1
|
Bunyoz KI, Tsikandylakis G, Mortensen K, Gromov K, Mohaddes M, Malchau H, Troelsen A. The size of the femoral head does not influence metal ion levels after metal-on-polyethylene total hip arthroplasty: a five-year report from a randomized controlled trial. Bone Joint J 2024; 106-B:31-37. [PMID: 38423094 DOI: 10.1302/0301-620x.106b3.bjj-2023-0795.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Aims In metal-on-polyethylene (MoP) total hip arthroplasty (THA), large metal femoral heads have been used to increase stability and reduce the risk of dislocation. The increased size of the femoral head can, however, lead to increased taper corrosion, with the release of metal ions and adverse reactions. The aim of this study was to investigate the relationship between the size of the femoral head and the levels of metal ions in the blood in these patients. Methods A total of 96 patients were enrolled at two centres and randomized to undergo MoP THA using either a 32 mm metal head or a femoral head of between 36 mm and 44 mm in size, being the largest possible to fit the thinnest available polyethylene insert. The levels of metal ions and patient-reported outcome measures (Oxford Hip Score, University of California, Los Angeles Activity Scale) were recorded at two and five years postoperatively. Results At five years, the median levels of chromium, cobalt, and titanium were 0.5 μg/l (interquartile range (IQR) 0.50 to 0.62), 0.24 μg/l (IQR 0.18 to 0.30), and 1.16 μg/l (IQR 1.0 to 1.68) for the 32 mm group, and 0.5 μg/l (IQR 0.5 to 0.54), 0.23 μg/l (IQR 0.17 to 0.39), and 1.30 μg/l (IQR 1 to 2.05) for the 36 mm to 44 mm group, with no significant difference between the groups (p = 0.825, p = 1.000, p = 0.558). There were increased levels of metal ions at two years postoperatively in seven patients in the 32 mm group, compared with four in the 36 mm to 44 mm group, and at five years postoperatively in six patients in the 32 mm group, compared with seven in the 36 mm to 44 mm group. There was no significant difference in either the OHS (p = 0.665) or UCLA (p = 0.831) scores between patients with or without an increased level of metal ions. Conclusion In patients who underwent MoP THA, we found no differences in the levels of metal ions five years postoperatively between those with a femoral head of 32 mm and those with a femoral head of between 36 mm and 44 mm, and no corrosion-related revisions. As taper corrosion can start after five years, there remains a need for longer-term studies investigating the relationship between the size of the femoral head size and corrosion in patients undergoing MoP THA.
Collapse
Affiliation(s)
- Kristine I Bunyoz
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Georgios Tsikandylakis
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Mortensen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maziar Mohaddes
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Malchau
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Harris Orthopaedic Laboratory, Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| |
Collapse
|
2
|
Rainey JP, Gililland JM, Peters CL, Archibeck MJ, Anderson LA, Pelt CE. Metallosis and Corrosion Associated With Revision Total Knee Arthroplasties With Metaphyseal Sleeves. Arthroplast Today 2023; 22:101167. [PMID: 37521734 PMCID: PMC10372174 DOI: 10.1016/j.artd.2023.101167] [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: 03/25/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 08/01/2023] Open
Abstract
Metallosis and corrosion have been associated with metal-on-metal and modular total hip arthroplasty but are rarely described in the setting of primary or revision total knee arthroplasty (TKA). In this series, we report on cases of metallosis due to mechanically assisted crevice corrosion at modular junctions of machined trunnion-bore tapers in a revision TKA system with metaphyseal sleeves. The unique design of metal modular junctions used in sleeve-based revision TKA, along with potential patient and surgical factors, may predispose these designs to fretting, corrosion, and adverse reaction to metal debris. We now consider metallosis and corrosion in the workup of painful or failed revision TKAs with sleeves. Future studies that investigate the incidence of this phenomenon may be warranted.
Collapse
Affiliation(s)
| | | | | | | | | | - Christopher E. Pelt
- Corresponding author. 590 Wakara Way, Salt Lake City, UT 84108, USA. Tel.: +1 801 703 4046.
| |
Collapse
|
3
|
Bunyoz KI, Tsikandylakis G, Mortensen K, Gromov K, Mohaddes M, Malchau H, Troelsen A. No difference in whole-blood metal ions between 32-mm and 36- to 44-mm femoral heads in metal-on-polyethylene total hip arthroplasty: a 2-year report from a randomised control trial. Hip Int 2023; 33:184-192. [PMID: 34102902 DOI: 10.1177/11207000211022623] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To investigate the effect of femoral head size on blood metal-ion levels caused by taper corrosion in metal-on-polyethylene total hip arthroplasty, comparing 36- to 44-mm heads with 32-mm heads. METHODS In a randomised, controlled, single-blinded trial, 96 patients were allocated to receive either a 32-mm metal head or the largest possible metal head (36-44 mm) that could be accommodated in the thinnest available vitamin E, cross-linked polyethylene insert. Blood metal ion levels were collected at 1- and 2-year follow-ups. RESULTS At 1-year, metal-ion levels did not differ between the groups. The median (interquartile range) blood-ion levels for the 32-mm versus the 36- to 44-mm group were 0.11 µg/L (0.08-0.15) versus 0.12 µg/L (0.08-0.22), p = 0.546, for cobalt, 0.50 µg/L (0.50-0.59) versus 0.50 µg/L (0.50-1.20), p = 0.059, for chromium and 1.58 µg/L (1.38-2.05) versus 1.48 µg/L (1.14-1.87), p = 0.385, for titanium. At 2 years, there was no difference either and the corresponding values were 0.15 µg/L (0.12-0.24) versus 0.18 µg/L (0.12-0.28), p = 0.682 for cobalt, 0.50 µg/L (0.50-0.50) versus 0.50 µg/L (0.50-0.57), p = 0.554, for chromium and 1.54 µg/L (1.16-1.87) versus 1.42 µg/L (1.01-1.72), p = 0.207 for titanium. CONCLUSIONS The use of the largest possible metal head (36-44 mm) compared to a 32-mm head in metal-on-polyethylene bearings does not appear to elevate blood metal-ion levels up to 2 years postoperatively. As taper corrosion is probably time-dependent, longer-term reports are needed to evaluate the association between large metal heads and blood metal ion levels.Trial registration: ClinicalTrials.gov (reg. ID NCT0231 6704).
Collapse
Affiliation(s)
- Kristine I Bunyoz
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Georgios Tsikandylakis
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Kristian Mortensen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maziar Mohaddes
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Henrik Malchau
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Harris Orthopaedic Laboratory, Department of Orthopaedics, Massachusetts General Hospital, Boston, USA
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| |
Collapse
|
4
|
Taper corrosion in total hip arthroplasty – How to assess and which design features are crucial? J Mech Behav Biomed Mater 2022; 133:105307. [DOI: 10.1016/j.jmbbm.2022.105307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022]
|
5
|
Díaz-Dilernia F, Sanchez-Mele H, Zanotti G, Comba F, Piccaluga F, Buttaro M. Fracture of a triple-polished tapered cemented femoral stem at the Morse taper after metal-on-metal primary total hip arthroplasty. Ann R Coll Surg Engl 2022; 104:e128-e132. [PMID: 34939858 PMCID: PMC9773908 DOI: 10.1308/rcsann.2021.0187] [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: 11/22/2022] Open
Abstract
Total hip arthroplasty, one of the most successful orthopaedic procedures, is influenced by several variables. Corrosion at the modular junction is known as trunnionosis. Despite being reported infrequently, corrosion between the femoral head and the Morse taper can result in severe complications. Fracture of the femoral component in primary metal-on-metal (MoM) total hip arthroplasty at the Morse taper is an extremely rare event and can be associated with several risk factors. We report a case of corrosion at the Morse taper in a hybrid primary MoM total hip arthroplasty, resulting in Morse taper fracture with consequent femoral head entrapment inside the acetabular component. We hypothesise that some risk factors, such as age over 60years, active male patients, body mass index above 30kg/m2, large femoral heads, high-offset stems, 9/10 Morse taper and MoM-bearing surfaces, are associated with this mode of failure.
Collapse
Affiliation(s)
- F Díaz-Dilernia
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - H Sanchez-Mele
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - G Zanotti
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - F Comba
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - F Piccaluga
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - M Buttaro
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| |
Collapse
|
6
|
Parametric analysis of the effect of impaction load on the stability of head-neck junction in total hip arthroplasty. Clin Biomech (Bristol, Avon) 2022; 94:105633. [PMID: 35364404 DOI: 10.1016/j.clinbiomech.2022.105633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/15/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tribocorrosion at head-neck interface is one of the main causes leading to the failure of hip implants in total hip arthroplasty. Impaction load has been acknowledged as one of the key factors influencing the stability of the taper junction. It is understood that the magnitude of impaction force differs from the surgeon to surgeon in primary total hip arthroplasty or revision. Clinically, it is sufficient enough to keep the male and female tapers inseparable utilizing a low impaction, which seems to contradict previous researches. The objective of this study was to investigate the effect of impaction loads on the stability of taper junction during assembly and gaits. METHODS A finite element model with 12/14 taper and the taper mismatch of 4' was developed for investigation. The impaction force profiles were collected from surgeon as the inputs, and then the contact mechanics over one or multiple gaits was further analyzed and validated utilizing hip simulator test. FINDINGS Impaction force ranging from 200 to 2000 N could provide the same taper connection effect after the first gait due to the secondary seating. As for impaction loads of 3000 N and above, an increased impaction force would lead to the tighter taper connection. INTERPRETATION The effect of impaction load on the stability of head-neck junction is a piecewise function, indicating that the stability of taper junction is not affected by different impaction loads and tends to be consistent while its magnitude is below the threshold. Instead, the stability of taper junction is positively correlated with impaction force.
Collapse
|
7
|
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.
Collapse
|
8
|
Qurashi S, Pelletier MH, Wang T, Bramich N, Chinnappa J, Walsh WR. Stand up! Are normal weight-bearing forces sufficient for a 12/14 Morse taper locking in total hip arthroplasty? Hip Int 2022; 32:231-236. [PMID: 33081513 DOI: 10.1177/1120700020967000] [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: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to investigate total hip arthroplasty (THA) Morse taper pull-off strengths after impaction prior to cyclical loading compared to cyclical loading alone. The practical relevance of the experiment is to provide a perspective on what may be clinically satisfactory taper assembly given the spectrum of head tapping patterns used by surgeons, as well as compare traditional impaction performed in standard THA with alternate methods of taper engagement such as 'in situ assembly' used in micro-invasive techniques. METHODS 36 taper constructs utilising a combination of cobalt-chrome alloy and ceramic-titanium alloy junctions were investigated in vitro in wet and dry conditions with cyclical loading of the constructs. Taper disengagement strengths with and without impaction were compared. Secondary investigation of the surface roughness of the heads and tapers was also assessed. RESULTS An impaction to a wet taper resulted in a greater pull off force compared to a dry taper with a CoCr head and taper combination. Impacting the head and dryness of the taper did not affect pull off forces of a ceramic femoral head on titanium taper. Pulling a head off a taper significantly alters the head surface roughness. CONCLUSION Impaction of a taper does not provide any benefit over cyclical loading of a taper assembly alone for pull-off strength.
Collapse
Affiliation(s)
- Suleman Qurashi
- Surgical & Orthopaedic Research Laboratories, Prince of Wales Clinical School University of New South Wales, Sydney, NSW, Australia.,The Hip & Knee Clinic at Harbour City Orthopaedics, Sydney, NSW, Australia.,Nepean Hospital, Kingswood, NSW Australia
| | - Matthew H Pelletier
- Surgical & Orthopaedic Research Laboratories, Prince of Wales Clinical School University of New South Wales, Sydney, NSW, Australia
| | - Tian Wang
- Surgical & Orthopaedic Research Laboratories, Prince of Wales Clinical School University of New South Wales, Sydney, NSW, Australia
| | - Nicholas Bramich
- Surgical & Orthopaedic Research Laboratories, Prince of Wales Clinical School University of New South Wales, Sydney, NSW, Australia
| | - Jason Chinnappa
- Surgical & Orthopaedic Research Laboratories, Prince of Wales Clinical School University of New South Wales, Sydney, NSW, Australia
| | - William R Walsh
- Surgical & Orthopaedic Research Laboratories, Prince of Wales Clinical School University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
9
|
Wight CM, Schemitsch EH. In vitro testing for hip head-neck taper tribocorrosion: A review of experimental methods. Proc Inst Mech Eng H 2022; 236:9544119221074582. [PMID: 35139678 PMCID: PMC8915230 DOI: 10.1177/09544119221074582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In vitro test methods are challenged by the multi-factorial nature of head-neck taper connection tribocorrosion due to the consequences of simplification. Incorrect study design and misinterpretation of results has led to contradictory findings regarding important factors affecting head-neck taper tribocorrosion. This review seeks to highlight important considerations when developing in vitro test methods, to help researchers strengthen their study design and analyze the implications of others' design decisions. The advantages, disadvantages, limitations and procedural considerations for finite element analyses, electrochemical studies and in vitro simulations related to head-neck taper connection tribocorrosion are discussed. Finite element analysis offers an efficient method for studying large ranges of mechanical parameters. However, they are limited by neglecting electrochemical, biological and fluid flow factors. Electrochemical studies may be preferred if these factors are considered important. Care must be taken in interpreting data from electrochemical studies, particularly when different materials are compared. Differences in material valence and toxicity affect clinical translation of electrochemical studies' results. At their most complex, electrochemical studies attempt to simulate all aspects of headneck taper connection tribocorrosion in a bench top study. Effective execution requires in-depth knowledge of the tribocorrosion phenomenon, the involved mechanisms, and their measures such that each study design decision is fully informed.
Collapse
Affiliation(s)
- Christian M Wight
- Institute of Biomaterial and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| |
Collapse
|
10
|
Brusalis CM, Thacher RR, Baral E, Wright TM, Gulotta LV, Dines DM, Warren RF, Fu MC, Taylor SA. Tribocorrosion is Common, but Mild in Modular Humeral Components in Shoulder Arthroplasty: An Implant Retrieval Analysis. JSES Int 2022; 6:401-405. [PMID: 35572421 PMCID: PMC9091787 DOI: 10.1016/j.jseint.2022.01.009] [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] [Indexed: 11/22/2022] Open
Abstract
Background Wear and corrosion at the junctions of modular implants are increasingly recognized issues in the design of hip and knee arthroplasty prostheses, yet less is known about their significance in shoulder arthroplasty. Methods A query of paired total shoulder implant specimens (eg, humeral head and stem components from the same patient) was performed using an institutional implant retrieval registry. Implants were examined under a stereomicroscope and evaluated for evidence of fretting and corrosion using the modified Goldberg scoring system. Available electronic medical records of included specimens were reviewed to report relevant clinical characteristics and identify potential associations with the presence of tribocorrosion. Results Eighty-three paired total shoulder implant specimens, explanted at a single institution between 2013 and 2020, were analyzed. Corrosion was identified in 52% (43/83) of humeral head components and 40% (33/83) of humeral stem components. Fretting was identified in 29% (24/83) of humeral head components and 28% (23/83) of humeral stem components. Of the 56 paired implants for which clinical data were available, the duration of implantation (DOI) was less than 2 years in 29% of paired implants and greater than 5 years in 36% of implants. The presence of corrosion or fretting was not associated with DOI, a male humeral head taper, or periprosthetic infection as the indication for revision. Conclusion Mild tribocorrosion was present in more than half of the retrieved humeral implant specimens. However, trunnionosis did not manifest as a clinical cause of revision surgery in our study.
Collapse
|
11
|
Tsikandylakis G, Mortensen KRL, Gromov K, Mohaddes M, Malchau H, Troelsen A. Does the use of the largest possible metal head increase the wear of vitamin E-doped cross-linked polyethylene? Two-year results from a randomized controlled trial. Bone Joint J 2021; 103-B:1206-1214. [PMID: 34192938 DOI: 10.1302/0301-620x.103b7.bjj-2020-2064.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We aimed to investigate if the use of the largest possible cobalt-chromium head articulating with polyethylene acetabular inserts would increase the in vivo wear rate in total hip arthroplasty. METHODS In a single-blinded randomized controlled trial, 96 patients (43 females), at a median age of 63 years (interquartile range (IQR) 57 to 69), were allocated to receive either the largest possible modular femoral head (36 mm to 44 mm) in the thinnest possible insert or a standard 32 mm head. All patients received a vitamin E-doped cross-linked polyethylene insert and a cobalt-chromium head. The primary outcome was proximal head penetration measured with radiostereometric analysis (RSA) at two years. Secondary outcomes were volumetric wear, periacetabular radiolucencies, and patient-reported outcomes. RESULTS At two years, 44 patients in each group were available for RSA assessment. The median total two-year proximal head penetration was -0.02 mm (IQR -0.09 to 0.07; p = 0.548) for the largest possible head and -0.01 mm (IQR -0.07 to 0.10; p = 0.525) for 32 mm heads. Their difference was not statistically significant (p = 0.323). Neither group demonstrated a bedding-in period. The median steady-state volumetric wear rates were 6.1 mm3/year (IQR -59 to 57) and 3.5 mm3/year (-21 to 34) respectively, and did not differ between the groups (p = 0.848). There were no statistically significant differences in periacetabular radiolucencies or patient-reported outcomes. CONCLUSION The use of the largest possible metal head did not increase vitamin E-doped cross-linked polyethylene wear compared with 32 mm heads at two years. Linear wear was negligible and volumetric wear rates were very low in both head size groups. There was a tendency towards higher values of volumetric wear in large heads that warrants longer-term evaluation before any definite conclusions about the association between head size and wear can be drawn. Cite this article: Bone Joint J 2021;103-B(7):1206-1214.
Collapse
Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, University of Gothenburg, Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden
| | - Kristian R L Mortensen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirill Gromov
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maziar Mohaddes
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, University of Gothenburg, Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden
| | - Henrik Malchau
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, University of Gothenburg, Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden.,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Anders Troelsen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| |
Collapse
|
12
|
Kretzer JP, Uhler M, Jäger S, Bormann T, Sonntag R, Schonhoff M, Schröder S. [Tribology in hip arthroplasty : Benefits of different materials]. DER ORTHOPADE 2021; 50:259-269. [PMID: 33630110 DOI: 10.1007/s00132-021-04077-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
When it comes to total hip replacements, choosing the suitable material combination is of clinical relevance. The present review article examines the technical differences in wear and corrosion of the relevant material combinations of ceramics, metals, ceramized metals and various types of polyethylene. The material characteristics, which were often tested under standardized conditions in the laboratory, are compared with clinical results on the basis of evidence-graded clinical studies and on the basis of register studies. This article thus represents an up-to-date snapshot of the expectations and actual clinical outcomes of the present choice of material combinations. It shows that some tendencies from the field of materials research, e.g. with regard to cross-linked polyethylene, coincide with observations from practical clinical experience, while for other materials, a proven technical superiority has not yet been confirmed as an evident advantage in clinical practice.
Collapse
Affiliation(s)
- J Philippe Kretzer
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - Maximilian Uhler
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Sebastian Jäger
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Therese Bormann
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Robert Sonntag
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Mareike Schonhoff
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Stefan Schröder
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| |
Collapse
|
13
|
Morlock MM, Hube R, Wassilew G, Prange F, Huber G, Perka C. Taper corrosion: a complication of total hip arthroplasty. EFORT Open Rev 2020; 5:776-784. [PMID: 33312704 PMCID: PMC7722945 DOI: 10.1302/2058-5241.5.200013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The focus on taper corrosion in modular hip arthroplasty increased around 2007 as a result of clinical problems with large-head metal-on-metal (MoM) bearings on standard stems. Corrosion problems with bi-modular primary hip stems focused attention on this issue even more. Factors increasing the risk of taper corrosion were identified in laboratory and retrieval studies: stiffness of the stem neck, taper diameter and design, head diameter, offset, assembly force, head and stem material and loading. The high variability of the occurrence of corrosion in the clinical application highlights its multi-factorial nature, identifying the implantation procedure and patient-related factors as important additional factors for taper corrosion. Discontinuing the use of MoM has reduced the revisions due to metal-related pathologies dramatically from 49.7% (MoM > 32 mm), over 9.2% (MoM ⩽ 32 mm) to 0.8% (excluding all MoM). Further reduction can be achieved by omitting less stiff Ti-alloys and large metal heads (36 mm and above) against polyethylene (PE). Standardized taper assembly of smaller and ceramic heads will reduce the clinical occurrence of taper corrosion even further. If 36 mm heads are clinically indicated, only ceramic heads should be used. Taper-related problems will not comprise a major clinical problem anymore if the mentioned factors are respected.
Cite this article: EFORT Open Rev 2020;5:776-784. DOI: 10.1302/2058-5241.5.200013
Collapse
Affiliation(s)
| | | | - Georgi Wassilew
- Department for Orthopaedics and Orthopaedic Surgery, University of Greifswald, Greifswald, Germany
| | - Felix Prange
- TUHH Hamburg University of Technology, Hamburg, Germany
| | - Gerd Huber
- TUHH Hamburg University of Technology, Hamburg, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Orthopedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Influence of Different Damage Patterns of the Stem Taper on Fixation and Fracture Strength of Ceramic Ball Heads for Total Hip Replacement. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7542062. [PMID: 32509869 PMCID: PMC7244970 DOI: 10.1155/2020/7542062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
Abstract
Background Modularity finds frequent application in total hip replacement, allowing a preferable individual configuration and a simplified revision by retaining the femoral stem and replacing the prosthetic head. However, micromotions within the interface between the head and the stem taper can arise, resulting in the release of wear debris and corrosion products. The aim of our experimental study was to evaluate the influence of different taper damages on the fixation and fracture stability of ceramic femoral heads, after static and dynamic implant loading. Methods Ceramic ball heads (36 mm diameter) and 12/14 stem tapers made of titanium with various mild damage patterns (intact, scratched, and truncated) were tested. The heads were assembled on the taper with a quasistatic load of 2 kN and separated into a static and a dynamic group afterwards. The dynamic group (n = 18) was loaded over 1.5 million gait cycles in a hip wear simulator (ISO 14242-1). In contrast, the static group (n = 18) was not mechanically loaded after assembly. To determine the taper stability, all heads of the dynamic and static groups were either pulled off (ASTM 2009) or turned off (ISO 7206-16). A head fracture test (ISO 7206-10) was also performed. Subsequent to the fixation stability tests, the taper surface was visually evaluated in terms of any signs of wear or corrosion after the dynamic loading. Results In 10 of the 18 cases, discoloration of the taper was determined after the dynamic loading and subsequent cleaning, indicating the first signs of corrosion. Pull-off forces as well as turn-off moments were increased between 23% and 54% after the dynamic loading compared to the unloaded tapers. No significant influence of taper damage was determined in terms of taper fixation strength. However, the taper damage led to a decrease in fracture strength by approximately 20% (scratched) and 40% (truncated), respectively. Conclusion The results suggest that careful handling and accurate manufacturing of the stem taper are crucial for the ceramic head fracture strength, even though a mild damage showed no significant influence on taper stability. Moreover, our data indicate that a further seating of the prosthetic head may occur during daily activities, when the resulting hip force increases the assembly load.
Collapse
|
16
|
Accolade TMZF trunnion corrosion and mechanical failure 9 yr after primary surgery: A case report and treatment options. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Taper Design, Head Material, and Manufacturer Affect the Onset of Fretting Under Simulated Corrosion Conditions. J Arthroplasty 2020; 35:1117-1122. [PMID: 31836326 DOI: 10.1016/j.arth.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We investigated the effect of taper design, head material, and manufacturer on simulated mechanically assisted crevice corrosion (MACC). METHODS Six pristine C-taper stems coupled with alumina-zirconia or cobalt-chromium (CoCr) heads were tested in a mechanical/electrochemical setup to measure average fretting currents and fretting current onset loads. Outcomes were compared with previous data from V40 tapers from the same manufacturer and 12/14 tapers from another manufacturer. RESULTS Within a single manufacturer, differences in average fretting current between V40 and C-taper designs were dependent on head material. Only with V40 tapers did CoCr heads show higher average fretting currents than ceramic heads. Between manufacturers, differences were found between similar taper designs, as 12/14 taper couples showed higher average fretting currents than C-taper couples, regardless of head material. CONCLUSION Taper design, head material, and factors inherent to different manufacturers influence fretting current in simulated MACC. Unlike clinical and retrieval studies, this experimental design allows for investigations of factors affecting MACC in a controlled environment. Taper design, independent of manufacturer, contributes to the observed differences in average fretting current between head materials. In some taper designs, head composition, specifically ceramic, should not be considered alone to reduce risk of corrosion.
Collapse
|
18
|
Xu J, Sonntag R, Kretzer JP, Taylor D, Forst R, Seehaus F. Model-Based Roentgen Stereophotogrammetric Analysis to Monitor the Head-Taper Junction in Total Hip Arthroplasty in Vivo-And They Do Move. MATERIALS 2020; 13:ma13071543. [PMID: 32230788 PMCID: PMC7178274 DOI: 10.3390/ma13071543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/01/2022]
Abstract
Model-based Roentgen stereophotogrammetric analysis (RSA) using elementary geometrical shape (EGS) models allows migration measurement of implants without the necessity of additional attached implant markers. The aims of this study were: (i) to assess the possibility of measuring potential head–taper movement in THA in vivo using model-based RSA and (ii) to prove the validity of measured head–taper migration data in vitro and in vivo. From a previous RSA study with a 10 years follow-up, retrospectively for n = 45 patients head–taper migration was calculated as the relative migration between femoral ball head and taper of the femoral stem using model-based RSA. A head–taper migration of 0.026 mm/year can be detected with available RSA technology. In vitro validation showed a total migration of 268 ± 11 µm along the taper axis in a similar range to what has been reported using the RSA method. In vivo, a proof for interchangeable applicability of model-based RSA (EGS) and standard marker-based RSA methods was indicated by a significant deviation within the migration result after 12-month follow-up for all translation measurements, which was significantly correlated to the measured head–taper migration (r from 0.40 to 0.67; p < 0.05). The results identified that model-based RSA (EGS) could be used to detect head–taper migration in vivo and the measured movement could be validated in vitro and in vivo as well. Those findings supported the possibility of applying RSA for helping evaluate the head–taper corrosion related failure (trunnionosis).
Collapse
Affiliation(s)
- Jing Xu
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - J. Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Dominic Taylor
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Raimund Forst
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Frank Seehaus
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Erlangen-Nürnberg, 91054 Erlangen, Germany
- Correspondence:
| |
Collapse
|
19
|
Wood TJ, Alzahrani M, Langohr D, Teeter MG, Howard JL, Schemitsch EH, Lanting BA. Catastrophic femoral head trunnion dissociation: a case series with surface wear analysis. Hip Int 2019; 29:NP1-NP5. [PMID: 31232108 DOI: 10.1177/1120700019860774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Modular designs enhance accuracy of limb length and offset during total hip arthroplasty. However, such interfaces can be the site of corrosion and implant failure. The purpose of this study was to review 5 cases of catastrophic femoral head trunnion dissociation to better understand clinical and implant related risk factors for this complication. METHODS We describe 5 cases of femoral head dissociation following significant trunnion wear. Patient and implant related factors are reviewed. Surface wear patterns were assessed using electron microscopy and wear patterns were described qualitatively. RESULTS Commonalties among 5 presented cases include male, age over 65 and increased BMI. All femoral heads were cobalt chromium with a head size of at least 36 mm or greater. 4 out of 5 had high offset. All stems were the same design. Surface wear analysis showed material removed initially on the inferomedial aspect of the trunnion where the femoral head contacted the stem. CONCLUSIONS Femoral head dissociation secondary to failure of the trunnion is a rare complication. We show associations with older age, increased BMI and male patients with increased femoral head size and offset. Material is removed initially inferomedially and progresses to fracturing the superior aspect of the trunnion.
Collapse
Affiliation(s)
- Thomas J Wood
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, ON, Canada.,2 Division of Orthopaedic Surgery, Department of Surgery, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mohammad Alzahrani
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, ON, Canada.,3 Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Daniel Langohr
- 4 Department of Mechanical and Materials Engineering, University of Western Ontario, London, ON, Canada
| | - Matthew G Teeter
- 5 Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, ON, Canada
| | - James L Howard
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, ON, Canada
| | - Emil H Schemitsch
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, ON, Canada
| | - Brent A Lanting
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, ON, Canada
| |
Collapse
|
20
|
Does Taper Design Affect Taper Fretting Corrosion in Ceramic-on-Polyethylene Total Hip Arthroplasty? A Retrieval Analysis. J Arthroplasty 2019; 34:S366-S372.e2. [PMID: 31000401 DOI: 10.1016/j.arth.2019.02.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/23/2019] [Accepted: 02/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ceramic-on-polyethylene (CoP) implants have exhibited lower fretting and corrosion scores than metal-on-polyethylene implants. This study aims at investigating the effect of taper design on taper corrosion and fretting in modular CoP total hip arthroplasty (THA) systems. METHODS Under an institutional review board--approved protocol, a query of an implant retrieval library from 2002 to 2017 identified 120 retrieved CoP THA systems with zirconia toughened alumina femoral heads. Femoral stem trunnions were visually evaluated and graded for fretting, corrosion, and damage at the taper interface. Medical records were reviewed for patient demographics and implant characteristics. Data were statistically analyzed using Spearman correlation and rank-sum tests with a Dunn's post hoc test, with a significance level of α = 0.05. RESULTS Four different taper designs were evaluated: 11/13 (n = 18), 12/14 (n = 53), 16/18 (n = 21), and V40 (n = 28). There were no statistically significant demographic differences between taper groups for duration of implantation, laterality, patient age, and patient sex, but patients with 16/18 tapers had a higher body mass index than V40 tapers (P = .012). Duration of implantation had a weak positive correlation with both trunnion fretting (ρ = 0.224, P = .016) and corrosion (ρ = 0.253, P = .006). Summed fretting and corrosion scores were significantly greater on the V40 and 16/18 tapers compared with the 12/14 tapers (all P ≤ .001). CONCLUSION Taper fretting and corrosion were observed in CoP THA implants and were greatest with V40 and 16/18 tapers and lowest with 12/14 tapers. Differences in taper design characteristics may lead to greater micromotion at the taper-head interface, leading to increased fretting and corrosion.
Collapse
|
21
|
Skinner JA, Haddad FS. Ceramics in total hip arthroplasty: a bearing solution? Bone Joint J 2018; 99-B:993-995. [PMID: 28768773 DOI: 10.1302/0301-620x.99b8.bjj-2017-0771] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/20/2017] [Indexed: 12/12/2022]
Affiliation(s)
- J A Skinner
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
| |
Collapse
|
22
|
Rowan FE, Wach A, Wright TM, Padgett DE. The onset of fretting at the head-stem connection in hip arthroplasty is affected by head material and trunnion design under simulated corrosion conditions. J Orthop Res 2018; 36:1630-1636. [PMID: 29319895 DOI: 10.1002/jor.23813] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/11/2017] [Indexed: 02/04/2023]
Abstract
Mechanically assisted crevice corrosion (MACC) is a mechanism for trunnion damage in total hip arthroplasties (THAs). Retrieval studies have shown reduced MACC-related damage for ceramic heads compared with cobalt-chromium (CoCr) heads. We propose that ceramic heads demonstrate fretting at higher cyclic compressive loads than CoCr heads on titanium alloy trunnions in a simulated corrosion model. A closed electrochemical chamber was used to measure fretting current onset loads for two modern titanium alloy trunnions (Zimmer 12/14 and Stryker V-40) in which trunnion failure has been reported. Ceramic and CoCr alloy 36 + 0 mm heads were impacted on each trunnion and cyclically loaded at 3 Hz with increasing magnitude from 100 to 3,400 N for 540 cycles. Onset load was the cyclic compressive load at which the slope of the average fretting current increased significantly. A CoCr head with V40 trunnion demonstrated the lowest onset load (1,400 N), while the V40 trunnion with a ceramic head showed the highest onset load (2,200 N). Significant differences occurred in average fretting current between head materials for V40 trunnions (p < 0.001) at loads over 2,000 N. CoCr-12/14 and ceramic-12/14 couples demonstrated similar onset loads (2,000 N). All head-trunnion combinations showed cyclical fretting response to loading at 100 N. Head material composition was observed to increase fretting at the taper junction but the effect was taper geometry dependent. Using ceramic heads may reduce the phenomena of trunnion fretting and corrosion but the effect of both trunnion geometry and metallurgy warrants further investigation. Statement of clinical significance: Trunnion corrosion may occur with titanium alloy stems regardless of the head material used. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1630-1636, 2018.
Collapse
Affiliation(s)
- Fiachra E Rowan
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, 10021, New York
| | - Amanda Wach
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, 10021, New York
| |
Collapse
|
23
|
Madanat R, Laaksonen I, Graves SE, Lorimer M, Muratoglu O, Malchau H. Ceramic bearings for total hip arthroplasty are associated with a reduced risk of revision for infection. Hip Int 2018; 28:222-226. [PMID: 30165763 DOI: 10.1177/1120700018776464] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Periprosthetic joint infection (PJI) is a serious complication after total hip arthroplasty (THA) and bearing material's associations to PJI prevalence is largely unknown. The main purposes of this study were to determine if revision for infection varied depending on the type of bearing surface used in primary THA and to study whether patient or implant related factors had an effect on this variation. METHODS A total of 177,237 primary THA procedures from the Australian Registry (AOANJRR) were analysed. 3 bearing surfaces were compared. Metal-on-highly cross-linked polyethylene (MoXP) bearing had been used in 95,129 hips, ceramic-on-highly cross-linked polyethylene (CoXP) in 24,269 hips, and ceramic-on-ceramic (CoC) in 57,839 hips. Revision rates for infection were compared between the 3 groups. RESULTS Both MoXP and CoXP had a higher revision rate for infection compared to CoC hips (hazard ratio [HR] 1.46 (1.25, 1.72), p < 0.001) and HR 1.42 (1.15, 1.75), p = 0.001 respectively). Patients aged 70 years or less had a lower revision rate for infection when a CoC bearing was used. This difference was independent of sex, and prostheses selection. No difference was evident if the femoral component was cemented or a head size of 28 mm was used. DISCUSSION In this registry-based material, use of a CoC bearing was associated with a lower risk of revision for infection in patients younger than 70 years when cementless femoral components were used. Further studies are needed to verify this finding.
Collapse
Affiliation(s)
- Rami Madanat
- 1 Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- 2 Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
- 3 Harvard Medical School, Boston, MA, USA
| | - Inari Laaksonen
- 1 Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- 3 Harvard Medical School, Boston, MA, USA
| | - Stephen E Graves
- 4 Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - Michelle Lorimer
- 5 South Australia Health and Medical Research Institution (SAHMRI), Adelaide, SA, Australia
| | - Orhun Muratoglu
- 1 Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- 2 Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Henrik Malchau
- 1 Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- 2 Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
24
|
Raji HY, Shelton JC. Prediction of taper performance using quasi static FE models: The influence of loading, taper clearance and trunnion length. J Biomed Mater Res B Appl Biomater 2018; 107:138-148. [DOI: 10.1002/jbm.b.34104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/19/2018] [Accepted: 02/18/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Halimat Y. Raji
- School of Engineering and Materials Science; Queen Mary University of London; London E1 4NS UK
| | - Julia C. Shelton
- School of Engineering and Materials Science; Queen Mary University of London; London E1 4NS UK
| |
Collapse
|
25
|
Bingley R, Martin A, Manfredi O, Nejadhamzeeigilani M, Oladokun A, Beadling AR, Siddiqui S, Anderson J, Thompson J, Neville A, Bryant M. Fretting-corrosion at the modular tapers interface: Inspection of standard ASTM F1875-98. Proc Inst Mech Eng H 2018. [PMID: 29529933 DOI: 10.1177/0954411918760958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interest in the degradation mechanisms at the modular tapers interfaces has been renewed due to increased reported cases of adverse reactions to metal debris and the appearance of wear and corrosion at the modular tapers interfaces at revision. Over the past two decades, a lot of research has been expended to understand the degradation mechanisms, with two primary implant loading procedures and orientations used consistently across the literature. ASTM F1875-98 is often used as a guide to understand and benchmark the tribocorrosion processes occurring within the modular tapers interface. This article presents a comparison of the two methods outlined in ASTM F1875-98 as well as a critique of the standard considering the current paradigm in pre-clinical assessment of modular tapers.
Collapse
Affiliation(s)
- Rachel Bingley
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Alan Martin
- 2 School of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Olivia Manfredi
- 2 School of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | | | - Abimbola Oladokun
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Andrew Robert Beadling
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Sohail Siddiqui
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | | | | | - Anne Neville
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Michael Bryant
- 1 Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| |
Collapse
|
26
|
Berstock JR, Whitehouse MR, Duncan CP. Trunnion corrosion: what surgeons need to know in 2018. Bone Joint J 2018; 100-B:44-49. [PMID: 29292339 PMCID: PMC6424439 DOI: 10.1302/0301-620x.100b1.bjj-2017-0569.r1] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/19/2017] [Indexed: 11/05/2022]
Abstract
AIMS To present a surgically relevant update of trunnionosis. MATERIALS AND METHODS Systematic review performed April 2017. RESULTS Trunnionosis accounts for approximately 2% of the revision total hip arthroplasty (THA) burden. Thinner (reduced flexural rigidity) and shorter trunnions (reduced contact area at the taper junction) may contribute to mechanically assisted corrosion, exacerbated by high offset implants. The contribution of large heads and mixed metallurgy is discussed. CONCLUSION Identifying causative risk factors is challenging due to the multifactorial nature of this problem. Cite this article: Bone Joint J 2018;100-B(1 Supple A):44-9.
Collapse
Affiliation(s)
- J R Berstock
- Musculoskeletal Research Unit, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - M R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - C P Duncan
- Vancouver General Hospital, University of British Columbia, JP North 3rd floor, Room 3114, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada
| |
Collapse
|
27
|
Panagiotidou A, Cobb T, Meswania J, Skinner J, Hart A, Haddad F, Blunn G. Effect of impact assembly on the interface deformation and fretting corrosion of modular hip tapers: An in vitro study. J Orthop Res 2018; 36:405-416. [PMID: 28485507 DOI: 10.1002/jor.23601] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 05/03/2017] [Indexed: 02/04/2023]
Abstract
Wear and corrosion at the modular head-neck junction has been recognised to be a potential clinical concern, with multiple reports on adverse local tissue reactions and subsequent early failure of metal-on-metal hip replacements. Furthermore, reports on head-neck taper corrosion are also being described with conventional metal-on-polyethylene bearings. Manufacturing tolerances, surgical technique, non-axial alignment, material combination, high frictional torque and high bending moment have all been implicated in the failure process. There is limited guidance on the force of impaction with which surgeons should assemble modular hip prostheses. This study aims to investigate the effect of impaction force on the deformation and corrosion of modular tapers. Short neck tapers with high surface roughness (average Rz = 16.58 μm, Ra = 4.14μm) and long neck tapers with low surface roughness (average Rz = 3.82 μm, Ra = 0.81μm), were assembled with CoCrMo alloy heads (smooth finish) under controlled conditions with 2, 4 or 8 kN of impaction force. Material combinations tested included CoCrMo-head/CoCrMo-neck and CoCrMo-head/Ti-6Al-4V-neck. Assessment of surface deformation before and after impaction was made using surface profilometry. Measurement of fretting current during sinusoidal cyclic loading evaluated mechanically assisted corrosion for each assembly load during short-term cyclic loading (1000-cycles) and long-term cyclic loading (5 million-cycles). Deformation on head and neck tapers increased with assembly load. Fretting currents during short term simulation testing showed significantly lower currents (p < 0.05), in 8 kN assemblies when compared to 2 and 4 kN, especially for the short-rough tapers. Long-term simulator testing demonstrated a progressive reduction in fretting corrosion for samples impacted with 4 and 8 kN; however, this reduction was greater for samples impacted at 8 kN even at the start of testing. Based on our results, surgeons could minimise mechanically assisted crevice corrosion by using higher impact loads when assembling the head to the stem in total hip arthroplasty. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:405-416, 2018.
Collapse
Affiliation(s)
- Anna Panagiotidou
- John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculo-Skeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom.,London Implant Retrieval Centre, Institute of Orthopaedics and Musculo-Skeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Timothy Cobb
- John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculo-Skeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Jay Meswania
- John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculo-Skeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom.,London Implant Retrieval Centre, Institute of Orthopaedics and Musculo-Skeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - John Skinner
- London Implant Retrieval Centre, Institute of Orthopaedics and Musculo-Skeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom.,Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Alister Hart
- John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculo-Skeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom.,London Implant Retrieval Centre, Institute of Orthopaedics and Musculo-Skeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Fares Haddad
- Department of Orthopaedics, University College Hospital, 235 Euston Rd, London, NW1 2BU, United Kingdom
| | - Gordon Blunn
- John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculo-Skeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom.,London Implant Retrieval Centre, Institute of Orthopaedics and Musculo-Skeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| |
Collapse
|
28
|
Evidence based recommendations for reducing head-neck taper connection fretting corrosion in hip replacement prostheses. Hip Int 2017; 27:523-531. [PMID: 29027189 DOI: 10.5301/hipint.5000545] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This systematic review seeks to summarise the published studies investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion at the head-neck taper connection, and provide clinical recommendations to reduce its occurrence. METHODS PubMed, MEDLINE and EMBASE electronic databases were searched using the terms taper, trunnion, cone and head-neck junction. Articles investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion were retrieved, reviewed and graded according to OCEBM levels of evidence and grades of recommendation. RESULTS The initial search yielded 1,224 unique articles, and 91 were included in the analysis. CONCLUSIONS There is fair evidence to recommend against the use of high offset femoral heads, larger diameter femoral heads, and to pay particular consideration to fretting corrosion's progression with time and risk with heavier or more active patients. Particular to metal-on-metal hip prostheses, there is fair evidence to recommend positioning the acetabular component to minimise edge loading. Particular to metal-on-polyethylene hip prostheses, there is fair evidence to recommend the use of ceramic femoral heads, against use of cast cobalt alloy femoral heads, and against use of low flexural rigidity femoral stems. Evidence related to taper connection design is largely conflicting or inconclusive. Head-neck taper connection fretting corrosion is a multifactorial problem. Strict adherence to the guidelines presented herein does not eliminate the risk. Prosthesis selection is critical, and well-controlled studies to identify each design parameter's relative contribution to head-neck taper connection fretting corrosion are required.
Collapse
|
29
|
Farhoudi H, Fallahnezhad K, Oskouei RH, Taylor M. A finite element study on the mechanical response of the head-neck interface of hip implants under realistic forces and moments of daily activities: Part 1, level walking. J Mech Behav Biomed Mater 2017; 75:470-476. [DOI: 10.1016/j.jmbbm.2017.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
|
30
|
Krull A, Morlock MM, Bishop NE. The Influence of Contamination and Cleaning on the Strength of Modular Head Taper Fixation in Total Hip Arthroplasty. J Arthroplasty 2017. [PMID: 28625686 DOI: 10.1016/j.arth.2017.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Intraoperative interface contamination of modular head-stem taper junctions of hip implants can lead to poor fixation strength, causing fretting and crevice corrosion or even stem taper fracture. Careful cleaning before assembly should help to reduce these problems. The purpose of this study was to determine the effect of cleaning (with and without drying) contaminated taper interfaces on the taper fixation strength. METHODS Metal or ceramic heads were impacted onto titanium alloy stem tapers with cleaned or contaminated (fat or saline solution) interfaces. The same procedure was performed after cleaning and drying the contaminated interfaces. Pull-off force was used to determine the influence of contamination and cleaning on the taper strength. RESULTS Pull-off forces after contamination with fat were significantly lower than those for uncontaminated interfaces for both head materials. Pull-off forces after application of saline solution were not significantly different from those for uncontaminated tapers. However, a large variation in taper strength was observed, pull-off forces for cleaned and dried tapers were similar to those for uncontaminated tapers for both head materials. CONCLUSION Intraoperative contamination of taper interfaces may be difficult to detect but has a major influence on taper fixation strength. Cleaning of the stem taper with saline solution and drying with gauze directly before assembly allows the taper strength of the pristine components to be achieved. Not drying the taper results in a large variation in pull-off forces, emphasizing that drying is essential for sufficient and reproducible fixation strength.
Collapse
Affiliation(s)
- Annika Krull
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Nicholas E Bishop
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany; Department of Medical Technology, Faculty of Life Science, HAW Hamburg University of Applied Sciences, Hamburg, Germany
| |
Collapse
|
31
|
Sonntag R, Braun S, Al-Salehi L, Reinders J, Mueller U, Kretzer JP. Three-dimensional friction measurement during hip simulation. PLoS One 2017; 12:e0184043. [PMID: 28886102 PMCID: PMC5590873 DOI: 10.1371/journal.pone.0184043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/16/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives Wear of total hip replacements has been the focus of many studies. However, frictional effects, such as high loading on intramodular connections or the interface to the bone, as well as friction associated squeaking have recently increased interest about the amount of friction that is generated during daily activities. The aim of this study was thus to establish and validate a three-dimensional friction setup under standardized conditions. Materials and methods A standard hip simulator was modified to allow for high precision measurements of small frictional effects in the hip during three-dimensional hip articulation. The setup was verified by an ideal hydrostatic bearing and validated with a static-load physical pendulum and an extension-flexion rotation with a dynamic load profile. Additionally, a pendulum model was proposed for screening measurement of frictional effects based on the damping behavior of the angular oscillation without the need for any force/moment transducer. Finally, three-dimensional friction measurements have been realized for ceramic-on-polyethylene bearings of three different sizes (28, 36 and 40 mm). Results A precision of less than 0.2 Nm during three-dimensional friction measurements was reported, while increased frictional torque (resultant as well as taper torque) was measured for larger head diameters. These effects have been confirmed by simple pendulum tests and the theoretical model. A comparison with current literature about friction measurements is presented. Conclusions This investigation of friction is able to provide more information about a field that has been dominated by the reduction of wear. It should be considered in future pre-clinical testing protocols given by international organizations of standardization.
Collapse
Affiliation(s)
- Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
- * E-mail:
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Loay Al-Salehi
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Joern Reinders
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - J. Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
32
|
Whittaker RK, Hothi HS, Eskelinen A, Blunn GW, Skinner JA, Hart AJ. Variation in taper surface roughness for a single design effects the wear rate in total hip arthroplasty. J Orthop Res 2017; 35:1784-1792. [PMID: 27704611 DOI: 10.1002/jor.23456] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/29/2016] [Indexed: 02/04/2023]
Abstract
Material loss from the head-stem taper junction of total hip arthroplasty (THA) is implicated in adverse reactions to metal debris (ARMD); the mechanisms for this are multi-factorial. We investigated the relationship between the roughness of the "as manufactured" taper surface and the wear rate from this junction. Fifty retrieved Pinnacle metal-on-metal (MOM) bearings paired with a Corail stem were included in the study. Multivariable statistical analysis was performed to determine the influence of taper roughness on material loss rate after controlling for other confounding surgical, implant, and patient factors. The surface roughness of the "as manufactured" head taper surface was associated with the rate of material loss from this surface. Four of eighteen roughness variables taken from ISO 4,287 and ISO 13,565-2 were significant: The Reduced Peak Height (Rpk, the protruding peaks above the core) (p = 0.004), Material Ratio 1 (Mr1, the ratio of the protruding peaks above the core) (p = 0.002), Area of the Peak Region (A1, the area of the Abbott-Curve that contains the peaks from the profile) (p = 0.003) and the Skewness (Rsk, the asymmetry of the height distribution corresponding to the height or depth of surface features) (p = 0.03). We found a large variability in the measured values with a median (range) of 0.50 (0.05-2.98), 11.98 (0.46-39.98), 30.89 (0.15-581.00), and 0.04 (-0.73-0.84), respectively. A 1-unit increase in Rpk was associated with a 73% increase in the taper wear rate. The variability of "as manufactured" surface roughness has a significant effect on taper material loss. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1784-1792, 2017.
Collapse
Affiliation(s)
- Robert K Whittaker
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, United Kingdom
| | - Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, United Kingdom
| | | | - Gordon W Blunn
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, United Kingdom
| | - John A Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, United Kingdom
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, United Kingdom
| |
Collapse
|
33
|
Bitter T, Khan I, Marriott T, Lovelady E, Verdonschot N, Janssen D. A combined experimental and finite element approach to analyse the fretting mechanism of the head-stem taper junction in total hip replacement. Proc Inst Mech Eng H 2017; 231:862-870. [PMID: 28599593 PMCID: PMC5562336 DOI: 10.1177/0954411917713774] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fretting corrosion at the taper interface of modular hip implants has been implicated as a possible cause of implant failure. This study was set up to gain more insight in the taper mechanics that lead to fretting corrosion. The objectives of this study therefore were (1) to select experimental loading conditions to reproduce clinically relevant fretting corrosion features observed in retrieved components, (2) to develop a finite element model consistent with the fretting experiments and (3) to apply more complicated loading conditions of activities of daily living to the finite element model to study the taper mechanics. The experiments showed similar wear patterns on the taper surface as observed in retrievals. The finite element wear score based on Archard’s law did not correlate well with the amount of material loss measured in the experiments. However, similar patterns were observed between the simulated micromotions and the experimental wear measurements. Although the finite element model could not be validated, the loading conditions based on activities of daily living demonstrate the importance of assembly load on the wear potential. These findings suggest that finite element models that do not incorporate geometry updates to account for wear loss may not be appropriate to predict wear volumes of taper connections.
Collapse
Affiliation(s)
- Thom Bitter
- 1 Orthopaedic Research Lab, Radboudumc, Nijmegen, The Netherlands
| | | | | | | | - Nico Verdonschot
- 1 Orthopaedic Research Lab, Radboudumc, Nijmegen, The Netherlands.,3 University of Twente, Enschede, The Netherlands
| | - Dennis Janssen
- 1 Orthopaedic Research Lab, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
34
|
Surface and subsurface changes as a result of tribocorrosion at the stem-neck interface of bi-modular prosthesis. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.biotri.2017.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
35
|
Affiliation(s)
- F. S. Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
| |
Collapse
|
36
|
Affiliation(s)
- Fares S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
| |
Collapse
|
37
|
Morlock M, Bünte D, Gührs J, Bishop N. Corrosion of the Head-Stem Taper Junction-Are We on the Verge of an Epidemic?: Review Article. HSS J 2017; 13:42-49. [PMID: 28167873 PMCID: PMC5264576 DOI: 10.1007/s11420-016-9526-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The modular head taper junction has contributed to the success of total hip arthroplasty (THA) greatly. Taper corrosion and wear problems reported for large and extra-large metal-on-metal bearings as well as for bi-modular THA stems have cast doubt on the benefit of the taper interface. Presently, corrosion problems are being reported for nearly all kinds of artificial hip joints incorporating metal heads, questioning taper connections in general. QUESTIONS/PURPOSES This study aimed to review the mechanical and electrochemical relationships that may lead to taper corrosion, which have been reported more commonly in recent literature, and to also review the contribution of patient characteristics and surgical techniques involved in taper assembly that may contribute to the problem. METHODS The search criteria "(corrosion) AND (hip arthroplasty) AND (taper OR trunnion)" and "(hip arthroplasty) AND ((pseudotumor) OR (pseudo-tumor))" in PubMed and the JAAOS were used for the literature search. In addition, the arthroplasty registers were considered. RESULTS Most studies acknowledge the multifactorial nature of the problem but concentrate their analysis on taper and implant design aspects, since this is the only factor that can be easily quantified. The sometimes conflicting results in the literature could be due to the fact that the other two decisive factors are not sufficiently considered: the loading situation in the patient and the assembly situation by the surgeon. All three factors together determine the fate of a taper junction in THA. There is no single reason as a main cause for taper corrosion. The combined "outcome" of these three factors has to be in a "safe range" to achieve a successful long-term taper fixation. CONCLUSION No, this is not the beginning of an epidemic. It is rather the consequence of disregarding known mechanical and electrochemical relationships, which in combination have recently caused a more frequent occurrence-and mainly reporting-of corrosion issues.
Collapse
Affiliation(s)
- Michael Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, 21073 Hamburg, Germany
| | - Dennis Bünte
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, 21073 Hamburg, Germany
| | - Julian Gührs
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, 21073 Hamburg, Germany
| | - Nicholas Bishop
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, 21073 Hamburg, Germany
| |
Collapse
|
38
|
Hothi HS, Kendoff D, Lausmann C, Henckel J, Gehrke T, Skinner J, Hart A. Clinically insignificant trunnionosis in large-diameter metal-on-polyethylene total hip arthroplasty. Bone Joint Res 2017; 6:52-56. [PMID: 28108481 PMCID: PMC5301900 DOI: 10.1302/2046-3758.61.bjr-2016-0150.r2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/21/2016] [Indexed: 12/13/2022] Open
Abstract
Objectives Mechanical wear and corrosion at the head-stem junction of total hip arthroplasties (THAs) (trunnionosis) have been implicated in their early revision, most commonly in metal-on-metal (MOM) hips. We can isolate the role of the head-stem junction as the predominant source of metal release by investigating non-MOM hips; this can help to identify clinically significant volumes of material loss and corrosion from these surfaces. Methods In this study we examined a series of 94 retrieved metal-on-polyethylene (MOP) hips for evidence of corrosion and material loss at the taper junction using a well published visual grading method and an established roundness-measuring machine protocol. Hips were retrieved from 74 male and 20 female patients with a median age of 57 years (30 to 76) and a median time to revision of 215 months (2 to 324). The reasons for revision were loosening of both the acetabular component and the stem (n = 29), loosening of the acetabular component (n = 58) and infection (n = 7). No adverse tissue reactions were reported by the revision surgeons. Results Evidence of corrosion was observed in 55% of hips. The median Goldberg taper corrosion score was 2 (1 to 4) and the annual rate of material loss at the taper was 0.084 mm3/year (0 to 0.239). The median trunnion corrosion score was 1 (1 to 3). Conclusions We have reported a level of trunnionosis for MOP hips with large-diameter heads that were revised for reasons other than trunnionosis, and therefore may be clinically insignificant. Cite this article: H. S. Hothi, D. Kendoff, C. Lausmann, J. Henckel, T. Gehrke, J. Skinner, A. Hart. Clinically insignificant trunnionosis in large-diameter metal-on-polyethylene total hip arthroplasty. Bone Joint Res 2017;6:52–56. DOI: 10.1302/2046-3758.61.BJR-2016-0150.R2.
Collapse
Affiliation(s)
- H S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - D Kendoff
- Orthopaedic Department, HELIOS, Endo-Klinik Hamburg, Hamburg, Germany
| | - C Lausmann
- Orthopaedic Department, HELIOS, Endo-Klinik Hamburg, Hamburg, Germany
| | - J Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - T Gehrke
- Orthopaedic Department, HELIOS, Endo-Klinik Hamburg, Hamburg, Germany
| | - J Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - A Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| |
Collapse
|
39
|
An Analytical Calculation of Frictional and Bending Moments at the Head-Neck Interface of Hip Joint Implants during Different Physiological Activities. MATERIALS 2016; 9:ma9120982. [PMID: 28774104 PMCID: PMC5456991 DOI: 10.3390/ma9120982] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 01/20/2023]
Abstract
This study predicts the frictional moments at the head-cup interface and frictional torques and bending moments acting on the head-neck interface of a modular total hip replacement across a range of activities of daily living. The predicted moment and torque profiles are based on the kinematics of four patients and the implant characteristics of a metal-on-metal implant. Depending on the body weight and type of activity, the moments and torques had significant variations in both magnitude and direction over the activity cycles. For the nine investigated activities, the maximum magnitude of the frictional moment ranged from 2.6 to 7.1 Nm. The maximum magnitude of the torque acting on the head-neck interface ranged from 2.3 to 5.7 Nm. The bending moment acting on the head-neck interface varied from 7 to 21.6 Nm. One-leg-standing had the widest range of frictional torque on the head-neck interface (11 Nm) while normal walking had the smallest range (6.1 Nm). The widest range, together with the maximum magnitude of torque, bending moment, and frictional moment, occurred during one-leg-standing of the lightest patient. Most of the simulated activities resulted in frictional torques that were near the previously reported oxide layer depassivation threshold torque. The predicted bending moments were also found at a level believed to contribute to the oxide layer depassivation. The calculated magnitudes and directions of the moments, applied directly to the head-neck taper junction, provide realistic mechanical loading data for in vitro and computational studies on the mechanical behaviour and multi-axial fretting at the head-neck interface.
Collapse
|
40
|
Tan SC, Lau ACK, Del Balso C, Howard JL, Lanting BA, Teeter MG. Tribocorrosion: Ceramic and Oxidized Zirconium vs Cobalt-Chromium Heads in Total Hip Arthroplasty. J Arthroplasty 2016; 31:2064-71. [PMID: 27067752 DOI: 10.1016/j.arth.2016.02.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 02/06/2016] [Accepted: 02/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This matched-cohort study aims to compare tribocorrosion between matched ceramic and cobalt-chromium femoral head trunnions and between matched Oxinium and cobalt-chromium femoral head trunnions. Secondary objectives were to investigate whether taper design, depth of trunnion, implantation time, age, body mass index, and gender have an effect on fretting and corrosion. METHODS All hip prostheses retrieved between 1999 and 2015 at one center were reviewed, giving a total of 52 ceramic heads. These were matched to a cobalt-chromium cohort according to taper design, head size, neck length, and implantation time. The trunnions were examined by 2 observers using a 4-point scoring technique and scored in 3 zones: apex, middle, and base. The observers were blinded to clinical and manufacturing data where possible. A separate matched-cohort analysis was performed between 8 Oxinium heads and 8 cobalt-chromium heads, which were similarly scored. RESULTS Ceramic head trunnions demonstrated a lower median fretting and corrosion score at the base zone (P < .001), middle zone (P < .001), and in the combined score (P < .001). Taper design had a significant effect on fretting and corrosion in the apex zone (P = .04) of the ceramic group, as well as the cobalt-chromium group (P = .03). Between Oxinium heads and cobalt-chromium heads, there was no significant difference in the fretting and corrosion score across all 3 zones (base: P = .22; middle: P = .92; and apex: P = .71) and for the combined score (P = .67). CONCLUSION This study shows that ceramic head confers an advantage in trunnion fretting and corrosion. Taper design and implantation time were also significant factors for fretting and corrosion.
Collapse
Affiliation(s)
- Sok Chuen Tan
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Adrian C K Lau
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Christopher Del Balso
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Matthew G Teeter
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
| |
Collapse
|
41
|
Matsen Ko L, Chen AF, Deirmengian GK, Hozack WJ, Sharkey PF. Catastrophic Femoral Head-Stem Trunnion Dissociation Secondary to Corrosion. J Bone Joint Surg Am 2016; 98:1400-4. [PMID: 27535443 DOI: 10.2106/jbjs.15.00914] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Modular femoral heads provide procedural enhancement by allowing accurate restoration of hip offset and limb-length equalization. However, corrosion may lead to adverse local tissue reactions. Severe trunnion corrosion can also lead to femoral head dissociation and catastrophic implant failure following primary total hip arthroplasty. METHODS We describe 5 cases, from our institution, in which the femoral head became dissociated from the femoral stem trunnion secondary to severe corrosion. Possible causes are evaluated. RESULTS Demographic commonalities among the 5 patients included a body mass index (BMI) of ≥30 kg/m(2) and male sex. All femoral heads were made of cobalt-chromium alloy and were larger-diameter implants (≥36 mm). Four of the 5 patients had a femoral head that increased the neck length above the default on a so-called standard head and 3 of the 5 had a stem with a 127° neck-shaft angle. CONCLUSIONS Although dissociation of the femoral head from the femoral trunnion following total hip arthroplasty is exceedingly rare, the prevalence may increase with longer follow-up. The dissociation is likely related to multiple factors, including a BMI of ≥30 kg/m(2), male sex, and corrosion resulting from the use of a larger metal head with a neck length of greater than the default and a stem with high offset. It is critical that surgeons be able to recognize this mode of implant failure and appropriately prepare to remove the femoral component during revision surgery. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
| | - Antonia F Chen
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gregory K Deirmengian
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - William J Hozack
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Peter F Sharkey
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
42
|
MacLeod AR, Sullivan NPT, Whitehouse MR, Gill HS. Large-diameter total hip arthroplasty modular heads require greater assembly forces for initial stability. Bone Joint Res 2016; 5:338-46. [PMID: 27496914 PMCID: PMC5013896 DOI: 10.1302/2046-3758.58.bjr-2016-0044.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/06/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives Modular junctions are ubiquitous in contemporary hip arthroplasty. The head-trunnion junction is implicated in the failure of large diameter metal-on-metal (MoM) hips which are the currently the topic of one the largest legal actions in the history of orthopaedics (estimated costs are stated to exceed $4 billion). Several factors are known to influence the strength of these press-fit modular connections. However, the influence of different head sizes has not previously been investigated. The aim of the study was to establish whether the choice of head size influences the initial strength of the trunnion-head connection. Materials and Methods Ti-6Al-4V trunnions (n = 60) and two different sizes of cobalt-chromium (Co-Cr) heads (28 mm and 36 mm; 30 of each size) were used in the study. Three different levels of assembly force were considered: 4 kN; 5 kN; and 6 kN (n = 10 each). The strength of the press-fit connection was subsequently evaluated by measuring the pull-off force required to break the connection. The statistical differences in pull-off force were examined using a Kruskal–Wallis test and two-sample Mann–Whitney U test. Finite element and analytical models were developed to understand the reasons for the experimentally observed differences. Results 36 mm diameter heads had significantly lower pull-off forces than 28 mm heads when impacted at 4 kN and 5 kN (p < 0.001; p < 0.001), but not at 6 kN (p = 0.21). Mean pull-off forces at 4 kN and 5 kN impaction forces were approximately 20% larger for 28 mm heads compared with 36 mm heads. Finite element and analytical models demonstrate that the differences in pull-off strength can be explained by differences in structural rigidity and the resulting interface pressures. Conclusion This is the first study to show that 36 mm Co-Cr heads have up to 20% lower pull-off connection strength compared with 28 mm heads for equivalent assembly forces. This effect is likely to play a role in the high failure rates of large diameter MoM hips. Cite this article: A. R. MacLeod, N. P. T. Sullivan, M. R. Whitehouse, H. S. Gill. Large-diameter total hip arthroplasty modular heads require greater assembly forces for initial stability. Bone Joint Res 2016;5:338–346. DOI: 10.1302/2046-3758.58.BJR-2016-0044.R1.
Collapse
Affiliation(s)
- A R MacLeod
- University of Bath, Claverton Down Rd, Bath, North East Somerset BA2 7AY, UK
| | - N P T Sullivan
- Southmead Hospital, Department of Trauma and Orthopaedics, North Bristol NHS Trust, Southmead Way, Bristol, BS10 5NB, UK
| | - M R Whitehouse
- University of Bristol, Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK, BS10 5NB, UK
| | - H S Gill
- University of Bath, Claverton Down Rd, Bath, North East Somerset BA2 7AY, UK
| |
Collapse
|
43
|
Berber R, Skinner JA, Hart AJ. Management of metal-on-metal hip implant patients: Who, when and how to revise? World J Orthop 2016; 7:272-9. [PMID: 27190754 PMCID: PMC4865716 DOI: 10.5312/wjo.v7.i5.272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/12/2016] [Accepted: 03/07/2016] [Indexed: 02/06/2023] Open
Abstract
The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed.
Collapse
|
44
|
Osman K, Panagiotidou AP, Khan M, Blunn G, Haddad FS. Corrosion at the head-neck interface of current designs of modular femoral components. Bone Joint J 2016; 98-B:579-84. [DOI: 10.1302/0301-620x.98b5.35592] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 12/10/2015] [Indexed: 11/05/2022]
Abstract
There is increasing global awareness of adverse reactions to metal debris and elevated serum metal ion concentrations following the use of second generation metal-on-metal total hip arthroplasties. The high incidence of these complications can be largely attributed to corrosion at the head-neck interface. Severe corrosion of the taper is identified most commonly in association with larger diameter femoral heads. However, there is emerging evidence of varying levels of corrosion observed in retrieved components with smaller diameter femoral heads. This same mechanism of galvanic and mechanically-assisted crevice corrosion has been observed in metal-on-polyethylene and ceramic components, suggesting an inherent biomechanical problem with current designs of the head-neck interface. We provide a review of the fundamental questions and answers clinicians and researchers must understand regarding corrosion of the taper, and its relevance to current orthopaedic practice. Cite this article: Bone Joint J 2016;98-B:579–84.
Collapse
Affiliation(s)
- K. Osman
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore HA7 4LP, UK
| | - A. P. Panagiotidou
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore HA7 4LP, UK
| | - M. Khan
- University College London, 170 Tottenham
Court Road, London W1T 7HA, UK
| | - G. Blunn
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore HA7 4LP, UK
| | - F. S. Haddad
- University College London Hospitals, 235
Euston Road, London, NW1
2BU, UK
| |
Collapse
|
45
|
van der Veen HC, Reininga IHF, Zijlstra WP, Boomsma MF, Bulstra SK, van Raay JJAM. Pseudotumour incidence, cobalt levels and clinical outcome after large head metal-on-metal and conventional metal-on-polyethylene total hip arthroplasty: mid-term results of a randomised controlled trial. Bone Joint J 2016; 97-B:1481-7. [PMID: 26530649 DOI: 10.1302/0301-620x.97b11.34541] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We compared the incidence of pseudotumours after large head metal-on-metal (MoM) total hip arthroplasty (THA) with that after conventional metal-on-polyethylene (MoP) THA and assessed the predisposing factors to pseudotumour formation. From a previous randomised controlled trial which compared large head (38 mm to 60 mm) cementless MoM THA with conventional head (28 mm) cementless MoP THA, 93 patients (96 THAs: 41 MoM (21 males, 20 females, mean age of 64 years, standard deviation (sd) 4) and 55 MoP (25 males, 30 females, mean age of 65 years, sd 5) were recruited after a mean follow-up of 50 months (36 to 64). The incidence of pseudotumours, measured using a standardised CT protocol was 22 (53.7%) after MoM THA and 12 (21.8%) after MoP THA. Women with a MoM THA were more likely to develop a pseudotumour than those with a MoP THA (15 vs 7, odds ratio (OR) = 13.4, p < 0.001). There was a similar incidence of pseudotumours in men with MoM THAs and those with MoP THAs (7 vs 5, OR = 2.1, p = 0.30). Elevated cobalt levels (≥ 5 microgram/L) were only associated with pseudotumours in women with a MoM THA. There was no difference in mean Oxford and Harris hip scores between patients with a pseudotumour and those without. Contrary to popular belief, pseudotumours occur frequently around MoP THAs. Women with a MoM THA and an elevated cobalt level are at greatest risk. In this study, pseudotumours had no effect on the functional outcome after either large head MoM or conventional MoP THA.
Collapse
Affiliation(s)
- H C van der Veen
- University of Groningen, University Medical Center Groningen, P.O. Box 30.033, 9700 RM Groningen, The Netherlands
| | - I H F Reininga
- University of Groningen, University Medical Center Groningen, P.O. Box 30.033, 9700 RM Groningen, The Netherlands
| | - W P Zijlstra
- Medical Center Leeuwarden, P.O. Box 888, 8901 BR Leeuwarden, The Netherlands
| | - M F Boomsma
- Isala Hospital, P.O. Box 10.400, 8000 GK Zwolle, The Netherlands
| | - S K Bulstra
- University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - J J A M van Raay
- Martini Hospital, P.O. Box 30.033, 9700 RM Groningen, The Netherlands
| |
Collapse
|