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Pagani NR, Coden GS, Ramsden DM, Zink TM, Ward DM, Bono JV, Talmo CT. Failure Following Revision Total Hip Arthroplasty After Cobalt-Chrome Femoral Heads are Placed on a Retained Femoral Stem. J Arthroplasty 2024:S0883-5403(24)00437-6. [PMID: 38754707 DOI: 10.1016/j.arth.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Failure due to trunnionosis with adverse local tissue reaction (ALTR) has been reported with cobalt-chrome (CoCr) heads in total hip arthroplasty (THA); however, there are limited data on the use of these heads in the revision setting. The purpose of this study was to analyze the outcomes of patients who underwent revision THA with a retained femoral component and received a CoCr femoral head on a used trunnion. METHODS In this retrospective review, we identified all patients who underwent revision THA with a retained femoral component and received a CoCr femoral head between February 2006 and March 2014. Demographic factors, implant details, and postoperative complications, including the need for repeat revisions, were recorded. In total, 107 patients were included (mean age 67 years, 74.0% women). Of the 107 patients, 24 (22.4%) required repeat revisions. RESULTS Patients who required repeat revision were younger than those who did not (mean age: 62.9 versus 69, P = .03). The most common indications for repeat revision were instability (8 of 24, 33.3%), ALTR (5 of 24, 20.8%), and infection (4 of 18, 16.7%). Evidence of ALTR or metallosis was identified at the time of reoperation in 10 of the 24 patients who underwent re-revision (41.7%). CONCLUSIONS The placement of a new CoCr femoral head on a used trunnion during revision THA with a retained femoral component carries a significant risk of complication (22.4%) and should be avoided when possible.
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Affiliation(s)
- Nicholas R Pagani
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Gloria S Coden
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - David M Ramsden
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Thomas M Zink
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Daniel M Ward
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - James V Bono
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Carl T Talmo
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
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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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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.
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Affiliation(s)
| | | | | | | | | | - Christopher E. Pelt
- Corresponding author. 590 Wakara Way, Salt Lake City, UT 84108, USA. Tel.: +1 801 703 4046.
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Klemt C, Uzosike AC, Esposito JG, Harvey MJ, Yeo I, Subih M, Kwon YM. The utility of machine learning algorithms for the prediction of patient-reported outcome measures following primary hip and knee total joint arthroplasty. Arch Orthop Trauma Surg 2023; 143:2235-2245. [PMID: 35767040 DOI: 10.1007/s00402-022-04526-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/16/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly used as quality benchmark in total hip and knee arthroplasty (THA; TKA) due to bundled payment systems that aim to provide a patient-centered, value-based treatment approach. However, there is a paucity of predictive tools for postoperative PROMs. Therefore, this study aimed to develop and validate machine learning models for the prediction of numerous patient-reported outcome measures following primary hip and knee total joint arthroplasty. METHODS A total of 4526 consecutive patients (2137 THA; 2389 TKA) who underwent primary hip and knee total joint arthroplasty and completed both pre- and postoperative PROM scores was evaluated in this study. The following PROM scores were included for analysis: HOOS-PS, KOOS-PS, Physical Function SF10A, PROMIS SF Physical and PROMIS SF Mental. Patient charts were manually reviewed to identify patient demographics and surgical variables associated with postoperative PROM scores. Four machine learning algorithms were developed to predict postoperative PROMs following hip and knee total joint arthroplasty. Model assessment was performed through discrimination, calibration and decision curve analysis. RESULTS The factors most significantly associated with the prediction of postoperative PROMs include preoperative PROM scores, Charlson Comorbidity Index, American Society of Anaesthesiology score, insurance status, age, length of hospital stay, body mass index and ethnicity. The four machine learning models all achieved excellent performance across discrimination (AUC > 0.83), calibration and decision curve analysis. CONCLUSION This study developed machine learning models for the prediction of patient-reported outcome measures at 1-year following primary hip and knee total joint arthroplasty. The study findings show excellent performance on discrimination, calibration and decision curve analysis for all four machine learning models, highlighting the potential of these models in clinical practice to inform patients prior to surgery regarding their expectations of postoperative functional outcomes following primary hip and knee total joint arthroplasty. LEVEL OF EVIDENCE Level III, case control retrospective analysis.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Akachimere Cosmas Uzosike
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - John G Esposito
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Michael Joseph Harvey
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ingwon Yeo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Murad Subih
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Trunnions and Modularity in Total Hip Arthroplasty: A Historical Review With Current Clinical Implications. J Am Acad Orthop Surg 2023; 31:189-197. [PMID: 36728328 DOI: 10.5435/jaaos-d-22-00498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/27/2022] [Indexed: 02/03/2023] Open
Abstract
Trunnion in total hip arthroplasty refers to the interface between the neck of a femoral stem and the femoral head. Clinical complications arising from damage to this junction, whether it be due to mechanical wear, corrosion, or a combination, are referred to as mechanically assisted crevice corrosion (MACC), also commonly known as trunnionosis. With the use of modular hip prostheses, which help customize offset and leg length to an individual patient's anatomy, the incidence of MACC and revision due to MACC has increased in recent years. Although the cause of MACC is multifactorial, with patient factors and technique factors contributing to this condition, taper design and geometry, metallurgical properties of implants, and size mismatch of the bearing couple are some of the implant factors that have also been implicated in this clinical phenomenon. Understanding the history of taper design and geometry, the track record of older implants, and the rationale behind the development of current prostheses can help surgeons choose the right implants for their patients and accurately assess the pros and cons of new implants being introduced to the market each year.
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Krumme JW, Bonanni S, Patel NK, Golladay GJ. Technical Considerations and Avoiding Complications in Total Hip Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202211000-00011. [PMID: 36733988 PMCID: PMC9668563 DOI: 10.5435/jaaosglobal-d-22-00234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/25/2022] [Indexed: 11/22/2022]
Abstract
Total hip arthroplasty (THA) is considered to be the surgical procedure of the 20th century. Current projections show that by 2030, primary THA is expected to grow by 171%, with revision THA expected to increase by 142% in the same time frame. Although complications are not common, when they occur, they can cause notable morbidity to the patient. Understanding the unique anatomy and needs of each patient will prepare the surgeon to avoid soft-tissue or bony injury, optimize prosthesis placement, and decrease the risk of infection. This article aims to highlight common causes of early revision THA and provide specific technical strategies to avoid these complications. Following a systematic approach to the primary THA and using these techniques will assist the surgeon in avoiding complications to revision hip arthroplasty.
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Affiliation(s)
- John W. Krumme
- From the Department of Orthopaedic Surgery, University of Missouri–Kansas City, Kansas City, MO (Dr. Krumme and Dr. Bonanni), and the Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA (Dr. Patel and Dr. Golladay)
| | - Sean Bonanni
- From the Department of Orthopaedic Surgery, University of Missouri–Kansas City, Kansas City, MO (Dr. Krumme and Dr. Bonanni), and the Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA (Dr. Patel and Dr. Golladay)
| | - Nirav K. Patel
- From the Department of Orthopaedic Surgery, University of Missouri–Kansas City, Kansas City, MO (Dr. Krumme and Dr. Bonanni), and the Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA (Dr. Patel and Dr. Golladay)
| | - Gregory J. Golladay
- From the Department of Orthopaedic Surgery, University of Missouri–Kansas City, Kansas City, MO (Dr. Krumme and Dr. Bonanni), and the Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA (Dr. Patel and Dr. Golladay)
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Metal Articulations as a Source of Total Hip Arthroplasty Pain. J Arthroplasty 2022; 37:1483-1487. [PMID: 35101592 DOI: 10.1016/j.arth.2022.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/03/2022] [Accepted: 01/20/2022] [Indexed: 02/02/2023] Open
Abstract
The consensus systematic risk stratification algorithm from the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and The Hip Society summarizes clinical challenges in evaluation and treatment of metal-on-polyethylene total hip arthroplasty (THA) patients with adverse local tissue reaction (ALTR) due to mechanically assisted crevice corrosion (MACC), reviews up-to-date evidence, and identifies the areas for future research in order to provide a useful resource for orthopedic surgeons providing care to these patients. A painful THA has various intrinsic and extrinsic causes. ALTR is one of the intrinsic causes in patients with painful THA. The occurrence of ALTR due to MACC at modular junctions is likely to be multifactorial, including implant, surgical, and patient factors. Therefore, a systematic evaluation needs to involve a focused clinical history, detailed physical examination, laboratory tests, and imaging in order to identify potential differential diagnoses. There should be a low threshold to perform a systematic evaluation of patients with painful non-metal-on-metal THA, including patients with metal-on-polyethylene THA, and modular dual-mobility THA with the CoCr metal acetabular insert, as early recognition and diagnosis of ALTR due to MACC will facilitate initiation of appropriate treatment prior to significant adverse biological reactions. Specialized tests such as blood metal analysis and metal artifact reduction sequence magnetic resonance imaging are important modalities in evaluation and management of ALTR in patients with painful THA.
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Tsai SHL, Lau NC, Chen WC, Chien RS, Tischler EH, Fu TS, Chen DWC. Total hip arthroplasty has higher complication rates in stiff spine patients: a systematic review and network meta-analysis. J Orthop Surg Res 2022; 17:353. [PMID: 35842632 PMCID: PMC9288065 DOI: 10.1186/s13018-022-03237-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) and spinal fusion (SF) classified as stiff spines have been associated with the increased rate of complications following total hip arthroplasty (THA). However, the differences between the two cohorts have inconsistent evidence. METHODS We searched for studies comparing complications among stiff spine patients, including SF and AS, who underwent THA in PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus until March 2021. Studies detailing rates of mechanical complications, aseptic loosening, dislocation, infection, and revisions were included. We performed network meta-analyses using frequentist random-effects models to compare differences between cohorts. We used P-score to rank the better exposure with the lowest complications. RESULTS Fourteen studies were included in the final analysis. A total of 740,042 patients were included in the systematic review and network meta-analysis. Mechanical complications were highest among SF patients (OR 2.33, 95% CI 1.86, 2.92, p < 0.05), followed by AS patients (OR 1.18, 95% CI 0.87, 1.61, p = 0.82) compared to controls. Long Spinal Fusions had the highest aseptic loosening (OR 2.33, 95% CI 1.83, 2.95, p < 0.05), dislocations (OR 3.25, 95% CI 2.58, 4.10, p < 0.05), infections (OR 2.14, 95% CI 1.73, 2.65, p < 0.05), and revisions (OR 5.25, 95% CI 2.23, 12.32, p < 0.05) compared to AS and controls. Our results suggested that SF with longer constructs may be associated with higher complications in THA patients. CONCLUSIONS THAs following SFs have higher mechanical complications, aseptic loosening, dislocations, and infections, especially with longer constructs. AS patients may have fewer complications compared to this cohort.
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Affiliation(s)
- Sung Huang Laurent Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, 204, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ngi Chiong Lau
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, 204, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Wei Cheng Chen
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan
| | - Ruei-Shyuan Chien
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan
| | - Eric H Tischler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan
| | - Dave Wei-Chih Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, 204, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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Movassaghi K, Patel A, Miller I, Levine BR. An Atypical Adverse Local Tissue Reaction After Ceramic-on-Ceramic Primary Total Hip Arthroplasty. Arthroplast Today 2022; 14:71-75. [PMID: 35252509 PMCID: PMC8889265 DOI: 10.1016/j.artd.2022.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/11/2021] [Accepted: 01/15/2022] [Indexed: 11/14/2022] Open
Abstract
Adverse local tissue reaction is an uncommon but frequently described complication after total hip arthroplasty (THA). It is most often associated with metal-on-metal hips and less frequently with metal-on-polyethylene implants as part of a mechanically assisted crevice corrosion process. In this report, we describe a rare case of an atypical adverse local tissue reaction in a patient with a ceramic-on-ceramic THA. Abrasive backside liner wear from a prominent screw head, failure of the liner locking mechanism, and liner fragmentation secondary to component-component impingement created an atypical mass and fluid collection leading to THA failure. This case demonstrates the importance of appropriate cup-liner positioning, thorough workup of pain after THA, and the ability of ceramic debris to cause an associated, atypical adverse local tissue reaction.
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10
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Improving the Endoprosthesis Design and the Postoperative Therapy as a Means of Reducing Complications Risks after Total Hip Arthroplasty. LUBRICANTS 2022. [DOI: 10.3390/lubricants10030038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
One of the most high-tech, efficient and reliable surgical procedures is Total Hip Arthroplasty (THA). Due to the increase in average life expectancy, it is especially relevant for older people suffering from chronic joint disease, allowing them to return to an active lifestyle. However, the rejuvenation of such a severe joint disease as osteoarthritis requires the search for new solutions that increase the lifespan of a Total Hip Replacement (THR). Current trends in the development of this area are primarily focused on the creation of new materials used in THR and methods for their processing that meet the requirements of biocompatibility, long-term strength, wear resistance and the absence of an immune system response aimed at rejection. This study is devoted to the substantiation of one of the possible approaches to increase the reliability and durability of THR, based on the improvement of the implant design and postoperative rehabilitation technology, potentially reducing the risk of complications in the postoperative period.
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Biopsy Proven Focal Osteolysis in a Stainless-Steel Limb-Lengthening Device: A Report of Three Cases. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202110000-00011. [PMID: 34644273 PMCID: PMC8517308 DOI: 10.5435/jaaosglobal-d-21-00101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/29/2021] [Indexed: 11/20/2022]
Abstract
Three pediatric patients presented with histologically confirmed osteolysis after limb lengthening with a magnetic, telescoping, stainless-steel device. The first patient's findings were discovered radiographically before routine removal of the device. In all cases, intraoperative histologic specimens taken from around the modular junction demonstrated particle-laden macrophages with suspicion for metal debris. Silicone debris was also identified. We found definitive osteolysis secondary to metal at the modular junction of three stainless-steel lengthening implants. This process is not well-understood in the setting of limb lengthening and should be examined further.
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12
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Pagani NR, LeRoy TE, Menendez ME, Stoker GE, Lococo DV, Nairus JG. Gross Trunnion Failure of a Type 1 Taper After Metal-on-Polyethylene Total Hip Arthroplasty: A Report of 2 Cases. JBJS Case Connect 2021; 11:01709767-202106000-00133. [PMID: 34166254 DOI: 10.2106/jbjs.cc.21.00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CASE We describe 2 cases of gross trunnion failure (GTF) in males with Centers for Disease Control and Prevention Class 3 obesity 10 years after metal-on-polyethylene total hip arthroplasty (THA) with a titanium-alloy femoral stem and Type 1 taper. One patient received a large diameter cobalt-chromium femoral head, whereas the other received a smaller diameter head, both with high-offset femoral stems. CONCLUSION This is the first report of GTF involving the Echo Bi-Metric femoral stem after metal-on-polyethylene THA, and surgeons should consider the potential complication of GTF when using this specific femoral stem with metal heads in obese male patients.
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Affiliation(s)
- Nicholas R Pagani
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
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