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Singh J, Panahifar A, Chernikov R, Dust WN. Pelvic Pseudotumor Associated With a Ceramic Bearing Total Hip. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00014. [PMID: 38513193 PMCID: PMC10959560 DOI: 10.5435/jaaosglobal-d-23-00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 03/23/2024]
Abstract
Pseudotumors have been well documented to occur most frequently in metal-metal bearing total hip arthroplasties and less frequently in metal-polyethylene bearings. There are few cases in the literature of pseudotumors occurring in ceramic-ceramic articulations. We report a case of a large pelvic pseudotumor in a patient with a ceramic-ceramic bearing articulation in a 67-year-old man. In addition to the usual investigations, we did a detailed wear analysis of the ceramic implants and an examination of the soft tissues for particulate debris. The detailed wear analysis did show evidence of stripe wear; however, the volumetric wear was within the expected range. Synchrotron imaging identified strontium and zirconium debris arising from the ceramic surfaces. Although association does not mean causation, no other cause for the large pseudotumor could be identified and presumably represents an idiosyncratic reaction to ceramic debris.
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Affiliation(s)
- Jaskaran Singh
- From the Department of Orthopedic Surgery Resident, University of Manitoba, Manitoba, Canada (Dr. Singh); Canadian Light Source, University of Saskatchewan, Saskatoon, Canada (Dr. Panahifar and Dr. Chernikov); Department of Surgery, University of Saskatchewan, Saskatoon, Canada (Dr. Dust)
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Fokter SK, Ledinek Ž, Kljaić Dujić M, Novak I. Extreme Serum Titanium Concentration Induced by Acetabular Cup Failure: Unveiling a Unique Scenario of Titanium Alloy Debris Accumulation. Bioengineering (Basel) 2024; 11:235. [PMID: 38534509 DOI: 10.3390/bioengineering11030235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
The majority of contemporary total hip arthroplasty (THA) implants are constructed from Ti alloys, which are generally believed to generate fewer adverse local tissue reactions (ALTRs) compared to CoCr alloys. This study presents a case of unusual primary THA failure where a substantial release of Ti alloy debris was observed. A 52-year-old active male underwent THA after post-traumatic aseptic necrosis of the femoral head in 2006. Seventeen years after the procedure, the patient presented with groin pain and a restricted range of motion. X-rays revealed the protrusion of the alumina ceramic head through the Ti6Al4V acetabular cup. Trace element analysis indicated significantly elevated levels of serum Ti, Al, and V. CT and MRI confirmed Ti alloy cup failure and a severe ALTR. During revision surgery, it was found that the worn-out ceramic head was in direct contact with the acetabular cup, having protruded through a central hole it had created over time. No acetabular liner was found. Histological analysis of his tissue samples showed wear-induced synovitis with areas of multinucleated foreign body giant cells and the accumulation of numerous metal particles but no acute inflammatory response. Six months after the revision THA, the patient has experienced favourable outcomes. This case provides an instructive illustration for studying the consequences of the substantial release of Ti alloy debris from orthopedic implants.
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Affiliation(s)
- Samo K Fokter
- Clinical Department of Orthopedic Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Slomškov trg 15, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
| | - Živa Ledinek
- Department of Pathology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Milka Kljaić Dujić
- Department of Radiology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Igor Novak
- Clinical Department of Orthopedic Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
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Hjorth MH, Mechlenburg I, Soballe K, Rømer L, Jakobsen SS, Stilling M. The anatomical location of cystic pseudotumors and muscle atrophy in metal-on-metal resurfacing hip arthroplasty is related to the surgical approach used for implantation. A subgroup analyses of a randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:5967-5976. [PMID: 36802238 DOI: 10.1007/s00402-023-04788-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Pseudotumors and muscle atrophy have been associated with metal-on-metal (MoM) resurfacing hip arthroplasty (RHA). We aimed to investigate the influence of the anterolateral (AntLat) and the posterior (Post) surgical approach on the location, grade and prevalence of pseudotumors and muscle atrophy in MoM RHA. PATIENTS AND METHODS Forty-nine patients were randomized to MoM RHA by the AntLat (n = 25) or the Post (n = 24) approach at Aarhus University Hospital. Patients underwent metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) scans for investigation of location, grade and prevalence of pseudotumors and muscle atrophy. Plain radiographs, metal-ions concentrations and clinical outcome scores were evaluated to compare outcomes of the surgical approaches. RESULTS MRI-detected pseudotumors were seen in 7 of 18 patients (39%) in the AntLat group and in 12 of 22 patients (55%) in the Post group (p = 0.33). Pseudotumors were mainly located anterolaterally to the hip joint in the AntLat group and postero-lateral to the hip joint in the Post group. Higher grades of muscle atrophy of the caudal part of the gluteus medius and minimus (p < 0.004) were seen in the AntLat group, and higher grades of muscle atrophy of the small external rotators were seen in the Post group (p < 0.001). The AntLat group had higher anteversion angles of mean 15.3° (range 6.1-7.5) versus mean 11.5° (range 4.9-22.5) in the Post group (p = 0.02). Metal-ion concentrations and clinical outcome scores were similar between groups (p > 0.08). CONCLUSION Muscle atrophy and pseudotumor location after MoM RHA follow the surgical approach used for implantation. This knowledge may help differentiate between "normal postoperative appearance" and "MoM disease."
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Affiliation(s)
- Mette Holm Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Inger Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Kjeld Soballe
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Kassarjian A, Isern-Kebschull J, Tomas X. Postoperative Hip MR Imaging. Magn Reson Imaging Clin N Am 2022; 30:673-688. [DOI: 10.1016/j.mric.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Driving electrochemical corrosion of implanted CoCrMo metal via oscillatory electric fields without mechanical wear. Sci Rep 2021; 11:22366. [PMID: 34785746 PMCID: PMC8595661 DOI: 10.1038/s41598-021-01810-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022] Open
Abstract
Decades of research have been dedicated to understanding the corrosion mechanisms of metal based implanted prosthetics utilized in modern surgical procedures. Focused primarily on mechanically driven wear, current fretting and crevice corrosion investigations have yet to precisely replicate the complex chemical composition of corrosion products recovered from patients' periprosthetic tissue. This work specifically targets the creation of corrosion products at the metal on metal junction utilized in modular hip prosthetics. Moreover, this manuscript serves as an initial investigation into the potential interaction between implanted CoCrMo metal alloy and low amplitude electrical oscillation, similar in magnitude to those which may develop from ambient electromagnetic radiation. It is believed that introduction of such an electrical oscillation may be able to initiate electrochemical reactions between the metal and surrounding fluid, forming the precursor to secondary wear particles, without mechanically eroding the metal's natural passivation layer. Here, we show that a low magnitude electrical oscillation (≤ 200 mV) in the megahertz frequency (106 Hz) range is capable of initiating corrosion on implanted CoCrMo without the addition of mechanical wear. Specifically, a 50 MHz, 200 mVpp sine wave generates corrosion products comprising of Cr, P, Ca, O, and C, which is consistent with previous literature on the analysis of failed hip prosthetics. These findings demonstrate that mechanical wear may not be required to initiate the production of chemically complex corrosion products.
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Surgical Treatment of Intrapelvic Pseudotumour after Hip Resurfacing Arthroplasty: Case Report and Literature Review. Case Rep Orthop 2018; 2018:3808362. [PMID: 30498612 PMCID: PMC6222224 DOI: 10.1155/2018/3808362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/08/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022] Open
Abstract
Hip replacement is the surgery of the last century due to its impact on the quality of life. A pseudotumour is a rare complication of hip arthroplasty, and it is related to a metal-bearing surface. Pseudotumour is a challenging scenario for hip surgeons due to poor clinical outcomes. The patient consulted for hip pain and paresthesia in the left lower extremity, and analyses showed that the cause was a sizeable intrapelvic pseudotumour. A multidisciplinary team surgery was planned. At first, an infraumbilical approach was made to resect the intrapelvic-retroperitoneum portion of the pseudotumour. Then, a posterolateral hip approach was performed, to resect the remaining portion of the pseudotumour and revision arthroplasty. At five years of follow-up, there are no clinical or imaging signs of recurrence of the pseudotumour. Treatment evidence is limited to a series of cases and expert opinions; we encourage complete resection and revision arthroplasty.
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Pisanu F, Doria C, Andreozzi M, Bartoli M, Saderi L, Sotgiu G, Tranquilli Leali P. Pleomorphic clinical spectrum of metallosis in total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018; 43:85-96. [PMID: 30269183 DOI: 10.1007/s00264-018-4176-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/18/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To summarize the biological effects of metal debris from hip arthroplasties which characterize a polymorphic clinical spectrum of local and remote manifestation. METHODS Retrospective study. Patient, implant, and surgical characteristics were collected, including implant survival, clinical manifestations, cause of arthroplasty revision or implant failure, and peri- and intra-operative complications. The primary endpoint was implant survivorship. Hip revision arthroplasty was decided considering clinical signs and symptoms, abnormal imaging (XR, MR, TC, echotomography, scintigraphy), and blood metal ion level. An ad hoc electronic form was used to collect demographic, epidemiological, and clinical variables. In-between group comparisons of quantitative variables were performed with the Student t test and the Mann-Whitney for parametric and non-parametric variables, respectively. Logistic regression analyses were carried out to assess the relationship between clinical and radiographic characteristics and stem and cup revision. Radiographic measurements of implant positioning validity and reliability were assessed using Krippendorff's alpha reliability coefficient. The statistical software STATA version 15 (StatsCorp, TX) was used to perform statistical computations. RESULTS In this MoM THA series, the most incident cause of implant failure was ARMD in 11 out of 14 (78.6%) patients. All clinical failure manifestations, revision surgery highlights, and intra-operative findings are reported. CONCLUSIONS The local adverse reactions include lesions of different clinical relevance from small asymptomatic soft tissue lesions to dramatic osteolysis, necrosis, effusion, and growing masses which can cause secondary pathological effects. Symptoms of systemic toxicity are rarely described but may have been largely unreported in literature. Despite the extensive literature on the topic, the patient's management is still uncertain and challenging. Every metallic implant (e.g., screws, plates, spinal instrumentations) has a potential local or systemic adverse effect. Organizing a national registry of arthroplasty should be mandatory, in order to collect data about the patients, the surgery, the implanted device (with a careful post-marketing tracking), and the follow-up for all the procedures performed at a national level. The data collected in the registry will allow to analyze the implant survival and to better recognize the undesirable and sometimes unexpected effects of different biomaterials on the whole body.
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Affiliation(s)
| | - Carlo Doria
- Università degli Studi di Sassari, Sassari, Italy
| | | | | | - Laura Saderi
- Università degli Studi di Sassari, Sassari, Italy
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Hjorth MH, Mechlenburg I, Soballe K, Jakobsen SS, Roemer L, Stilling M. Physical Activity Is Associated With the Level of Chromium but Not With Changes in Pseudotumor Size in Patients With Metal-on-Metal Hip Arthroplasty. J Arthroplasty 2018; 33:2932-2939. [PMID: 29807790 DOI: 10.1016/j.arth.2018.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Metal-on-metal (MoM) total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA) were previously considered an excellent option for young and physically active patients. However, the relationship between MoM THA/RHA patients' daily physical activity (PA), metal ion measurements of chromium and cobalt, and pseudotumor dynamic is insufficiently explored. METHODS One hundred eleven patients with 148 hip articulations, 77 MoM THA/RHA and 71 MoP THA, participated in a prospective cohort study, with 5 cross-sectional analyses during a 1-year follow-up. Baseline follow-up was at mean 7.1 (range: 0.2-21.5) years postoperative. At baseline and every 3 months thereafter, patients' daily PA was monitored during a 2-week period using a triaxial accelerometer, and next metal artifact reducing sequence magnetic resonance imaging scans, metal ion measurements of chromium and cobalt, and the Copenhagen Hip and Groin Outcome Score questionnaire were completed. RESULTS We found a statistically significant relationship between daily PA and metal ion measurements of chromium at all follow-ups in MoM THA/RHA patients (P ≤ .03) but not in MoP THA patients (P > .35). Patients' daily PA was not related to changes in pseudotumor size at any follow-up (P > .30). Ten of 26 (38%) pseudotumors in MoM THA/RHA and 8 of 29 (28%) pseudotumors in MoP THA changed classification according to the Anderson grading. No pseudotumors transformed in appearance or changed anatomical location. CONCLUSION The daily PA of MoM THA/RHA patients is associated with metal ion measurements of chromium but not with changes in pseudotumor size. This is new and important knowledge, which may be useful for hip surgeons in recommendation and monitoration of the consequences of PA in active patients with MoM THA/RHA.
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Affiliation(s)
- Mette H Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kjeld Soballe
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stig S Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Roemer
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Serrano PM, Rodrigues C, S. Silva M, Coelho R, Cardoso P, Oliveira V. Pseudotumor complicating a well-fixed ceramic-on-polyethylene total hip arthroplasty. Clin Case Rep 2018; 6:1756-1760. [PMID: 30214757 PMCID: PMC6132105 DOI: 10.1002/ccr3.1720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/25/2018] [Indexed: 12/12/2022] Open
Abstract
A suspicious area surrounding hardware components, usually following arthroplasty, should raise awareness to a possible particle related disease. Even in the presence of confusing or less typical symptoms, clinicians and surgeons must join efforts to diagnose and treat the patient effectively and in the appropriate time.
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Affiliation(s)
- Pedro M. Serrano
- Serviço de Ortopedia e TraumatologiaCentro Hospitalar do PortoPortoPortugal
| | - Cláudia Rodrigues
- Serviço de Ortopedia e TraumatologiaCentro Hospitalar do PortoPortoPortugal
| | - Marta S. Silva
- Serviço de Ortopedia e TraumatologiaCentro Hospitalar do PortoPortoPortugal
| | - Rafaela Coelho
- Serviço de Ortopedia e TraumatologiaCentro Hospitalar do PortoPortoPortugal
| | - Pedro Cardoso
- Serviço de Ortopedia e TraumatologiaCentro Hospitalar do PortoPortoPortugal
| | - Vânia Oliveira
- Serviço de Ortopedia e TraumatologiaCentro Hospitalar do PortoPortoPortugal
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Higher Prevalence of Mixed or Solid Pseudotumors in Metal-on-Polyethylene Total Hip Arthroplasty Compared With Metal-on-Metal Total Hip Arthroplasty and Resurfacing Hip Arthroplasty. J Arthroplasty 2018. [PMID: 29526334 DOI: 10.1016/j.arth.2018.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pseudotumors are a common finding in metal-on-metal (MoM) total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). However, information on pseudotumors in metal-on-polyethylene (MoP) THA is limited. METHODS One hundred eleven patients with 148 hip articulations-30 MoM THA, 47 MoM RHA, and 71 MoP THA-participated in a cross-sectional study at mean 7.1 (range: 0.2-21.5) years postoperatively. Patients were evaluated with metal artifact reducing sequence magnetic resonance imaging, measurements of metal ions, clinical scores of Harris Hip Score, Oxford Hip Score, the Copenhagen Hip and Groin Outcome Score, and conventional radiographs. RESULTS Pseudotumors were present in 13 of 30 (43%) MoM THA, 13 of 47 (28%) MoM RHA, and 29 of 71 (41%) MoP THA patients, which was a similar prevalence (P = .10). The prevalence of mixed or solid pseudotumors was significantly higher in patients with MoP THA (n = 10) compared to MoM THA (n = 3) and MoM THA (n = 0), (P = .01). Hips with a mixed or solid pseudotumor had significantly poorer scores of Harris Hip Score (P = .01) and OHS (P = .002) and higher metal ion levels of cobalt (P = .0009) compared to hips without a pseudotumor or with a cystic pseudotumor. CONCLUSION Pseudotumors have primarily been associated with MoM hip articulations, but we found a similar pseudotumor prevalence in MoP THA, which is the most common bearing worldwide. Mixed or solid pseudotumors were more often seen in MoP THA compared with MoM hip articulations, and patients with a mixed or solid pseudotumor had poorer clinical scores and higher metal ion levels than patients without a pseudotumor or with a cystic pseudotumor.
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Fallahnezhad K, Oskouei RH, Badnava H, Taylor M. An adaptive finite element simulation of fretting wear damage at the head-neck taper junction of total hip replacement: The role of taper angle mismatch. J Mech Behav Biomed Mater 2017; 75:58-67. [DOI: 10.1016/j.jmbbm.2017.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/22/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022]
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Mueller U, Braun S, Schroeder S, Sonntag R, Kretzer JP. Same Same but Different? 12/14 Stem and Head Tapers in Total Hip Arthroplasty. J Arthroplasty 2017; 32:3191-3199. [PMID: 28552447 DOI: 10.1016/j.arth.2017.04.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/27/2017] [Accepted: 04/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Taper corrosion has been identified to be a major concern in total hip arthroplasty during the past years. So far, the mechanisms that lead to taper corrosion in modular taper junctions are not fully understood. However, it has been shown that corrosion is also influenced by the geometry and topography of the taper, and these parameters vary among the implant manufacturers. The purpose of this study was to investigate the variations of common stem and head tapers regarding design and surface characteristics. METHODS An analysis of selected commercially available 12/14 stem and head tapers was performed. As geometric parameters, the taper angle, the opening taper diameter, and the taper length were measured using a coordinate measuring machine. Several topographic parameters were determined using a tactile roughness measurement instrument. RESULTS Although all investigated tapers are so-called 12/14 tapers, this study showed that the stem and head tapers differ among the manufacturers. The stem tapers were clearly different in both geometry and topography, and the range in variation of the topographic parameter was greater than it was for the geometric parameter. In contrast, the head tapers were different in their geometry, although not in topography. CONCLUSION Ultimately, this study provides an overview on the characteristics and variations of modular hip taper connections, and in addition, a new classification system regarding the surface finish is presented. These findings could be further considered in experimental corrosion or retrieval studies.
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Affiliation(s)
- Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Sonntag
- 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
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Oskouei RH, Barati MR, Farhoudi H, Taylor M, Solomon LB. A new finding on the in-vivo crevice corrosion damage in a CoCrMo hip implant. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017. [DOI: 10.1016/j.msec.2017.05.086] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Mikkelsen RT, Fløjstrup M, Klem N, Tellefsen RA, Lund C, Kjærsgaard-Andersen P, Skjødt T, Varnum C. Modular Neck vs Nonmodular Femoral Stems in Total Hip Arthroplasty-Clinical Outcome, Metal Ion Levels, and Radiologic Findings. J Arthroplasty 2017; 32:2774-2778. [PMID: 28457759 DOI: 10.1016/j.arth.2017.03.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/17/2017] [Accepted: 03/30/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Modular neck femoral stem (MNFS) for total hip arthroplasty (THA) was introduced to optimize the outcome, but created concerns about pain, elevated blood metal ion levels, and adverse reaction to metal debris such as pseudotumors (PTs), related to corrosion between femoral neck and stem. We compared these outcomes in patients with MNFS or nonmodular femoral stem (NFS) THA. METHODS Thirty-three patients with unilateral MNFS THA were compared with 30 patients with unilateral NFS THA. Levels of pain, serum cobalt, serum chromium were determined. Magnetic resonance imaging was performed to describe PT and fatty atrophy of muscles. RESULTS The MNFS and NFS group had a mean follow-up of 2.3 and 3.1 years, respectively. Four and 13 patients in the MNFS and NFS group had pain, respectively (P = .005). The MNFS group had higher levels of serum cobalt (P < .0001) and chromium (P = .006). PTs were present in both the MNFS (n = 15) and NFS (n = 7) groups (P = .066). PTs were related to serum cobalt (P = .04) but not to pain or serum chromium. Fatty atrophy prevalence in the piriformis and gluteal muscles were higher in patients with MNFS (P = .009 and P = .032, respectively). CONCLUSION More patients in the NFS group had pain. Serum cobalt and chromium levels were higher in the MNFS group. Prevalence of PTs was twice as high in the MNFS group, but the difference was insignificant.
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Affiliation(s)
- Rasmus T Mikkelsen
- Section for Hip and Knee Replacement, Department of Orthopaedic Surgery, Vejle Hospital, Vejle, Denmark
| | | | | | | | | | - Per Kjærsgaard-Andersen
- Section for Hip and Knee Replacement, Department of Orthopaedic Surgery, Vejle Hospital, Vejle, Denmark
| | - Thomas Skjødt
- Department of Radiology, Vejle Hospital, Vejle, Denmark
| | - Claus Varnum
- Section for Hip and Knee Replacement, Department of Orthopaedic Surgery, Vejle Hospital, Vejle, Denmark
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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.
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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
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16
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Campbell J, Rajaee S, Brien E, Paiement GD. Inflammatory pseudotumor after ceramic-on-ceramic total hip arthroplasty. Arthroplast Today 2017; 3:83-87. [PMID: 28695179 PMCID: PMC5485220 DOI: 10.1016/j.artd.2016.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 12/12/2022] Open
Abstract
We present a unique case of a symptomatic adverse local tissue reaction in a patient with a ceramic-on-ceramic total hip bearing surface. To our knowledge, this pathological finding has not yet been described in a ceramic-on-ceramic articulation without a cobalt-chromium alloy trunnion or modular neck component as a source of metal wear. We conclude that despite its mechanical mostly benign wear characteristics, ceramic wear debris is not entirely inert and may lead to the development of adverse local tissue reaction.
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Affiliation(s)
- Joshua Campbell
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean Rajaee
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Earl Brien
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Guy D Paiement
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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17
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Pourzal R, Hall DJ, Ha NQ, Urban RM, Levine BR, Jacobs JJ, Lundberg HJ. Does Surface Topography Play a Role in Taper Damage in Head-neck Modular Junctions? Clin Orthop Relat Res 2016; 474:2232-42. [PMID: 27339123 PMCID: PMC5014821 DOI: 10.1007/s11999-016-4933-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are increasing reports of total hip arthroplasty failure subsequent to modular taper junction corrosion. The surfaces of tapers are machined to have circumferential machining marks, resulting in a surface topography of alternating peaks and valleys on the scale of micrometers. It is unclear if the geometry of this machined surface topography influences the degree of fretting and corrosion damage present on modular taper junctions or if there are differences between modular taper junction material couples. QUESTIONS/PURPOSES (1) What are the differences in damage score and surface topography between CoCr/CoCr and CoCr/Ti modular junctions? (2) How are initial surface topography, flexural rigidity, taper angle mismatch, and time in situ related to visual taper damage scores for CoCr/CoCr couples? (3) How are initial surface topography, flexural rigidity, taper angle mismatch, and time in situ related to visual taper damage scores for CoCr/Ti couples? METHODS Damage on stem and head tapers was evaluated with a modified Goldberg score. Differences in damage scores were determined between a group of 140 CoCr/CoCr couples and 129 CoCr/Ti couples using a chi-square test. For a subgroup of 70 retrievals, selected at random, we measured five variables, including initial stem taper machining mark height and spacing, initial head taper roughness, flexural rigidity, and taper angle mismatch. All retrievals were obtained at revision surgeries. None were retrieved as a result of metal-on-metal failures or were recalled implants. Components were chosen so there was a comparable number of each material couple and damage score. Machining marks around the circumference of the tapers were measured using white light interferometry to characterize the initial stem taper surface topography in terms of the height of and spacing between machining mark peaks as well as initial head taper roughness. The taper angle mismatch was assessed with a coordinate measuring machine. Flexural rigidity was determined based on measurements of gross taper dimensions and material properties. Differences of median or mean values of all variables between material couples were determined (Wilcoxon rank-sum tests and t-tests). The effect of all five variables along with time in situ on stem and head taper damage scores was tested with a multiple regression model. With 70 retrievals, a statistical power of 0.8 could be achieved for the model. RESULTS Damage scores were different between CoCr/CoCr and CoCr/Ti modular taper junction material couples. CoCr/CoCr stem tapers were less likely to be mildly damaged (11%, p = 0.006) but more likely to be severely damaged (4%, p = 0.02) than CoCr/Ti stem tapers (28% and 1%, respectively). CoCr/CoCr couples were less likely to have moderately worn head tapers (7% versus 17%, p = 0.003). Stem taper machining mark height and spacing and head taper roughness were 11 (SD 3), 185 (SD 46), and 0.57 (SD 0.5) for CoCr/CoCr couples and 10 (SD 3), 170 (SD 56), and 0.64 (SD 0.4) for CoCr/Ti couples, respectively. There was no difference (p = 0.09, p = 0.1, p = 0.16, respectively) for either factor between material couples. Larger stem taper machining mark heights (p = 0.001) were associated with lower stem taper damage scores, and time in situ (p = 0.006) was associated with higher stem taper damage scores for CoCr/CoCr material couples. Stem taper machining marks that had higher peaks resulted in slower damage progression over time. For CoCr/Ti material couples, head taper roughness was associated with higher stem (p = 0.001) and head taper (p = 0.003) damage scores, and stem taper machining mark height, but not time in situ, was associated with lower stem taper damage scores (p = 0.007). CONCLUSIONS Stem taper surface topography was related to damage scores on retrieved head-neck modular junctions; however, it affected CoCr/CoCr and CoCr/Ti couples differently. CLINICAL RELEVANCE A taper topography of circumferential machining marks with higher peaks appears to enable slower damage progression and, subsequently, a reduction of the reported release of corrosion products. This may be of interest to implant designers and manufacturers in an effort to reduce the effects of metal release from modular femoral components.
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Affiliation(s)
- Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Deborah J. Hall
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Nguyen Q. Ha
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Robert M. Urban
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Brett R. Levine
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Joshua J. Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
| | - Hannah J. Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL 60612 USA
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18
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Tischler EH, Plummer DR, Chen AF, Della Valle CJ, Parvizi J. Leukocyte Esterase: Metal-on-Metal Failure and Periprosthetic Joint Infection. J Arthroplasty 2016; 31:2260-3. [PMID: 27094243 DOI: 10.1016/j.arth.2016.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 03/01/2016] [Accepted: 03/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adverse local tissue reactions (ALTRs) and periprosthetic joint infection can occur after metal-on-metal total hip arthroplasty (THA), both potentially generating purulent synovial fluid (SF) and elevated white cell count. This makes it difficult to distinguish between diagnoses; therefore, we evaluated leukocyte esterase (LE) strip test's reliability in ruling out periprosthetic joint infection in ALTR revision THA. METHODS Sixty-one patients with ALTRs and an LE strip test were evaluated, excluding 15 cases with SF metallic debris. LE strip tests were classified -/trace, + (mildly positive), and ++ (strongly positive). RESULTS LE strip tests were ++, +, -/trace in 8 patients (13.1%), 14 (23.0%), and 39 (63.9%), respectively. Means and ranges of SF white cell count and polymorphonuclear percentage were 1291.4 (0-10,886 cells/μL), and 46.1% (0%-94%), respectively. CONCLUSION ++ LE strip test, in conjunction with preoperative work-ups, reliably rules out infection in 92.9% of patients undergoing THA revision secondary to ALTR.
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Affiliation(s)
- Eric H Tischler
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Antonia F Chen
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Javad Parvizi
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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19
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Liow MHL, Urish KL, Preffer FI, Nielson GP, Kwon YM. Metal Ion Levels Are Not Correlated With Histopathology of Adverse Local Tissue Reactions in Taper Corrosion of Total Hip Arthroplasty. J Arthroplasty 2016; 31:1797-802. [PMID: 26923497 DOI: 10.1016/j.arth.2016.01.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The underlying biological mechanism in the formation of adverse local tissue reaction in taper corrosion of total hip arthroplasty (THA) remains unknown. This study evaluated whether there was a dose-dependent relationship between metal ion levels, intraoperative tissue damage and ALVAL (aseptic lymphocyte-dominated vasculitis-associated lesion) scores in dual taper THA patients who underwent revisions for taper corrosion. METHODS We performed a retrospective review of 31 dual taper THA patients who underwent revision surgery from May 2013 to October 2013. Preoperative serum metal ion levels, intraoperative tissue damage grading, and ALVAL scores were reviewed. Multivariate analysis was performed to determine if an association existed between metal ion levels, intraoperative tissue damage, and ALVAL scores. RESULTS Findings consistent with adverse local tissue reaction were found in all cases. We noted 10 patients with low, 8 with moderate, and 13 with high ALVAL scores, respectively. For intraoperative tissue damage, we recorded 2 (grade 1), 22 (grade 2) and 7 (grade 3) cases. Preoperatively, there was preferential elevation of serum cobalt (3.8 ng/mL, 2.3-17.0) compared to serum chromium (1.0 ng/mL, 0.2-5.8). There was no correlation between preoperative metal ion levels and intraoperative tissue damage (R = -0.06, P = .74) or ALVAL scores (R = -0.04, P = .481). There was also no correlation between intraoperative tissue damage and ALVAL score (R = -0.06, P = .73). CONCLUSION There was no significant correlation between ALVAL scores and prerevision surgery metal ion levels or intraoperative tissue damage, suggesting that the biological mechanism of histologic morphology cannot be solely attributed to elevated metal ion levels and is likely multifactorial, reflecting a complex interplay between implant and patient factors.
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Affiliation(s)
- Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kenneth L Urish
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frederic I Preffer
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gunnlaugur P Nielson
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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20
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Influence of geometry and materials on the axial and torsional strength of the head–neck taper junction in modular hip replacements: A finite element study. J Mech Behav Biomed Mater 2016; 60:118-126. [DOI: 10.1016/j.jmbbm.2015.12.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/26/2015] [Accepted: 12/29/2015] [Indexed: 11/23/2022]
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21
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Fagotti L, Vicente JRN, Miyahara HS, de Oliveira PV, Bernabé AC, Croci AT. Formation of a pseudotumor in total hip arthroplasty using a tribological metal-polyethylene pair. Rev Bras Ortop 2016; 50:747-51. [PMID: 27218090 PMCID: PMC4868081 DOI: 10.1016/j.rboe.2015.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022] Open
Abstract
The aim here was to report a case of a young adult patient who evolved with tumor formation in the left thigh, 14 years after revision surgery on hip arthroplasty. Davies in 2005 made the first description of this disease in patients undergoing metal-on-metal hip arthroplasty. Over the last decade, however, pseudotumors around metal-on-polyethylene surfaces have become more prevalent. Our patient presented with increased volume of the left thigh 8 years after hip arthroplasty revision surgery. Two years before the arising of the tumor in the thigh, a nodule in the inguinal region was investigated to rule out a malignant neoplastic process, but the results were inconclusive. The main preoperative complaints were pain, functional limitation and marked reduction in the range of motion of the left hip. Plain radiographs showed loosening of acetabular and femoral, and a large mass between the muscle planes was revealed through magnetic resonance imaging of the left thigh. The surgical procedure consisted of resection of the lesion and removal of the components through lateral approach. In respect of total hip arthroplasty, pseudotumors are benign neoplasms in which the bearing surface consists of metal-on-metal, but they can also occur in different tribological pairs, as presented in this case.
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Affiliation(s)
- Lorenzo Fagotti
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - José Ricardo Negreiros Vicente
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Helder Souza Miyahara
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Antônio Carlos Bernabé
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Alberto Tesconi Croci
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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22
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Davis DL, Morrison JJ. Hip Arthroplasty Pseudotumors: Pathogenesis, Imaging, and Clinical Decision Making. J Clin Imaging Sci 2016; 6:17. [PMID: 27195183 PMCID: PMC4863402 DOI: 10.4103/2156-7514.181493] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/14/2016] [Indexed: 12/13/2022] Open
Abstract
Pseudotumors are a complication of hip arthroplasty. The goal of this article is to review the clinical presentation, pathogenesis, histology, and the role of diagnostic imaging in clinical decision making for treatment, and surveillance of pseudotumors. We will discuss the multimodal imaging appearances, differential diagnosis, associated complications, treatment, and prognosis of pseudotumors, as an aid to the assessment of orthopedic prostheses at the hip.
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Affiliation(s)
- Derik L Davis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James J Morrison
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
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23
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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.
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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
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24
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Formação de pseudotumor na artroplastia total do quadril com par tribológico metal‐polietileno. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2015.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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25
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Goto T, Mineta K, Takasago T, Hamada D, Sairyo K. Pseudotumor associated with cemented bipolar hemiarthroplasty: an unusual presentation as a granulomatous thigh mass. Skeletal Radiol 2015; 44:1541-5. [PMID: 26096584 DOI: 10.1007/s00256-015-2196-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/21/2015] [Accepted: 06/10/2015] [Indexed: 02/02/2023]
Abstract
Although polyethylene wear-induced osteolysis is a common complication of hip arthroplasty, extensile osteolysis developing into a large granulomatous thigh mass at a site distant from the joint is rare. We report a case of a thigh pseudotumor 25 years after cemented bipolar hemiarthroplasty, in which x-rays revealed a radiolucent line around the stem at the proximal site only, not at the diaphysis of the femur. We initially suspected a real tumor because it had a unique appearance, as if the mass resorbed the posterior cortex of the femur, and it was located at a site distant from the proximal osteolytic lesions. We clearly showed the existence of a connection between the thigh mass and the joint space by performing intra-articular injection of contrast medium with continuous pressure. It seemed that polyethylene wear particles were transported distally along the stem-cement interface by fluid pressure, and an osteolytic reaction against polyethylene wear particles had occurred at the posterior middle third of the stem where the cement mantle was nonuniform and polyethylene particles first came into contact with the bone. Our findings suggest that nonuniform cemented prosthesis with osteolysis, even if it is low grade in a limited area, carries the risk of extensile osteolysis with asymptomatic development of an extra-articular granulomatous mass.
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Affiliation(s)
- Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan,
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26
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Banerjee S, Cherian JJ, Bono JV, Kurtz SM, Geesink R, Meneghini RM, Delanois RE, Mont MA. Gross trunnion failure after primary total hip arthroplasty. J Arthroplasty 2015; 30:641-8. [PMID: 25499678 DOI: 10.1016/j.arth.2014.11.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 10/17/2014] [Accepted: 11/13/2014] [Indexed: 02/01/2023] Open
Abstract
Unfavorable outcomes from trunnion fretting and corrosion damage have been reported in the literature, gross failures of tapers in primary total hip arthroplasties have been less frequently reported. We report on 5 patients, who presented with gross trunnion failures of modular metal-on-polyethylene or ceramic-on-polyethylene bearings from 5 implant manufacturers, all necessitating revision surgery. None of these patients had an antecedent history of trauma, and the majority presented with pain or instability. No common factor was identified that may be predictive of these type of failures. Since there were 5 different stem designs, this suggests that it may be a rare generic phenomenon occurring with multiple designs. Currently, further investigations are necessary, including retrieval analysis, to identify risk factors that may predispose to such failures.
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27
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Abstract
Use of large-head metal-on-metal (MoM) bearing surfaces in total hip arthroplasty (THA) has created new and unique modes of failure for this type of articulation. These unique modes are in addition to the traditional modes of failure seen in conventional THA, which include instability, osteolysis, infection, iliopsoas tendinitis, aseptic loosening, and periprosthetic fracture. Ion levels and cross-sectional imaging are helpful when evaluating a MoM patient in the identification of adverse local tissue reactions. Unique modes of failure in MoM THA include tissue necrosis, metallosis-induced osteolysis, skin hypersensitivity reactions, and rarely systemic cobaltism. This article outlines the evaluation and treatment of modes of failure in MoM THA.
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Affiliation(s)
- Keith A Fehring
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Thomas K Fehring
- Ortho Carolina Hip and Knee Center, 2001 Vail Avenue, Charlotte, NC 28209, USA
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28
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Trunnionosis: the latest culprit in adverse reactions to metal debris following hip arthroplasty. Skeletal Radiol 2015; 44:433-40. [PMID: 25109382 DOI: 10.1007/s00256-014-1978-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/27/2014] [Accepted: 07/30/2014] [Indexed: 02/02/2023]
Abstract
The imaging findings of periprosthetic soft tissue lesions (pseudotumours) have been typically defined in the context of newer second-generation metal-on-metal hip arthroplasty. More recently, similar findings have been described in the setting of non-metal-on-metal prostheses. Although uncommon, wear and corrosion between the metal surfaces at the head-neck ('trunnionosis') and neck-stem interfaces are the potential culprits. With modular junctions containing at least one cobalt chromium component frequently present in hip arthroplasty prostheses, the incidence of this mode of adverse wear may be higher than previously thought (irrespective of the specific bearing couple used). In the present report, we described a case of a severe adverse local tissue reaction secondary to suspected corrosion at the head-neck taper in a metal-on-polyethylene total hip arthroplasty and reviewed the literature. Knowledge of this topical entity should help radiologists facilitate early diagnosis and ensure early management of this potentially serious complication.
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29
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Fehring TK, Fehring K, Odum SM. Metal artifact reduction sequence MRI abnormalities occur in metal-on-polyethylene hips. Clin Orthop Relat Res 2015; 473:574-80. [PMID: 25141843 PMCID: PMC4294897 DOI: 10.1007/s11999-014-3873-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND To determine the importance of MRI abnormalities in metal-on-metal (MoM) bearings, it is important to understand the baseline features of this diagnostic tool in conventional metal-on-polyethylene (MoP) bearings. QUESTIONS/PURPOSES What are the frequency, size, and types of MRI-documented adverse local tissue reactions in asymptomatic patients with MoP bearings? METHODS We recruited 50 patients 5 years after a MoP total hip arthroplasty from a pool of patients in our joint registry who had a Harris hip score of >90. To be included, patients had to be without pain and have adequate radiographs. Our data set included 50 asymptomatic patients with MoP bearings who underwent a metal artifact reduction sequence MRI. RESULTS MRI abnormalities were seen in 14 of 50 (28%) asymptomatic patients who were studied. Thirteen of the 14 abnormalities were cystic thin-walled lesions with a mean of 18 cm3 (range, 1-79 cm3). CONCLUSIONS MRI abnormalities were noted in nearly one-third of asymptomatic patients with MoP bearings. Decisions concerning revision of MoM bearings should not be based on isolated MRI findings because MRI abnormalities are commonly seen regardless of bearing type. A number of factors should determine the need for intervention including pain, mechanical symptoms, abductor weakness, component type, component position, and ion levels as well as MRI findings. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thomas K. Fehring
- />OrthoCarolina Hip and Knee Center, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28209 USA
| | - Keith Fehring
- />Virginia Commonwealth University Medical Center, West Hospital, Richmond, VA USA
| | - Susan M. Odum
- />OrthoCarolina Research Institute, Charlotte, NC USA
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Ebramzadeh E, Campbell P, Tan TL, Nelson SD, Sangiorgio SN. Can wear explain the histological variation around metal-on-metal total hips? Clin Orthop Relat Res 2015; 473:487-94. [PMID: 25141844 PMCID: PMC4294923 DOI: 10.1007/s11999-014-3874-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a general perception that adverse local tissue reactions in metal-on-metal hip arthroplasties are caused by wear, but the degree to which this is the case remains controversial. QUESTIONS/PURPOSES To what extent is the magnitude of wear associated with (1) the histological changes; (2) presence of metallosis; and (3) likelihood of pseudotumor formation in the periprosthetic tissues? METHODS One hundred nineteen metal-on-metal total hip arthroplasties and hip resurfacings were selected from a retrieval collection of over 500 implants (collected between 2004 and 2012) based on the availability of periprosthetic tissues collected during revision, clinical data including presence or absence of pseudotumor or metallosis observed intraoperatively, and wear depth measured using a coordinate measurement machine. Histological features of tissues were scored for aseptic lymphocytic vasculitis-associated lesions (ALVAL). Correlation analysis was performed on the three endpoints of interest. RESULTS With the sample size available, no association was found between wear magnitude and ALVAL score (ρ=-0.092, p=0.423). Median wear depth (ball and cup) was greater in hips with metallosis (137 μm; range, 8-873 μm) than in those without (18 μm; range, 8-174 μm; p<0.0001). With the numbers available, no statistically significant association between wear depth and pseudotumor formation could be identified; median wear depth was 74 μm in hips with pseudotumors and 26 μm in those without (p=0.741). CONCLUSIONS Wear alone did not explain the histopathological changes in the periprosthetic tissues. A larger sample size and more sensitive outcome variable assessments may have revealed a correlation. However, wear depth has been inconsistently associated with pseudotumor formation, perhaps because some patients with hypersensitivity may develop pseudotumors despite low wear. CLINICAL RELEVANCE Metal wear alone may not explain the histological reactions and pseudotumors around metal-on-metal hip implants.
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Affiliation(s)
- Edward Ebramzadeh
- The J. Vernon Luck, Sr, MD Orthopaedic Research Center, UCLA, Los Angeles, CA USA ,Department of Orthopaedic Surgery, Orthopaedic Institute for Children, 403 West Adams Boulevard, Los Angeles, CA 90007 USA
| | - Patricia Campbell
- The J. Vernon Luck, Sr, MD Orthopaedic Research Center, UCLA, Los Angeles, CA USA ,Department of Orthopaedic Surgery, Orthopaedic Institute for Children, 403 West Adams Boulevard, Los Angeles, CA 90007 USA
| | - Timothy L. Tan
- The J. Vernon Luck, Sr, MD Orthopaedic Research Center, UCLA, Los Angeles, CA USA ,Department of Orthopaedic Surgery, Orthopaedic Institute for Children, 403 West Adams Boulevard, Los Angeles, CA 90007 USA
| | - Scott D. Nelson
- Department of Pathology, Santa Monica UCLA Medical Center, 1250 16th street, Santa Monica, CA 90404 USA
| | - Sophia N. Sangiorgio
- The J. Vernon Luck, Sr, MD Orthopaedic Research Center, UCLA, Los Angeles, CA USA ,Department of Orthopaedic Surgery, Orthopaedic Institute for Children, 403 West Adams Boulevard, Los Angeles, CA 90007 USA
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Jakobsen SS, Lidén C, Søballe K, Johansen JD, Menné T, Lundgren L, Bregnbak D, Møller P, Jellesen MS, Thyssen JP. Failure of total hip implants: metals and metal release in 52 cases. Contact Dermatitis 2014; 71:319-25. [PMID: 25041132 DOI: 10.1111/cod.12275] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/14/2014] [Accepted: 05/20/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The pathogenesis of total joint replacement failure is multifactorial. One hypothesis suggests that corrosion and wear of alloys result in metal ion release, which may then cause sensitization and even implant failure, owing to the acquired immune reactivity. OBJECTIVES To assess cobalt, nickel and chromium(VI) release from, and the metal composition of, failed metal-on-ethylene total hip replacements. MATERIALS/METHODS Implant components from 52 revision cases were evaluated with spot tests for free nickel, cobalt, and chromium (VI) ions. Implant composition was determined with X-ray fluorescence spectroscopy, and information on the reason for revision and complications in relation to surgery was collected from the medical charts when possible (72%). For 10 implants, corrosion was further characterized with scanning electron microscopy. RESULTS We detected cobalt release from three of 38 removed femoral heads and from one of 24 femoral stems. Nickel release was detected from one of 24 femoral stems. No chromium(VI) release was detected. CONCLUSIONS We found that cobalt and nickel were released from some failed total hip arthroplasties, and corrosion was frequently observed. Metal ions and particles corroded from metal-on-polyethylene may play a role in the complex aetiopathology of implant failure.
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Affiliation(s)
- Stig S Jakobsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, DK-8000, Aarhus, Denmark
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van Erve RHGP. The absence of a metal-on-metal bearing does not preclude the formation of a destructive pseudotumor in the hip--a case report. Acta Orthop 2013; 84:598. [PMID: 24237423 PMCID: PMC3851676 DOI: 10.3109/17453674.2013.862461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- R H G P van Erve
- Orthopaedic surgeon, Care to Move, Centrum voor bewegingsdiagnostiek en behandeling,7418 ET 8-c Deventer,the Netherlands
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