials currently available. Our study therefore does not advocate the additional cost associated with the use of ceramic heads in combination with polyethylene bearings in order to minimise revision rates. This contrasts the findings of in vitro studies and the major joint registries.
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Affiliation(s)
- Oliver B Gosling
- Avon Orthopaedic Centre, Brunel Building, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Thomas G Ferreri
- Department of Emergency Medicine, Central Michigan University College of Medicine, MI, USA
| | - Amir Khoshbin
- St Michaels Hospital, Toronto, Canada.,Faculty of Surgery, University of Toronto, Canada
| | - Michael R Whitehouse
- Avon Orthopaedic Centre, Brunel Building, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, School of Clinical Sciences, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| | - Amit Atrey
- St Michaels Hospital, Toronto, Canada.,Faculty of Surgery, University of Toronto, Canada
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van Doesburg PG, van Langelaan EJ, Apachitei I, Bénard MR, Verdegaal SHM. Femoral prosthesis neck fracture following total hip arthroplasty - a systematic review. ARTHROPLASTY 2020; 2:28. [PMID: 35236443 PMCID: PMC8796592 DOI: 10.1186/s42836-020-00047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Head-neck modularity was introduced into total hip arthroplasty to provide more intraoperative surgical options. However, modularity led to new problems, such as trunnionosis and fractures of the femoral prosthesis neck. The purpose of this study was to identify risk factors for hip neck fractures and to provide recommendations to prevent damage and fractures of the neck. METHODS A systematic review of the literature was performed according to the PRISMA guidelines. RESULTS Thirty-three case studies were included. Methodologically, most included studies were of moderate or good quality. The 80 neck fractures included in the review took place, on average, 7 years after stem placement. Male gender, high body weight, obesity, previous revision surgery, mixing components from different manufacturers, use of long skirted heads, cobalt-chromium (large size) heads were identified as potential risk factors. CONCLUSION Hip neck fractures occur on average 7 years after stem placement. The etiology of hip neck fractures is multifactorial. This review revealed several preventable implant- and surgeon-related risk factors.
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Affiliation(s)
- P G van Doesburg
- Department of Orthopaedic Surgery, Alrijne Hospital Leiderdorp, Simon Smitweg 1, 2353GA, Leiderdorp, The Netherlands.
| | - E J van Langelaan
- Biomechanical Engineering Department Biomaterials & Tissue Biomechanics Section, Delft University of Technology, Delft, The Netherlands
| | - I Apachitei
- Biomechanical Engineering Department Biomaterials & Tissue Biomechanics Section, Delft University of Technology, Delft, The Netherlands
| | - M R Bénard
- Department of Orthopaedic Surgery, Alrijne Hospital Leiderdorp, Simon Smitweg 1, 2353GA, Leiderdorp, The Netherlands
| | - S H M Verdegaal
- Department of Orthopaedic Surgery, Alrijne Hospital Leiderdorp, Simon Smitweg 1, 2353GA, Leiderdorp, The Netherlands
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Corrosion Concerns? Trends in Metal-on-Polyethylene Total Hip Arthroplasty Revision Rates and Comparisons Against Ceramic-on-Polyethylene up to 10 Years of Follow-Up. J Arthroplasty 2020; 35:2919-2925. [PMID: 32475785 DOI: 10.1016/j.arth.2020.05.007] [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] [Received: 01/11/2020] [Revised: 04/10/2020] [Accepted: 05/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We compared the revision risk between metal-on-polyethylene (MOP) and ceramic-on-polyethylene (COP) total hip arthroplasty patients and evaluated temporal changes in short-term revision risks for MOP patients. METHODS Primary MOP (n = 9480) and COP (n = 3620) total hip arthroplasties were evaluated from the Medicare data set (October 2005 to December 2015) for revision risk, with up to 10 years of follow-up using multivariate analysis. Temporal change in the short-term revision risk for MOP was evaluated (log-rank and Wilcoxon tests). RESULTS Revision incidence was 3.8% for COP and 4.3% for MOP. MOP short-term revision risk did not change over time (P ≥ .844 at 1 year and .627 at 2 years). Dislocation was the most common reason for revision (MOP: 23.5%; COP: 24.8%). Overall adjusted revision risks were not different between MOP and COP up to 10 years of follow-up (P ≥ .181). CONCLUSIONS Concerns with corrosion for metal heads do not appear to result in significantly elevated revision risk for MOP at up to 10 years. Corrosion does not appear as a primary reason for revision compared to other mechanisms.
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Widmer KH. The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components. Clin Orthop Relat Res 2020; 478:1904-1918. [PMID: 32732575 PMCID: PMC7371099 DOI: 10.1097/corr.0000000000001233] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lewinnek's recommendation for orienting the cup in THA is criticized because it involves a static assessment of the safe zone and because it does not consider stem geometry. A revised concept of the safe zone should consider those factors, but to our knowledge, this has not been assessed. QUESTIONS/PURPOSES (1) To determine the shape, size, and location of target zones for combined cup and stem orientation for a straight stem/hemispheric cup THA to maximize the impingement-free ROM and (2) To determine whether and how these implant positions change as stem anteversion, neck-shaft angle, prosthetic head size and target range of movements are varied. METHODS A three-dimensional computer-assisted design model, in which design geometry was expressed in terms of parameters, of a straight stem/hemispheric cup hip prosthesis was designed, its design parameters modified systematically, and each prosthesis model was implanted virtually at predefined component orientations. Functional component orientation referencing to body planes was used: cups were abducted from 20° to 70°, and anteverted from -10° to 40°. Stems were rotated from -10° to 40° anteversion, neck-shaft angles varied from 115° to 143°, and head sizes varied from 28 to 40 mm. Hip movements up to the point of prosthetic impingement were tested, including simple flexion/extension, internal/external rotation, ab/adduction, combinations of these, and activities of daily living that were known to trigger dislocation. For each combination of parameters, the impingement-free combined target zone was determined. Maximizing the size of the combined target zone was the optimization criterion. RESULTS The combined target zones for impingement-free cup orientation had polygonal boundaries. Their size and position in the diagram changed with stem anteversion, neck-shaft angle, head size, and target ROM. The largest target zones were at neck-shaft angles from 125° to 127°, at stem anteversions from 10° to 20°, and at radiographic cup anteversions between 17° and 25°. Cup anteversion and stem anteversion were inverse-linearly correlated supporting the combined-anteversion concept. The range of impingement-free cup inclinations depended on head size, stem anteversion, and neck-shaft angle. For a 127°-neck-shaft angle, the lowest cup inclinations that fell within the target zone were 42° for the 28-mm and 35° for the 40-mm head. Cup anteversion and combined version depended on neck-shaft angle. For head size 32-mm cup, anteversion was 6° for a 115° neck-shaft angle and 25° for a 135°-neck-shaft angle, and combined version was 15° and 34° respectively. CONCLUSIONS The shape, size, and location of the combined target zones were dependent on design and implantation parameters of both components. Changing the prosthesis design or changing implantation parameters also changed the combined target zone. A maximized combined target zone was found. It is mandatory to consider both components to determine the accurate impingement-free prosthetic ROM in THA. CLINICAL RELEVANCE This study accurately defines the hypothetical impingement-free, design-specific component orientation in THA. Transforming it into clinical precision may be the case for navigation and/or robotics, but this is speculative, and as of now, unproven.
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Affiliation(s)
- Karl-Heinz Widmer
- K.-H. Widmer, Medical Faculty University of Basel, Basel, Switzerland
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43
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Dover C, Kuiper JH, Craig P, Shaylor P. Ten years on: increased metal ion levels in a cohort of patients who underwent uncemented metal-on-polyethylene total hip arthroplasty. Bone Joint J 2020; 102-B:832-837. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1372.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We have previously demonstrated raised cobalt and chromium levels in patients with larger diameter femoral heads, following metal-on-polyethylene uncemented total hip arthroplasty. Further data have been collected, to see whether these associations have altered with time and to determine the long-term implications for these patients and our practice. Methods Patients from our previous study who underwent Trident-Accolade primary total hip arthroplasties using a metal-on-polyethylene bearing in 2009 were reviewed. Patients were invited to have their cobalt and chromium levels retested, and were provided an Oxford Hip Score. Serum ion levels were then compared between groups (28 mm, 36 mm, and 40 mm heads) and over time. Results Metal ion levels were repeated in 33 patients. When comparing the results of serum metal ion levels over time, regardless of head size, there was a significant increase in both cobalt and chromium levels (p < 0.001). Two patients with larger head sizes had undergone revision arthroplasty with evidence of trunnion damage at surgery. Two patients within the 40 mm subgroup had metal ion levels above the MHRA (Medicines and Healthcare Products Regulatory Agency) threshold for detailed investigation. The increase in cobalt and chromium, when comparing the 36 mm and 40 mm groups with those of the 28 mm group, was not significant (36 mm vs 28 mm; p = 0.092/p = 0.191; 40 mm vs 28 mm; p = 0.200/p = 0.091, respectively). There was no difference, between femoral head sizes, when comparing outcome as measured by the Oxford Hip Score. Conclusion This study shows an increase in cobalt and chromium levels over time for all modular femoral head sizes in patients with metal-on-polyethylene bearings, with two patients demonstrating ion levels above the MHRA threshold for failure, and a further two patients requiring revision surgery. These results may have clinical implications regarding longer term follow-up of patients and future implant choice, particularly among younger patients. Cite this article: Bone Joint J 2020;102-B(7):832–837.
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Affiliation(s)
- Caroline Dover
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Oswestry, UK
| | - Jan Herman Kuiper
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Peter Craig
- The Holland Orthopaedic and Arthritic Centre, University of Toronto, Toronto, Canada
| | - Phillip Shaylor
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Oswestry, UK
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Meek RMD, Treacy R, Manktelow A, Timperley JA, Haddad FS. Sport after total hip arthroplasty: undoubted progress but still some unknowns. Bone Joint J 2020; 102-B:661-663. [PMID: 32475237 DOI: 10.1302/0301-620x.102b6.bjj-2020-0208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this review, we discuss the evidence for patients returning to sport after hip arthroplasty. This includes the choices regarding level of sporting activity and revision or complications, the type of implant, fixation and techniques of implantation, and how these choices relate to health economics. It is apparent that despite its success over six decades, hip arthroplasty has now evolved to accommodate and support ever-increasing patient demands and may therefore face new challenges. Cite this article: Bone Joint J 2020;102-B(6):661-663.
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Affiliation(s)
| | | | | | - John A Timperley
- Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter Hip Unit, Exeter, UK
| | - Fares S Haddad
- University College London Hospitals NHS Foundation Trust, London, UK
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What Is the Risk of THA Revision for ARMD in Patients with Non-metal-on-metal Bearings? A Study from the Australian National Joint Replacement Registry. Clin Orthop Relat Res 2020; 478:1244-1253. [PMID: 32345846 PMCID: PMC7319380 DOI: 10.1097/corr.0000000000001277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are increasing reports of corrosion between the femoral head and trunnion in primary conventional THA, resulting in metal particulate release often termed trunnionosis. There may be heightened awareness of this condition because of severe soft-tissue reactions initially thought to be solely attributable to prostheses with a metal-on-metal (MoM) bearing surface. It is unclear what percentage of revisions for THA with non-MoM bearing surfaces can be attributed to trunnionosis and to what extent adverse reaction to metal debris (ARMD) seen with MoM bearings may also be seen with other bearing surfaces in THA. QUESTIONS/PURPOSES We analyzed data from a large national registry to ask: (1) What is the revision risk for the indication of ARMD in patients with conventional THA and modern non-MoM bearing surfaces such as metal or ceramic-on-cross-linked polyethylene (XLPE) or ceramic-on-ceramic? (2) What prosthesis factors are associated with an increased risk of such revision? (3) What is the relative revision risk for ARMD in THAs with large-head MoM bearings, small-head MoM bearings, and non-MoM modern bearing surfaces? METHODS The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) longitudinally maintains data on all primary and revision joint arthroplasties, with nearly 100% capture. The study population included all THAs using modern bearing surfaces (defined as metal or ceramic heads-on-XLPE and ceramic-on-ceramic bearing couples) revised because of ARMD between September 1999 and December 2018. Prostheses with modular necks were excluded. The cumulative percent revision (CPR) because of ARMD was determined. The study group consisted of 350,027 THAs with a modern bearing surface, 15,184 THAs with a large-head MoM bearing (≥ 36 mm), and 5474 THAs with a small head MoM bearing (≤ 32 mm). The patients in the group who received the modern bearing surfaces were slightly older than the patients in the groups who received the large- and small-head bearing surfaces, with a mean age 68 years (SD 12) versus a mean age 63 years (SD 12), and a mean age 62 years (SD 11), respectively. There was a higher proportion of women in the modern bearing surface group; 55% (193,312 of 350,027), compared with 43% (6497 of 15,184) in the large-head MoM group and 50% (2716 of 5474) in the small-head MoM group. The outcome measure was the CPR, which was defined using Kaplan-Meier estimates of survivorship to describe the time to the first revision for ARMD at 17 years. Hazard ratios (HR) from Cox proportional hazards models, adjusting for age and sex, were performed to compare the revision rates among groups. The registry defines a revision as a reoperation of a previous hip arthroplasty in which one or more of the prosthetic components is replaced or removed, or one or more components is added. RESULTS The CPR for ARMD for patients with a modern bearing surface at 17 years was 0.1% (95% confidence interval 0.0 to 0.1). After controlling for age and sex, we found that cobalt chrome heads, two specific prostheses (Accolade® I and M/L Taper), and head sizes ≥ 36 mm were associated with an increased risk of revision for ARMD. Metal-on-XLPE had a higher risk of revision for ARMD than ceramic-on-ceramic or ceramic-on-XLPE (HR 3.4 [95% CI 1.9 to 6.0]; p < 0.001). The Accolade 1 and the M/L Taper stems had a higher risk of revision than all other stems (HR, 8.3 [95% CI 4.7 to 14.7]; p < 0.001 and HR 14.4 [95% CI 6.0 to 34.6]; p < 0.001, respectively). Femoral stems with head sizes ≥ 36 mm had a higher rate of revision for ARMD than stems with head sizes ≤ 32 mm (HR 3.2 [95% CI 1.9 to 5.3]; p < 0.001).Large-head MoM bearings had a greater increase in revision for ARMD compared with modern bearing surfaces. The CPR for patients with a large-head MoM bearing at 17 years for ARMD was 15.5% (95% CI 14.5 to 16.6) and it was 0.1% for modern bearing surfaces (HR 340 [95% CI 264.2 to 438.0]; p < 0.001). Modern bearing surfaces likewise had a lower HR for revision for ARMD than did THAs with small-head MoM bearings, which had a 0.9% (95% CI 0.7 to 1.4) CPR compared with modern bearings from 0 to 9 years (HR 10.5 [95% CI 6.2 to 17.7]; p < 0.001). CONCLUSIONS The revision risk for ARMD with modern bearing surfaces in THA is low. The Accolade 1 and the M/L Taper stem have a higher risk of revision for ARMD and cobalt-chrome heads, and head sizes ≥ 36 mm have a higher rate of revision than ≤ 32 mm head sizes. ARMD is a rare failure mode for THA with non-MoM bearings, but in patients presenting with unexplained pain with no other obvious cause, this diagnosis should be considered and investigated further. LEVEL OF EVIDENCE Level III, therapeutic study.
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Hall DJ, Pourzal R, Jacobs JJ. What Surgeons Need to Know About Adverse Local Tissue Reaction in Total Hip Arthroplasty. J Arthroplasty 2020; 35:S55-S59. [PMID: 32005621 PMCID: PMC7239747 DOI: 10.1016/j.arth.2020.01.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/01/2023] Open
Abstract
Adverse local tissue reactions (ALTRs) were first associated with patients with failed metal-on-metal surface replacements and total hip arthroplasty (THA). However, an increasing number of cases of ALTR in metal-on-polyethylene (MOP) THA patients is being reported. Clinically, ALTR appears as benign, aseptic masses or bursae in the periprosthetic tissues. Histopathologically, ALTRs are distinguished by an intense lymphocyte infiltrate, destruction of the synovial surfaces, widespread necrosis, and fibrin exudate. Tribocorrosion of modular junctions appears to be the cause of ALTR in MOP patients. The various tribocorrosion damage modes occurring at modular junctions produce metal ions and a diversity of particulates in relation to size, chemical composition, and structure. The mechanisms by which these various products of tribocorrosion lead to ALTR are still a matter of considerable research. This review clarifies what constitutes ALTR, its relationship to implant factors, and highlights current methods for diagnosis and management of patients with ALTR in the setting of MOP THA.
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Affiliation(s)
- Deborah J Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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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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Falkenberg A, Biller S, Morlock MM, Huber G. Micromotion at the head-stem taper junction of total hip prostheses is influenced by prosthesis design-, patient- and surgeon-related factors. J Biomech 2020; 98:109424. [DOI: 10.1016/j.jbiomech.2019.109424] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/25/2019] [Accepted: 10/13/2019] [Indexed: 12/28/2022]
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Lützner J, Günther KP, Postler A, Morlock M. Metal Ion Release after Hip and Knee Arthroplasty - Causes, Biological Effects and Diagnostics. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 158:369-382. [PMID: 31820432 DOI: 10.1055/a-0929-8121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
All metal implants in human bodies corrode which results in metal ions release. This is not necessarily a problem and represents for most patients no hazard. However, if a critical metal ion concentration is exceeded, local or rarely systemic problems can occur. This article summarizes the mechanisms of metal ion release and its clinical consequences. Several situations can result in increased metal ion release: metal-on-metal hip arthroplasties with increased wear, increased micromotion at taper interfaces, direct metal-metal contact (polyethylene wear, impingement), erroneously used metal heads after ceramic head fracture. Possible problems are in most cases located close to the concerned joint. Furthermore, there are reports about toxic damage to several organs. Most of these reports refer to erroneously used metal heads in revisions after a broken ceramic head. There is currently no evidence of carcinogenic or teratogenic effects of implants but data is not sufficient to exclude possible effects. Cobalt and chromium blood levels (favorably in whole blood) should be measured in patients with suspected elevated metal ions. According to current knowledge levels below 2 µg/l seem to be uncritical, levels between 2 and 7 µg/l are considered borderline with unknown biological consequences and levels above 7 µg/l indicate a local problem which should be further diagnosed. Metal ion levels always need to be interpreted together with clinical symptoms and imaging results.
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Affiliation(s)
- Jörg Lützner
- University Center of Orthopaedics and Trauma Surgery, TU Dresden
| | | | - Anne Postler
- University Center of Orthopaedics and Trauma Surgery, TU Dresden
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Liu F, Lian C, Feng L, Wang J, Du W. The effect of femoral head size on edge loading in metal-on-metal hip joint replacement under dynamic separation conditions. J Biomed Mater Res B Appl Biomater 2019; 108:1897-1906. [PMID: 31785080 DOI: 10.1002/jbm.b.34531] [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: 04/29/2019] [Revised: 10/15/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022]
Abstract
Edge loading that occurs in hip joint replacements due to dynamic separation of the joint bearings has been shown to cause severe wear for meal-on-metal bearings. In the present study, the multibody dynamics model for metal-on-metal (MoM) hip joints with a medial-lateral translational mismatch in the centers of rotation of the cup and head has been developed to predict the dynamic separation and contact force of edge loading under gait loading conditions. The effects of larger head diameters (28-55 mm), in combination with the translational mismatch (0-4 mm) and varied cup inclination angles (45°-65°), on edge loading of MoM bearings have been computationally investigated. For the given translational mismatch, increasing head diameters results in negligible effects on the dynamic separation, contact force and severity of edge loading. Increasing head size also leads to increased offset loading torque which has been found to reach at the level that may cause cup loosening under larger translational mismatch at 4 mm. The result highlights the importance of the cup inclination angle of 45° and a lower translational mismatch to avoid severe edge loading.
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Affiliation(s)
- Feng Liu
- School of Mechanical Engineering, North University of China, Taiyuan, People's Republic of China
| | - Chao Lian
- School of Mechanical Engineering, North University of China, Taiyuan, People's Republic of China
| | - Li Feng
- MC Heavy Duty Vehicle Co., Ltd, Taiyuan, People's Republic of China
| | - Junyuan Wang
- School of Mechanical Engineering, North University of China, Taiyuan, People's Republic of China
| | - Wenhua Du
- School of Mechanical Engineering, North University of China, Taiyuan, People's Republic of China
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