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Metz AK, Kurtz MA, Egan CR, Kurtz SM, Pelt CE. Early Failure of a Novel Modular Dual Mobility Liner After Metal Release: Clinical Presentation and Detailed Retrieval Analysis. Arthroplast Today 2025; 33:101687. [PMID: 40276527 PMCID: PMC12019210 DOI: 10.1016/j.artd.2025.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Revised: 03/01/2025] [Accepted: 03/16/2025] [Indexed: 04/26/2025] Open
Abstract
Cobalt chrome alloy (CoCrMo) corrosion and subsequent metal release has been described as a potential complication of total hip arthroplasty. Here, we present the case of a patient with a well-seated dual mobility (DM) implant revised after 10 months. Prior to revision, the patient experienced pain and stiffness. Following a negative infection workup, we measured elevated metal concentrations, hypothesized to originate from the CoCrMo DM liner. While corrosion has been extensively reported in other constructs, the CoCrMo liner described here includes a post and tabs, features added to reduce the risk of corrosion. Retrieval analysis demonstrated a severe chemically based corrosion attack on the liner. Continued caution and ongoing close monitoring of outcomes associated with the use of modular DM constructs is likely warranted.
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Affiliation(s)
- Allan K. Metz
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Michael A. Kurtz
- Implant Research Center, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Cameron R. Egan
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Steven M. Kurtz
- Implant Research Center, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
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Ahlgren CD, Beydoun RS, Maxwell MJ, Cascardo CA, Karadsheh MS, Moore DD. Surveillance of Dual-Mobility Hip Systems: Damage Mode and Clinical Data Analysis. J Arthroplasty 2025:S0883-5403(25)00066-X. [PMID: 39880052 DOI: 10.1016/j.arth.2025.01.037] [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: 08/15/2024] [Revised: 01/20/2025] [Accepted: 01/21/2025] [Indexed: 01/31/2025] Open
Abstract
BACKGROUND Hip instability following total hip arthroplasty (THA) is among the most common indications for revision surgery. The implantation of dual-mobility (DM) systems, designed to improve stability, continues to rise, and thus, characterizing in vivo implant damage modes is paramount. METHODS Under an implant retrieval protocol, 51 DM THA systems were analyzed. Each component was examined for macroscopic damage and microscopically graded for fretting corrosion at the trunnion interface. Clinically relevant data were collected from medical records. RESULTS Revision indications included mechanical complications (n = 15, 27%), infection (n = 12, 22%), and dislocation (n = 9, 16%). The average duration of implantation was 12 months, which significantly correlated with summed femoral head taper corrosion (P = 0.044). Average summed fretting and corrosion scores were 2.9 and 3.0 for heads (two regions, 2 to 8 summed scores possible) and 7.6 and 7.1 for trunnions (four quadrants, 4 to 16 summed scores possible), respectively. Scratching (n = 26, 65.4%) was the most common damage mode on articular surfaces of acetabular cups, burnishing (n = 29, 55.2%) on metal liners, and edge deformation (n = 22, 45.5%) on polyethylene liners. Screw-liner corrosion was noted on 10.3% (n = 3) of available acetabular liners; an increased incidence of acetabular and femoral osteolysis was noted when this damage mode was present (P = 0.019 and P = 0.022, respectively). CONCLUSIONS This series demonstrated in vivo damage of DM THA components following short-term-to-midterm (zero to five years) implantation, with overall mild-to-moderate fretting and corrosion scores. Femoral head taper corrosion correlated with longer implantation, and amplified trunnion corrosion was observed in the setting of infection. Screw-liner corrosion may be related to acetabular and femoral osteolysis. This study indicates trends that merit further evaluation.
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Affiliation(s)
- Conner D Ahlgren
- Department of Orthopedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Rami S Beydoun
- Department of Orthopedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Michael J Maxwell
- Department of Orthopedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Camilla A Cascardo
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Mark S Karadsheh
- Department of Orthopedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Drew D Moore
- Department of Orthopedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
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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; 39:2569-2574. [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] [MESH Headings] [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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Fa-Binefa M, Rojas-Sayol R, Peiró A, Trullols L, Machado P, Gracia I. Metal Ion Release in Cancer Patients Following Megaprosthesis Salvage Surgery. J Arthroplasty 2024; 39:2336-2340. [PMID: 38640965 DOI: 10.1016/j.arth.2024.04.034] [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: 11/06/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Megaprostheses contain many more modular components than conventional total hip and knee arthroplasty, which may lead to higher serum levels of metal ions. The aim of this study was to determine serum concentrations of titanium, chromium, and cobalt ions in cancer patients after limb salvage surgery with a megaprosthesis. METHODS A retrospective, descriptive cohort analysis consisting of patients who underwent cancer-related limb salvage surgery with a megaprosthesis at our hospital between 2010 and 2020 was conducted. Baseline and follow-up data were extracted from clinical and surgical records. Blood samples were prospectively obtained. Descriptive statistics were used for the analysis. RESULTS A total of 71 patients underwent limb salvage surgery during the study period. Of these, 22 (10 women, 12 men) were included in the study. The mean age was 52 years (range, 21 to 80). Most cases (n = 16; 72.7%) involved the femur. Most patients (n = 14, 63.6%) underwent total knee megaprosthesis surgery. Implant revision surgery was required in 45% of cases (n = 10), with a mean interval of 4.32 years between the initial and revision surgeries. The mean follow-up time after revision surgery was 4.05 years. High levels of chromium were observed in 22.7% of patients (n = 5). High cobalt levels were found in 68.2% (n = 15) of patients, with toxic levels in 9.1% (n = 2). Titanium levels were high in 77.3% (n = 17) of cases and toxic in 22.7% (n = 5). Postoperative chemotherapy was significantly associated with titanium levels (P = .017). No correlation was observed between metal ion levels and time from primary or revision surgery or time from the first to revision surgery. CONCLUSIONS This study shows that cancer-related limb salvage surgery with megaprosthesis is associated with metal ion levels that exceed established safe thresholds. Compared to conventional hip arthroplasty, a higher proportion of the patients in this cohort presented elevated levels of metal ions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manel Fa-Binefa
- Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Oncology Orthopaedic Surgery Unit, Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roger Rojas-Sayol
- Septic Surgery Unit, Orthopaedic Surgery Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Ana Peiró
- Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Oncology Orthopaedic Surgery Unit, Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Trullols
- Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Oncology Orthopaedic Surgery Unit, Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pau Machado
- Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Oncology Orthopaedic Surgery Unit, Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isidro Gracia
- Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Oncology Orthopaedic Surgery Unit, Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
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Sacher SE, Baral EC, Wright TM, Bauer TW, Li Q, Padgett DE, Potter HG, Koff MF. Association of Total Hip Arthroplasty Flexural Rigidity With Magnetic Resonance Imaging and Histological Findings. J Arthroplasty 2024; 39:2116-2123.e1. [PMID: 38428693 DOI: 10.1016/j.arth.2024.02.072] [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: 12/11/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Modular connections in total hip arthroplasty (THA) offer surgical advantages, but can contribute to implant fretting and corrosion due to micromotion at the head-stem interface. Previous studies implicated lower flexural rigidity as a key contributing factor to THA corrosion and fretting, but none associated flexural rigidity with direct histological evaluation or magnetic resonance imaging (MRI) outcomes. The purpose of this study was to determine how implant flexural rigidity is associated with MRI imaging metrics and histopathological outcomes in patients who have a failed THA. METHODS Patients requiring revision THA surgery underwent preoperative MRIs with 3-dimensional multispectral imaging techniques to suppress metal artifacts. The MRI images were graded for adverse local tissue reactions. For each hip, trunnion flexural rigidity was measured from the retrieved femoral stem, and a periprosthetic tissue sample was retrieved and evaluated using semiquantitative histology. Generalized linear models and analyses of variance were used to assess associations between flexural rigidity and MRI and histology outcomes. RESULTS A total of 106 THA stems were retrieved (46 women and 60 men, age: 68 years (range, 60 to 73 years). After adjustment for length of implantation, flexural rigidity was negatively correlated with histologic aseptic lymphocyte-dominant vasculitis-associated lesion severity (β = -26.27, P = .018), Fujishiro lymphocyte grading (β = -13.4, P = .039), perivascular lymphocyte layers (β = -17.8, P = .022), the grade of tissue organization (β = -22.5, P = .009), the presence of diffuse synovitis (β = -66.5, P = .003), and the presence of lymphoid aggregates (β = -75.9, P = .022). No association was found between MRI metrics and flexural rigidity. CONCLUSIONS Among these implants, decreased trunnion stiffness was associated with increased histologic features of adverse host-mediated soft tissue reactions.
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Affiliation(s)
- Sara E Sacher
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Elexis C Baral
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Timothy M Wright
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Thomas W Bauer
- Hospital for Special Surgery, Department of Pathology and Laboratory Medicine, New York, New York
| | - Qian Li
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Douglas E Padgett
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Hollis G Potter
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Matthew F Koff
- Hospital for Special Surgery, Department of Radiology, New York, New York
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Dolinar D, Kocjančič B, Avsec K, Šetina Batič B, Kocijan A, Godec M, Sedlaček M, Debeljak M, Grant JT, Zupanc T, Jenko M. Characterization of Micro-Threaded Stem Taper Surfaces of Cementless Hip Endoprostheses. MATERIALS (BASEL, SWITZERLAND) 2024; 17:2751. [PMID: 38894016 PMCID: PMC11173811 DOI: 10.3390/ma17112751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
We investigated micro-threaded stem taper surface and its impact on premature failures, aseptic loosening, and infection in cementless hip endoprostheses. Our study focused on the fretting, and crevice corrosion of micro-threaded tapers, as well as the characterization of the microstructure and surface properties of two new and three retrieved Zweymüller stem tapers. The retrieved samples were selected and examined based on the head-stem taper interface being the sole source of modularity with a metallic component, specifically between the Ti alloy taper stem and the ceramic head. To determine the surface chemistry and microstructures of both new and retrieved hip endoprostheses stem taper titanium alloy, scanning -electron microscopy (SEM) was employed for morphological and microstructural analyses. Energy dispersive spectroscopy (EDS) was utilized for characterizing chemical element distribution, and electron backscattered diffraction (EBSD) was used for phase analysis. The roughness of the micro-threated stem tapers from different manufacturers was investigated using an optical profilometer, with standard roughness parameters Ra (average surface roughness) and Rz (mean peak to valley height of the roughness profile) being measured. Electrochemical studies revealed no fretting corrosion in retrieved stem tapers with ceramic heads. Consequently, three retrieved tapers and two new ones for comparison underwent potentiodynamic measurements in Hank's solution to determine the corrosion rate of new and retrieved stem taper surfaces. The results showed a low corrosion rate for both new and prematurely failed retrieved samples due to aseptic loosening. However, the corrosion rate was higher in infected and low-grade infected tapers. In conclusion, our study suggests that using ceramic heads reduces taper corrosion and subsequently decreases the incidence of premature failures in total hip arthroplasty.
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Affiliation(s)
- Drago Dolinar
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
- Orthopaedic Surgery Chair, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Boštjan Kocjančič
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
- Orthopaedic Surgery Chair, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Klemen Avsec
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
- Orthopaedic Surgery Chair, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Barbara Šetina Batič
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Aleksandra Kocijan
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Matjaž Godec
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Marko Sedlaček
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (A.K.); (M.G.); (M.S.)
| | - Mojca Debeljak
- University Rehabilitation Institute Republic of Slovenia, Linhartova 51, 1000 Ljubljana, Slovenia;
| | - John T. Grant
- Research Institute, University of Dayton, Dayton, OH 45469, USA;
| | - Timon Zupanc
- Department for Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (D.D.); (B.K.); (K.A.); (T.Z.)
| | - Monika Jenko
- MD-RI Institute for Materials Research in Medicine, Bohoričeva 5, 1000 Ljubljana, Slovenia
- MD Medicina, Sanatorium, Bohoričeva 5a, 1000 Ljubljana, Slovenia
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Lanting BA, Sogbein OA, MacDonald SJ, Shah N, Kok TL, Willing R, Teeter MG. Quantification of trunnion damage in a series of intact total hip arthroplasty femoral stems previously identified to be at risk of catastrophic failure. Hip Int 2024; 34:363-371. [PMID: 37786293 DOI: 10.1177/11207000231199941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Corrosion at the head-neck junction of femoral stems is a rare complication of total hip arthroplasty (THA) with manifestations ranging from subclinical wear to failure. Prior studies have identified a single femoral component design with an increased propensity for catastrophic trunnion failure. The purpose of the present study was to quantify trunnion damage of this femoral component retrieved from patients undergoing revision THA for non-trunnionosis indications. METHODS 24 femoral components from a single manufacturer were identified for study inclusion. Each prosthesis underwent stereomicroscopic inspection. Corrosion and fretting scores were assigned per the Goldberg criteria to quadrants of the trunnion. Material loss was calculated based on cone angles across trunnion quadrants. This was carried out using a coordinate measuring machine that digitised each trunnion surface. Stems were compared to a series of femoral stems with the same trunnion design. RESULTS 20 of the 24 (83%) trunnions demonstrated corrosion, all 24 trunnions demonstrated fretting. Corrosion scores did not statistically differ with respect to trunnion zone (p = 0.53), while fretting scores were higher in the inferior compared to the superior zones (p < 0.001). There was no significant difference in cone angles assessing material loss between stems (p = 0.25). CONCLUSIONS Evidence of trunnion damage was observed in each stem retrieved for non-trunnionosis revision. Fretting occurred more frequently about the inferior quadrants. However, digitised trunnion shapes were similar between compared stems exhibiting no material loss. Therefore, it is possible that previous reports of trunnion failures for this implant are not a systemic issue, and that further investigation is required.
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Affiliation(s)
- Brent A Lanting
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
| | - Olawale A Sogbein
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
| | - Steven J MacDonald
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
| | - Nirmit Shah
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Tea-Lyn Kok
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Ryan Willing
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Matthew G Teeter
- Department of Surgery, London Health Sciences Centre - University Hospital, Division of Orthopaedic Surgery, ON, Canada
- Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
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Matar HE, van Duren BH, Bloch BV, Berber R, James PJ, Manktelow ARJ. Lower Risk of Revision With 32- and 36-Millimeter Femoral Heads Compared With 28-mm Heads in Primary Total Hip Arthroplasty: A Comparative Single-Center Study (10,104 Hips). J Arthroplasty 2024; 39:991-996. [PMID: 38661490 DOI: 10.1016/j.arth.2023.10.042] [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: 03/08/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND We aimed to compare the clinical outcomes of different head sizes (28-, 32-, and 36- millimeter) in primary total hip arthroplasty (THA) at mean 6 years follow-up (range, 1 to 17.5 years). METHODS This was a retrospective consecutive study of primary THA at our institution (2003 to 2019). Demographic and surgical data were collected. The primary outcome measures were all-cause revision, revision for dislocation, and all-cause revision excluding dislocation. Continuous descriptive statistics used means, median values, ranges, and 95% confidence intervals, where appropriate. Kaplan-Meier survival curves were used to estimate time to revision. Cox proportional hazard regression analyses were used to compare revision rates between the femoral head size groups. Adjustments were made for age at surgery, sex, primary diagnosis, American Society of Anesthesiologists score, articulation type, and fixation methods. There were 10,104 primary THAs included; median age was 69 years (range, 13 to 101) with 61.5% women. A posterior approach was performed in 71.6%. There were 3,295 hips with 28-mm heads (32.6%), 4,858 (48.1%) with 32-mm heads, and 1,951 (19.3%) with 36-mm heads. RESULTS Overall rate of revision was 1.7% with the lowest rate recorded for the 36-mm group (2.7 versus 1.3 versus 1.1%). Cox regression analyses showed a decreased risk of all-cause revision for 32 and 36-mm head sizes as compared to 28-mm; this was statistically significant for the 32-mm group (P = .01). Risk of revision for dislocation was significantly reduced in both 32-mm (P = .03) and 36-mm (P = .03) head sizes. Analysis of all cause revision excluding dislocation showed no significant differences between head sizes. CONCLUSIONS We found a significantly reduced risk of revision for all causes, but particularly revision for dislocation with larger head sizes. Concerns regarding increased risk of early revision for aseptic loosening, polyethylene wear, or taper corrosion with larger heads appear to be unfounded in this cohort of 10,104 patients with up to 17 years follow-up.
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Affiliation(s)
- Hosam E Matar
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Bernard H van Duren
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Reshid Berber
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Peter J James
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Andrew R J Manktelow
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Mace AO, Kurtz MA, Gilbert JL. Fretting and Fretting Corrosion Behavior of Additively Manufactured Ti-6Al-4V and Ti-Nb-Zr Alloys in Air and Physiological Solutions. J Funct Biomater 2024; 15:38. [PMID: 38391891 PMCID: PMC10889821 DOI: 10.3390/jfb15020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Additive manufacturing (AM) of orthopedic implants has increased in recent years, providing benefits to surgeons, patients, and implant companies. Both traditional and new titanium alloys are under consideration for AM-manufactured implants. However, concerns remain about their wear and corrosion (tribocorrosion) performance. In this study, the effects of fretting corrosion were investigated on AM Ti-29Nb-21Zr (pre-alloyed and admixed) and AM Ti-6Al-4V with 1% nano yttria-stabilized zirconia (nYSZ). Low cycle (100 cycles, 3 Hz, 100 mN) fretting and fretting corrosion (potentiostatic, 0 V vs. Ag/AgCl) methods were used to compare these AM alloys to traditionally manufactured AM Ti-6Al-4V. Alloy and admixture surfaces were subjected to (1) fretting in the air (i.e., small-scale reciprocal sliding) and (2) fretting corrosion in phosphate-buffered saline (PBS) using a single diamond asperity (17 µm radius). Wear track depth measurements, fretting currents and scanning electron microscopy/energy dispersive spectroscopy (SEM/EDS) analysis of oxide debris revealed that pre-alloyed AM Ti-29Nb-21Zr generally had greater wear depths after 100 cycles (4.67 +/- 0.55 µm dry and 5.78 +/- 0.83 µm in solution) and higher fretting currents (0.58 +/- 0.07 µA). A correlation (R2 = 0.67) was found between wear depth and the average fretting currents with different alloys located in different regions of the relationship. No statistically significant differences were observed in wear depth between in-air and in-PBS tests. However, significantly higher amounts of oxygen (measured by oxygen weight % by EDS analysis of the debris) were embedded within the wear track for tests performed in PBS compared to air for all samples except the ad-mixed Ti-29Nb-21Zr (p = 0.21). For traditional and AM Ti-6Al-4V, the wear track depths (dry fretting: 2.90 +/- 0.32 µm vs. 2.51 +/- 0.51 μm, respectively; fretting corrosion: 2.09 +/- 0.59 μm vs. 1.16 +/- 0.79 μm, respectively) and fretting current measurements (0.37 +/- 0.05 μA vs. 0.34 +/- 0.05 μA, respectively) showed no significant differences. The dominant wear deformation process was plastic deformation followed by cyclic extrusion of plate-like wear debris at the end of the stroke, resulting in ribbon-like extruded material for all alloys. While previous work documented improved corrosion resistance of Ti-29Nb-21Zr in simulated inflammatory solutions over Ti-6Al-4V, this work does not show similar improvements in the relative fretting corrosion resistance of these alloys compared to Ti-6Al-4V.
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Affiliation(s)
- Annsley O Mace
- Clemson-Medical University of South Carolina Bioengineering Program, Department of Bioengineering, Clemson University, Charleston, SC 29464, USA
| | - Michael A Kurtz
- Clemson-Medical University of South Carolina Bioengineering Program, Department of Bioengineering, Clemson University, Charleston, SC 29464, USA
| | - Jeremy L Gilbert
- Clemson-Medical University of South Carolina Bioengineering Program, Department of Bioengineering, Clemson University, Charleston, SC 29464, USA
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Poursalehian M, Zafarmandi S, Razzaghof M, Mortazavi SMJ. The impact of retaining the femoral stem in revision total hip arthroplasty: a systematic review, meta-analysis, and meta-regression. Arch Orthop Trauma Surg 2024; 144:947-966. [PMID: 37831198 DOI: 10.1007/s00402-023-05087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION The management of well-fixed femoral stems in revision total hip arthroplasty (rTHA) remains a subject of debate, with concerns over potential complications arising from stem retention. This study aimed to investigate the re-revision rates due to aseptic loosening of the stem, overall re-revision rates, dislocation rates, and factors influencing these outcomes in rTHA with a retained well-fixed femoral stem. MATERIALS AND METHODS A systematic search was conducted across several databases including PubMed, EMBASE, and CENTRAL to identify pertinent publications from their inception through 2023. We specifically focused on studies that reported outcomes of rTHA with retained well-fixed femoral stems. The study designs incorporated in our research encompassed both cohort studies and case series studies. Thirty-five studies involving isolated acetabular revision and retaining the stem were included, representing a total of 3497 patients. Data extraction was tailored to the study questions. Meta-analyses, meta-regression, and subgroup analyses were conducted to evaluate the outcomes and their relationship with various factors. Pooled results, meta-regression, and subgroup analyses were performed using random-effects models. To assess and reduce bias, we employed Egger's test and the trim and fill method. RESULTS The meta-analysis included 3497 patients with a mean follow-up of 9.28 years. The 10-year risk of re-revision after retaining femoral stem using highly cross-linked polyethylene was 1.7% (95% CI 1.1%-2.3%; I2: 60%) for stem aseptic loosening and 8.8% (95% CI 6.2%-11.4%; I2: 78%) overall re-revision. Dislocation risk was 5.7% (95% CI 4.1-7.0%; I2: 61%). Ceramic heads showed lower stem failure risk than metal heads in long-term follow-ups (P < 0.001). The posterolateral approach in revision surgery resulted in better long-term outcomes compared to the direct lateral approach (P < 0.001). Follow-up duration, timeline of study, Harris Hip Score, type of stem fixation, femoral head material, BMI, age, stem age, and surgical approach were evaluated as influential factors on these outcomes. CONCLUSION The re-revision rate due to aseptic loosening of the retained stem during rTHA was found to be significantly low, supporting the idea of retaining well-fixed stems during rTHA. The overall re-revision and dislocation rates also presented comparable or better outcomes to prior studies. A range of factors, including the use of highly cross-linked polyethylene and ceramic femoral heads, was found to influence these outcomes. LEVEL OF EVIDENCE IV. PROSPERO REGISTRATION NUMBER CRD42022351157.
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Affiliation(s)
- Mohammad Poursalehian
- Orthopedic Surgery Department, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, 1419733141, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Zafarmandi
- Orthopedic Surgery Department, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, 1419733141, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghof
- Orthopedic Surgery Department, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, 1419733141, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Javad Mortazavi
- Orthopedic Surgery Department, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, 1419733141, Iran.
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran.
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Saracco M, Ciriello V, Spinarelli A, Solarino G, Goderecci R, Logroscino G. Ceramic-on-Metal Bearing in Total Hip Arthroplasty—Was It So Bad? A Narrative Review and a Critical Analysis of the Literature. JOURNAL OF COMPOSITES SCIENCE 2023; 8:9. [DOI: https:/doi.org/10.3390/jcs8010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2023]
Abstract
Hip replacement has significantly improved the quality of life of patients with symptomatic hip osteoarthritis. Various bearings have been developed over the years. Each of these has advantages and disadvantages. On the one hand, Metal-on-Metal (MoM) has been associated with a high level of wear and metal ion release of chromium (Cr) and cobalt (Co). On the other hand, Ceramic-on-Ceramic (CoC) bearings, known to have a wear rate close to zero, have been associated with an increased risk of squeaking and component fracture. Ceramic-on-Metal (CoM), a hybrid hard-on-hard bearing, was proposed to overcome the CoC and MoM limits. Preliminary clinical and radiographical results have been described as favourable. Due to the failure of MoM and the increased risk of ion release and metal toxicity, CoM was withdrawn from the market without causing significant clinical complications. Data from the literature showed that CoM bearings are reliable and safe at medium- and long-term follow-up, if correctly implanted. In this narrative review, we analysed the real risks and benefits associated with the implantation of CoM bearings.
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Affiliation(s)
- Michela Saracco
- Department of Orthopaedics, ASL Napoli 2 Nord, 80027 Naples, Italy
| | - Vincenzo Ciriello
- Department of Surgery, Orthopaedic and Trauma Unit, S. Croce e Carle Hospital, 12100 Cuneo, Italy
| | - Antonio Spinarelli
- Department of Translational Biomedicine and Neuroscience, School of Medicine, University of Bari Aldo Moro, AOU Consorziale ‘Policlinico’, 70100 Bari, Italy
| | - Giuseppe Solarino
- Department of Translational Biomedicine and Neuroscience, School of Medicine, University of Bari Aldo Moro, AOU Consorziale ‘Policlinico’, 70100 Bari, Italy
| | - Remo Goderecci
- Department of Life, Health and Environmental Sciences, Orthopaedic Unit, University of L’Aquila, 67100 L’Aquila, Italy
| | - Giandomenico Logroscino
- Department of Life, Health and Environmental Sciences, Orthopaedic Unit, University of L’Aquila, 67100 L’Aquila, Italy
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12
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Saracco M, Ciriello V, Spinarelli A, Solarino G, Goderecci R, Logroscino G. Ceramic-on-Metal Bearing in Total Hip Arthroplasty—Was It So Bad? A Narrative Review and a Critical Analysis of the Literature. JOURNAL OF COMPOSITES SCIENCE 2023; 8:9. [DOI: 10.3390/jcs8010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2025]
Abstract
Hip replacement has significantly improved the quality of life of patients with symptomatic hip osteoarthritis. Various bearings have been developed over the years. Each of these has advantages and disadvantages. On the one hand, Metal-on-Metal (MoM) has been associated with a high level of wear and metal ion release of chromium (Cr) and cobalt (Co). On the other hand, Ceramic-on-Ceramic (CoC) bearings, known to have a wear rate close to zero, have been associated with an increased risk of squeaking and component fracture. Ceramic-on-Metal (CoM), a hybrid hard-on-hard bearing, was proposed to overcome the CoC and MoM limits. Preliminary clinical and radiographical results have been described as favourable. Due to the failure of MoM and the increased risk of ion release and metal toxicity, CoM was withdrawn from the market without causing significant clinical complications. Data from the literature showed that CoM bearings are reliable and safe at medium- and long-term follow-up, if correctly implanted. In this narrative review, we analysed the real risks and benefits associated with the implantation of CoM bearings.
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Affiliation(s)
- Michela Saracco
- Department of Orthopaedics, ASL Napoli 2 Nord, 80027 Naples, Italy
| | - Vincenzo Ciriello
- Department of Surgery, Orthopaedic and Trauma Unit, S. Croce e Carle Hospital, 12100 Cuneo, Italy
| | - Antonio Spinarelli
- Department of Translational Biomedicine and Neuroscience, School of Medicine, University of Bari Aldo Moro, AOU Consorziale ‘Policlinico’, 70100 Bari, Italy
| | - Giuseppe Solarino
- Department of Translational Biomedicine and Neuroscience, School of Medicine, University of Bari Aldo Moro, AOU Consorziale ‘Policlinico’, 70100 Bari, Italy
| | - Remo Goderecci
- Department of Life, Health and Environmental Sciences, Orthopaedic Unit, University of L’Aquila, 67100 L’Aquila, Italy
| | - Giandomenico Logroscino
- Department of Life, Health and Environmental Sciences, Orthopaedic Unit, University of L’Aquila, 67100 L’Aquila, Italy
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13
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Kim HS, Lee HJ, Lee SJ, Yoo JJ. Ceramic-on-Ceramic or Metal-on-Polyethylene: The Bearing of Choice after Ceramic Component Fracture in Total Hip Arthroplasty along with Concise Follow-Up of the Previous Cohort. Orthop Surg 2023; 15:2864-2871. [PMID: 37749775 PMCID: PMC10622264 DOI: 10.1111/os.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE We previously reported the questionable result of reoperation using metal-on-polyethylene (MoP) bearing after the fracture of the ceramic component. After the report, we abandoned the use of MoP; instead, we used ceramic-on-ceramic (CoC) bearing. This report aimed to present the outcome of reoperation to CoC bearing after ceramic component failures along with the longer-term outcome of the previously reported cohort with an MoP bearing. RESULTS The mean follow-up of the MoP cohort was extended from 4.3 years to 8.8 years. Metallosis had occurred in three of nine patients of the previous cohort, which all required re-reoperations. Two hips from 11 patients with revision to CoC had re-reoperations due to ceramic liner fracture and non-union of the osteotomized fragment, respectively. No metallosis and wear occurred in the cohort revised with CoC articulation. Otherwise, there were no adverse changes in radiographs and no impairment in functions. METHODS We conducted an extended prospective evaluation of a previous cohort consisting of six head fractures and three liner fractures. In this cohort, the patients underwent a bearing change to metal-on-polyethylene. Additionally, we retrospectively analyzed 11 cases of third-generation ceramic bearing fractures, comprising nine head fractures and two liner fractures. These cases were subsequently treated with a bearing change to fourth-generation CoC. We assessed clinical and radiological outcomes, including complication rates, in both groups. CONCLUSION We recommend the latest CoC as the bearing of choice in reoperation after the fracture of ceramic components. In the case of an MoP bearing after the ceramic component fracture, the risk of metallosis seemed high in the early postoperative period.
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Affiliation(s)
- Hong Seok Kim
- Department of Orthopedic SurgerySeoul National University HospitalSeoulSouth Korea
- Department of Orthopedic Surgery, College of MedicineSeoul National UniversitySeoulSouth Korea
| | - Han Jin Lee
- Department of Orthopedic SurgeryHanil General HospitalSeoulSouth Korea
| | - Soong Joon Lee
- Department of Orthopedic Surgery, SMG‐SNU Boramae Medical CenterSeoul National University College of MedicineSeoulSouth Korea
| | - Jeong Joon Yoo
- Department of Orthopedic SurgerySeoul National University HospitalSeoulSouth Korea
- Department of Orthopedic Surgery, College of MedicineSeoul National UniversitySeoulSouth Korea
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14
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Deans CF, Buckner BC, Garvin KL. Wear, Osteolysis, and Aseptic Loosening Following Total Hip Arthroplasty in Young Patients with Highly Cross-Linked Polyethylene: A Review of Studies with a Follow-Up of over 15 Years. J Clin Med 2023; 12:6615. [PMID: 37892754 PMCID: PMC10607435 DOI: 10.3390/jcm12206615] [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: 09/01/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Total hip arthroplasty (THA) has in recent years trended toward a younger, more physically demanding patient population. Mid- to long-term studies of all ages of THA patients using highly cross-linked polyethylene (HXLPE) have been favorable, but concerns about its long-term failure and wear-related complications remain for young THA patients. In this narrative review, a search of the PubMed/MEDLINE and Cochrane databases was performed, and we identified six studies with a minimum 15-year follow-up of HXLPE with various femoral head materials. Wear-related revisions were exceedingly low for patients under the age of 55, with variable reports of non-clinically significant osteolysis. Higher activity levels, a larger femoral head size, and femoral head material were not associated with greater long-term wear rates. Young THA with metal or ceramic on HXLPE is exceedingly durable with favorable outcomes at follow-ups of over 15 years.
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Affiliation(s)
| | | | - Kevin L. Garvin
- Department of Orthopaedic Surgery & Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE 68198, USA
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Herbster M, Müller E, Jahn J, Buchholz A, Tootsi K, Lohmann CH, Halle T, Bertrand J. In vivo corrosion on retrieved hip endoprostheses and in vitro effects of corrosion products on bone mineralization. Bone 2023; 175:116852. [PMID: 37473933 DOI: 10.1016/j.bone.2023.116852] [Citation(s) in RCA: 4] [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: 04/03/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
In vivo corrosion of modular endoprostheses remains a great concern, as the release of heavy metal ions can impair the implant's service life and the wellbeing of the patient. The detailed corrosion mechanisms that occur in vivo are so far not completely understood. In this context, the effects of implant released cobalt (Co) and chromium (Cr) ions on osteoblast mineralization and gene expression have not been investigated extensively. This comprehensive study aimed at furthering the understanding of in vivo implant corrosion from the clinical signs via prosthesis retrievals and histology of the synovial membranes down to the molecular processes instigated by corrosion products and its effects on bone mineralization. A detailed in vivo failure analysis was performed investigating 22 retrieved hip endoprostheses from different manufacturers and taper material combinations. The aim was to find a correlation of taper damage and especially corrosion to susceptible biomedical alloys and its effect on periprosthetic tissue as well as the clinical implant performance with regard to revision diagnosis and presence of radiolucent lines (RLL). A second part investigated the effects of Co and Cr ions on the in vitro mineralization process of osteoblasts. Cell cultures were exposed to relevant concentrations of CoCl2 and CrCl3 (0 μM, 100 μM, 200 μM) with and without addition of phosphate. Mineralization behavior was analyzed with Alizarin Red assay and Von Kossa staining of calcium depots, alkaline phosphatase activity of osteoblasts and gene expression was analyzed with real time quantitative PCR. The retrieval study provides evidence of in vivo fretting and crevice corrosion on all metallic tapers combined with either ceramic or metal femoral heads. Within the modular taper junctions, selective dissolution of the α phase occurred in wrought TiAl6V4 alloys, and etching of the fine-grained wrought CoCr28Mo6 alloy implants was observed in formed crevices. In addition, significant amounts of wear particles and corrosion products were detected in retrieved synovial membranes. An increased risk for the occurrence of a RLL in the proximal zones was determined for patients with a corroded mixed metal taper. Whereas Co ions have hardly any effects on mineralization, Cr ions cause a significant concentration dependent decrease in mineralization rate of osteoblasts. However, this effect is alleviated by addition of a phosphate source. Our data reveal that Cr ions depleted dissolved phosphates by forming an insoluble complex (CrPO4), which inhibits the phosphate dependent mineralization process. No significant effect of the heavy metal ions on osteoblast activity by means of alkaline phosphate activity as well as on gene expression is determined. This study broadens the understanding of in vivo corrosion of metallic modular implants and its clinically relevant effects on mineralization. Based on these findings, in vivo corrosion of CoCr28Mo6 endoprostheses should be limited to avoid inhibitory effects of Cr3+ on bone mineralization which can contribute to premature implant failure.
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Affiliation(s)
- Maria Herbster
- Institute of Materials and Joining Technology, Otto-von-Guericke University Magdeburg, Germany.
| | - Eva Müller
- Department of Orthopedic Surgery, Otto-von-Guericke University Magdeburg, Germany
| | - Jannik Jahn
- Department of Orthopedic Surgery, Otto-von-Guericke University Magdeburg, Germany
| | - Adrian Buchholz
- Department of Orthopedic Surgery, Otto-von-Guericke University Magdeburg, Germany
| | - Kaspar Tootsi
- Department of Orthopedic Surgery, Otto-von-Guericke University Magdeburg, Germany; Department of Traumatology and Orthopedics, University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - Christoph H Lohmann
- Department of Orthopedic Surgery, Otto-von-Guericke University Magdeburg, Germany
| | - Thorsten Halle
- Institute of Materials and Joining Technology, Otto-von-Guericke University Magdeburg, Germany
| | - Jessica Bertrand
- Department of Orthopedic Surgery, Otto-von-Guericke University Magdeburg, Germany
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Mathew MT, Cheng KY, Sun Y, Barao VAR. The Progress in Tribocorrosion Research (2010-21): Focused on the Orthopedics and Dental Implants. JOURNAL OF BIO- AND TRIBO-CORROSION 2023; 9:48. [PMID: 38525435 PMCID: PMC10959289 DOI: 10.1007/s40735-023-00767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/20/2023] [Accepted: 05/05/2023] [Indexed: 03/26/2024]
Abstract
Tribocorrosion is an integration of two areas-tribology and corrosion. It can be defined as the material degradation caused by the combined effect of corrosion and tribological process at the material interfaces. Significant development has occurred in the field of tribocorrosion over the past years. This development is due to its applications in various fields, such as aerospace, marine, biomedical, and space. Focusing on biomedical applications, tribocorrosion finds its applications in the implants used in cardiovascular, spine, orthopedics, trauma, and dental areas. It was reported that around 7.2 million Americans are living with joint implants. Implant surgery is a traumatic and expensive procedure. Tribocorrosion can affect the lifespan of the implants, thus leading to implant failure and a potential cause of revision surgery. Hence, it is essential to understand how tribocorrosion works, its interaction with the implants, and what procedures can be implemented to protect materials from tribocorrosion. This paper discusses how tribocorrosion research has evolved over the past 11 years (2010-2021). This is a comprehensive overview of tribocorrosion research in biomedical applications.
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Affiliation(s)
- Mathew T. Mathew
- Department of Biomedical Science, UIC College of Medicine, Rockford, IL 61107, USA
- Department of Biomedical Engineering, UIC, Chicago, IL 60612, USA
- Department of Restorative Dentistry, College of Dentistry, UIC, Chicago, IL 60612, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kai-yuan Cheng
- Department of Biomedical Science, UIC College of Medicine, Rockford, IL 61107, USA
| | - Yani Sun
- Department of Biomedical Science, UIC College of Medicine, Rockford, IL 61107, USA
| | - Valentim A. R. Barao
- Departament of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo 13414-903, Brazil
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17
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Youngman TR, Verhotz D, Layon D, Parilla F, Pashos G, Thornton T, Bendich I, Clohisy JC. Mean 16-Year Results of Total Hip Arthroplasty with Alumina Ceramic Femoral Heads on Highly Cross-Linked Polyethylene in Patients 50 Years or Less. J Arthroplasty 2023:S0883-5403(23)00397-2. [PMID: 37105332 DOI: 10.1016/j.arth.2023.04.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) is a widely used bearing surface in total hip arthroplasty (THA); long-term results in young patients are limited. We previously demonstrated excellent results in HXPLE on cobalt-chrome femoral heads at 15-year mean follow-up. The purpose of the present study was to investigate polyethylene wear rates, implant survivorships, wear-related revisions, and patient-reported outcomes (PROs) in a young patient cohort who had alumina ceramic on HXPLE coupling at an average 16-year follow-up. METHODS This was a retrospective study of 128 hips who underwent THA with HXLPE on alumina ceramic bearings between March 1, 2004, and April 15, 2007. Patient mean age was 38 years (range, 13 to 50). All THAs utilized HXPLE liners with alumina ceramic heads. The University of California, Los Angeles (UCLA) Activity Score and modified Harris Hip Scores (mHHS) were collected pre-operatively and at each follow-up. Martell Hip Analysis Suite was used for wear calculations. RESULTS At average 16 years (range, 13 to 18), aseptic revision survivorship was 93.3% and osteolysis/wear survivorship was 99.2%. The mean linear wear rate was 0.0191 millimeters (mm)/year and mean volumetric wear rate was 19.43 mm3/year, both of which were clinically undetectable. We observed excellent patient reported outcomes with a significant increase in mean mHHS (43.6 to 87.4, P <0.0001) and UCLA Activity Scores (4.0 to 6.0, P <0.0001). There were no statistically significant differences in PROs or wear rates between ceramic and cobalt-chrome groups. CONCLUSION At mean 16-year follow-up, young patients who had HXLPE on ceramic coupling had excellent wear properties, PROs, and acceptable survivorships.
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Affiliation(s)
- Tyler R Youngman
- Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri
| | | | - Daniel Layon
- Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri
| | - Frank Parilla
- Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri
| | - Gail Pashos
- Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri
| | - Tanner Thornton
- Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri
| | - Ilya Bendich
- Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri
| | - John C Clohisy
- Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri.
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Krull P, Steinbrück A, Grimberg AW, Melsheimer O, Morlock MM, Perka C. [Standard and special liner in primary hip arthroplasty : Current study and survey results from the German Arthroplasty Registry (EPRD)]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:222-232. [PMID: 36635446 DOI: 10.1007/s00132-022-04333-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Instability constitutes the main reason for revision hip arthroplasties. Modified polyethylene liners are designed to improve the stability of a hip replacement. In July 2022 The Bone & Joint Journal published a study with data of the German Arthroplasty Registry (EPRD). The study investigated mechanical failure of standard and modified liner designs in primary, cementless total hip arthroplasty. Following the study, the EPRD conducted a survey of German clinics to research the utilization of lipped liners in primary total hip replacement. METHODS The liner study included 151,096 primary, elective, cementless total hip arthroplasties. Data from November 2012 to November 2020 were obtained from the EPRD. Standard polyethylene liners were compared with lipped, angulated, offset and angulated/offset inlays. Cumulative incidences for endpoint revision due to mechanical complication were calculated with a competing risk analysis. The influence of other variables was investigated with a multivariate Cox regression. In the following online survey, 237 out of 789 hospitals completed a form. RESULTS AND CONCLUSION In our analysis, only offset liners were, compared to standard liners, associated with a reduced risk of mechanical failure in a short to medium follow up. However, the resultant joint reaction force is increased with offset liners due to the lateralization of the hip center of rotation. Thus, the long-term performance of offset liners needs to be observed. Our survey indicated that lipped liners were implanted more often if the posterior approach was used. Moreover, lipped liners were mostly positioned with the elevated rim in the biomechanically less optimal posterior-superior quadrant. To improve stability it is suggested to position the elevated rim in the posterior-inferior quadrant.
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Affiliation(s)
- Paula Krull
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland. .,Centrum für Muskuloskeletale Chirurgie (CMSC), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Arnd Steinbrück
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland.,Orthopädisch Chirurgisches Kompetenzzentrum Augsburg (OCKA), Vinzenz-von-Paul-Platz 1, 86152, Augsburg, Deutschland
| | - Alexander W Grimberg
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland
| | - Oliver Melsheimer
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland
| | - Michael M Morlock
- Technische Universität Hamburg (TUHH), Am Schwarzenberg-Campus 1, 21073, Hamburg, Deutschland
| | - Carsten Perka
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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19
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Codirenzi AM, Lanting BA, Teeter MG. What Patient and Implant Factors Affect Trunnionosis Severity? An Implant Retrieval Analysis of 664 Femoral Stems. J Arthroplasty 2023; 38:376-382. [PMID: 36084756 DOI: 10.1016/j.arth.2022.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Corrosion at the modular head-neck taper interface of total and hemiarthroplasty hip implants (trunnionosis) is a cause of implant failure and thus a clinical concern. Patient and device factors contributing to the occurrence of trunnionosis have been investigated in prior implant retrieval studies but generally with limited sample sizes and a narrow range of models. The purpose of the present investigation was to determine which patient and device factors were associated with corrosion damage on the femoral stem taper across a large collection of different implant models retrieved following revision hip arthroplasty. METHODS A retrieval study of 664 hip arthroplasty modular stem components was performed. Patient and device information was collected. Trunnions were imaged under digital microscopy and scored for corrosion damage using a scaling system. Damage was related to patient and device factors using regression analyses. RESULTS Greater duration of implantation (P = .005) and larger head size (P < .001) were associated with an elevated corrosion class. Older age at index surgery (P = .035), stainless steel stem material (P = .022), indication for revision as bone or periprosthetic fracture (P = .017), and infection (P = .018) and certain larger taper geometries were associated with a decreased corrosion class. CONCLUSION Factors identified as contributing to a higher or lower risk of more severe corrosion are consistent with most prior smaller retrieval studies. Surgeons should be aware of these risk factors when selecting implants for their patients and when diagnosing trunnionosis in symptomatic hip arthroplasty patients.
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Affiliation(s)
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Matthew G Teeter
- School of Biomedical Engineering, Western University, London, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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20
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Martelli A, Erani P, Pazzagli N, Cannillo V, Baleani M. Surface Analysis of Ti-Alloy Micro-Grooved 12/14 Tapers Assembled to Non-Sleeved and Sleeved Ceramic Heads: A Comparative Study of Retrieved Hip Prostheses. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1067. [PMID: 36770073 PMCID: PMC9920329 DOI: 10.3390/ma16031067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Ti6Al4V titanium alloy (Ti-alloy) sleeved ceramic heads have become widely used in revision surgery when the hip stem is left in situ. This solution guarantees a new junction between the bore of the ceramic head and the Ti-alloy sleeve, regardless of any possible, slight surface damage to the Ti-alloy taper of the stem. However, this solution introduces an additional Ti-alloy/Ti-alloy interface pairing, which is potentially susceptible to mechanically assisted crevice corrosion. This study evaluated both qualitatively and quantitatively the damage that occurred in vivo on Ti-alloy micro-grooved 12/14 tapers of (i) primary implants with non-sleeved ceramic heads (Group 1), (ii) secondary implants with non-sleeved ceramic heads (Group 2), and (iii) secondary implants with sleeved ceramic heads (Group 3). A total of 45 explants-15 for each group, including short-, medium- and long-neck heads-underwent optical evaluation for surface damage (Goldberg scoring), surface roughness analysis, and SEM/EDX analysis. The Goldberg scores did not reveal different patterns in the tapers' surface damage; surface damage was classified as absent or mild (surface damage score ≤2) in 94%, another 94%, and 92% of the analysed regions for Group 1, Group 2, and Group 3, respectively. Small but significant differences in morphological changes occurred in the tapers of the three groups: reductions no greater than a few percentage points in median values of roughness parameters were found in Group 1 and Group 2, while negligible changes were found in Group 3. SEM/EDX analysis revealed little (i.e., a slight increase in the oxygen content) to undetectable changes in the chemical composition on the Ti-alloy surface independently of the group. These results suggest that the Ti-alloy/Ti-alloy sleeve/taper junction is only mildly susceptible to mechanically assisted crevice corrosion. Assembling a sleeved ceramic head, with variable neck lengths up to a "long-neck", to a Ti-alloy micro-grooved 12/14 taper of a stem left in situ does not seem to increase the risk of revision due to trunnionosis, as long as junction stability (i.e., the proper seating of the sleeved ceramic head on the 12/14 taper) is achieved intraoperatively.
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Affiliation(s)
- Andrea Martelli
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Ingegneria Enzo Ferrari, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
| | - Paolo Erani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Nicola Pazzagli
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Valeria Cannillo
- Dipartimento di Ingegneria Enzo Ferrari, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
| | - Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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21
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Hornung AL, Hall DJ, Je M, Wright JL, Nicholson GP, Garrigues GE, Pourzal R. Do total shoulder arthroplasty implants corrode? J Shoulder Elbow Surg 2022; 31:2381-2391. [PMID: 35671932 PMCID: PMC9588611 DOI: 10.1016/j.jse.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/12/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) has become the gold-standard treatment to relieve joint pain and disability in patients with glenohumeral osteoarthritis who do not respond to conservative treatment. An adverse reaction to metal debris released due to fretting corrosion has been a major concern in total hip arthroplasty. To date, it is unclear how frequently implant corrosion occurs in TSA and whether it is a cause of implant failure. This study aimed to characterize and quantify corrosion and fretting damage in a single anatomic TSA design and to compare the outcomes to the established outcomes of total hip arthroplasty. METHODS We analyzed 21 surgically retrieved anatomic TSAs of the same design (Tornier Aequalis Pressfit). The retrieved components were microscopically examined for taper corrosion, and taper damage was scored. Head and stem taper damage was quantitatively measured with a non-contact optical coordinate-measuring machine. In selected cases, damage was further characterized at high magnifications using scanning electron microscopy. Energy-dispersive x-ray spectroscopy and metallographic evaluations were performed to determine underlying alloy microstructure and composition. Comparisons between groups with different damage features were performed with independent-samples t tests; Mann-Whitney tests and multivariate linear regression were conducted to correlate damage with patient factors. The level of statistical significance was set at P < .05. RESULTS The average material loss for head and stem tapers was 0.007 mm3 and 0.001 mm3, respectively. Material loss was not correlated with sex, age, previous implant, or time in situ (P > .05). We observed greater volume loss in head tapers compared with stem tapers (P = .002). Implants with evidence of column damage had larger volumetric material loss than those without such evidence (P = .003). Column damage aligned with segregation bands within the alloy (preferential corrosion sites). The average angular mismatch was 0.03° (standard deviation, 0.0668°), with negative values indicating distal engagement and positive values indicating proximal engagement. Implants with proximal engagement were significantly more likely to have column damage than those with distal engagement (P = .030). DISCUSSION This study has shown not only that the metal components of TSA implants can corrode but also that the risk of corrosion can be reduced by (1) eliminating preferential corrosion sites and (2) ensuring distal engagement to prevent fluid infiltration into the modular junction.
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Affiliation(s)
- Alexander L Hornung
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Deborah J Hall
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mable Je
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jennifer L Wright
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA; Midwest Orthopedics at Rush, Chicago, IL, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA; Midwest Orthopedics at Rush, Chicago, IL, USA
| | - Robin Pourzal
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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22
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Taper corrosion in total hip arthroplasty – How to assess and which design features are crucial? J Mech Behav Biomed Mater 2022; 133:105307. [DOI: 10.1016/j.jmbbm.2022.105307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022]
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Bormann T, Müller U, Gibmeier J, Mai PT, Renkawitz T, Kretzer JP. Insights into Imprinting: How Is the Phenomenon of Tribocorrosion at Head-Neck Taper Interfaces Related to Corrosion, Fretting, and Implant Design Parameters? Clin Orthop Relat Res 2022; 480:1585-1600. [PMID: 35383614 PMCID: PMC9278900 DOI: 10.1097/corr.0000000000002202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/15/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Wear and corrosion at modular neck tapers in THA can lead to major clinical implications such as periprosthetic osteolysis, adverse local tissue reactions, or implant failure. The material degradation processes at the taper interface are complex and involve fretting corrosion, third-body abrasion, as well as electrochemical and crevice corrosion. One phenomenon in this context is imprinting of the head taper, where the initially smooth surface develops a topography that reflects the rougher neck taper profile. The formation mechanism of this specific phenomenon, and its relation to other observed damage features, is unclear. An analysis of retrieved implants may offer some insights into this process. QUESTIONS/PURPOSES (1) Is imprinting related to time in situ of the implants and to the taper damage modes of corrosion and fretting? (2) Are implant design parameters like neck taper profile, stem material, or head seating associated with the formation of imprinting? (3) Is imprinting created by an impression of the neck taper profile or can a different mechanistic explanation for imprinting be derived? METHODS Thirty-one THAs with cobalt-chromium-molybdenum-alloy (CoCrMo) heads retrieved between 2013 and 2019 at revision surgery from an institutional registry were investigated. Inclusion criteria were: 12/14 tapers, a head size of 36 mm or smaller, time in situ more than 1 year, and intact nonmodular stems without sleeve adaptors. After grouping the residual THAs according to stem type, stem material, and manufacturer, all groups of three or more were included. Of the resulting subset of 31 retrievals, nine THAs exhibited a still assembled head-neck taper connection. The median (range) time in situ was 5 years (1 to 23). Two stem materials (21 titanium-alloy and 10 stainless steel), three kinds of bearing couples (11 metal-on-metal, 13 metal-on-polyethylene, and seven dual-mobility heads), and two different neck taper profiles (six wavy profile and 25 fluted profile) were present in the collection. Four THAs exhibited signs of eccentric head seating. The 31 investigated THAs represented 21% of the retrieved THAs with a CoCrMo alloy head during the specified period.At the head tapers, the damage modes of corrosion, fretting, and imprinting were semiquantitatively rated on a scale between 0 (no corrosion/fretting/imprinting) and 3 (severe corrosion/fretting/imprinting). Corrosion and fretting were assessed applying the Goldberg score, with the modification that the scale started at 0 and not at 1. Imprinting was assessed with a custom scoring system. Rating was done individually at the proximal and distal head taper half and summed to one total damage score for each retrieval and damage mode. Correlations between the damage modes and time in situ and between the damage modes among each other, were assessed using the Spearman rank order correlation coefficient (ρ). Associations between imprinting and implant design parameters were investigated by comparing the total imprinting score distributions with the Mann-Whitney U-test. Metallographically prepared cross-sections of assembled head-neck taper connections were examined by optical microscopy and disassembled head and neck taper surfaces were assessed by scanning electron microscopy (SEM). RESULTS The imprinting damage score increased with time in-situ (ρ = 0.72; p < 0.001) and the corrosion damage score (ρ = 0.63; p < 0.001) but not with the fretting damage score (ρ = 0.35; p = 0.05). There was no difference in total imprinting score comparing neck taper profiles or stem materials, with the numbers available. Eccentric head seating had elevated total imprinting score (median 6 [interquartile range 0]) compared with centric seating (median 1 [2]; p = 0.001). Light optical investigations showed that imprinting can be present on the head taper surfaces even if the depth of abraded material exceeds the neck taper profile height. SEM investigations showed bands of pitting corrosion in the imprinted grooves. CONCLUSION The microscopic investigations suggest that imprinting is not an independent phenomenon but a process that accompanies the continuous material degradation of the head taper surface because of circular damage on the passive layer induced by grooved neck tapers. CLINICAL RELEVANCE Material loss from head-neck taper connections involving CoCrMo alloy heads is a source of metal ions and could potentially be reduced if hip stems with smooth neck tapers were used. Surgeons should pay attention to the exact centric seating of the femoral head onto the stem taper during joining of the parts.
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Affiliation(s)
- Therese Bormann
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike Müller
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jens Gibmeier
- Institute for Applied Materials, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Phuong Thao Mai
- Institute for Applied Materials, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Tobias Renkawitz
- Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
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24
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Upfill-Brown AM, Paisner ND, Donnelly PC, De A, Sassoon AA. Lower Rates of Ceramic Femoral Head Use in Non-White Patients in the United States, a National Registry Study. J Arthroplasty 2022; 37:S919-S924.e2. [PMID: 35307527 PMCID: PMC9386729 DOI: 10.1016/j.arth.2022.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of our study was to investigate the association of race and ethnicity with the use of the newest technology and postoperative outcomes in total hip arthroplasty (THA) using the American Academy of Orthopaedic Surgeons (AAOS) American Joint Replacement Registry (AJRR). METHODS Adult THA procedures were queried from the AJRR from 2012 to 2020. A mixed-effects multivariate regression model was used to evaluate the association of race and ethnicity with the use of the newest technology (ceramic femoral head, dual-mobility implant, and robotic assist) at 30-day, and 90-day readmission. A proportional subdistribution hazard model was used to model a risk of revision THA. RESULTS There were 85,188 THAs with complete data for an analysis of outcomes and 103,218 for an analysis of ceramic head usage. The median length of follow-up was 37.9 months (interquartile range [IQR] 21.6 to 56.3 months). In multivariate models, compared to White non-Hispanic patients, Black (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.69-0.92, P < .001), Hispanic (OR 0.76, CI 0.59-0.99, P = .037), Asian (OR 0.74, CI 0.55-1.00, P = .045), and Native American (OR 0.52, CI 0.30-0.87, P = .004) patients all had significantly lower rates of ceramic head use in THA. Compared to White non-Hispanic patients, Asian (hazard ratio [HR] 0.39, CI 0.18-0.86, P = .008) and Hispanic (HR 0.43, CI 0.19-0.98, P = .043) patients had significantly lower rates of revision. No differences in 30-day or 90-day readmission rates were seen. CONCLUSION Black, Hispanic, Native American, and Asian patients had lower rates of ceramic head use in THA when compared to White patients. These differences did not translate into worse clinical outcomes on a short-term follow-up. In fact, Asian patients had lower revision rates compared to non-Hispanic White patients. Additional study is necessary to evaluate the long-term consequence of lower ceramic head use in non-White patients in the United States.
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Affiliation(s)
| | - Noah D. Paisner
- Pacific Northwest University School of Health Sciences, Yakima, WA
| | - Patrick C. Donnelly
- American Joint Replacement Registry, American Academy of Orthopaedic Surgery, Rosemont, IL
| | - Ayushmita De
- American Joint Replacement Registry, American Academy of Orthopaedic Surgery, Rosemont, IL
| | - Adam A. Sassoon
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA,Address correspondence to: Adam A. Sassoon, MD, MS, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th, Street, Suite 2100, Santa Monica, CA 90404
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25
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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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26
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Fernandez-Fairen M. CORR Insights®: Insights into Imprinting: How Is the Phenomenon of Tribocorrosion at Head-Neck Taper Interfaces Related to Corrosion, Fretting, and Implant Design Parameters? Clin Orthop Relat Res 2022; 480:1601-1603. [PMID: 35638900 PMCID: PMC9278905 DOI: 10.1097/corr.0000000000002267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/12/2022] [Indexed: 01/31/2023]
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27
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Lucchini S, Baleani M, Giardina F, Martelli A, Castagnini F, Bordini B, Traina F. A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture. J Orthop Surg Res 2022; 17:293. [PMID: 35658905 PMCID: PMC9164427 DOI: 10.1186/s13018-022-03190-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ceramic bearings are used in total hip arthroplasty due to their excellent wear behaviour and biocompatibility. The major concern related to their use is material brittleness, which significantly impacts on the risk of fracture of ceramic components. Fracture toughness improvement has contributed to the decrease in fracture rate, at least of the prosthetic head. However, the root cause behind these rare events is not fully understood. This study evaluated head fracture occurrence in a sizeable cohort of patients with fourth-generation ceramic-on-ceramic implants and described the circumstances reported by patients in the rare cases of head fracture. METHODS The clinical survivorship of 29,495 hip prostheses, with fourth-generation ceramic bearings, was determined using data from a joint replacement registry. The average follow-up period was 5.2 years (range 0.1-15.6). Retrieval analysis was performed in one case for which the ceramic components were available. RESULTS Clinical outcomes confirmed the extremely low fracture rate of fourth-generation ceramic heads: only two out of 29,495 heads fractured. The two fractures, both involving 36 mm heads, occurred without a concurrent or previous remarkable trauma. Considering the feature of the fractured head, a multi-stage crack growth mechanism has been hypothesized to occur following damage at the head-neck taper interface. CONCLUSIONS Surgeons must continue to pay attention to the assembly of the femoral head: achieving a proper head seating on a clean taper is a prerequisite to decrease the risk of occurrence of any damage process within head-neck junction, which may cause high stress concentration at the contact surface, promoting crack nucleation and propagation even in toughened ceramics.
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Affiliation(s)
- Stefano Lucchini
- IRCCS Istituto Ortopedico Rizzoli, Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e Ginocchio, Bologna, Italy
| | - Massimiliano Baleani
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Bologna, Italy.
| | - Federico Giardina
- IRCCS Istituto Ortopedico Rizzoli, Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e Ginocchio, Bologna, Italy
| | - Andrea Martelli
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Bologna, Italy
| | - Francesco Castagnini
- IRCCS Istituto Ortopedico Rizzoli, Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e Ginocchio, Bologna, Italy
| | - Barbara Bordini
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Bologna, Italy
| | - Francesco Traina
- IRCCS Istituto Ortopedico Rizzoli, Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e Ginocchio, Bologna, Italy
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28
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Díaz-Dilernia F, Sanchez-Mele H, Zanotti G, Comba F, Piccaluga F, Buttaro M. Fracture of a triple-polished tapered cemented femoral stem at the Morse taper after metal-on-metal primary total hip arthroplasty. Ann R Coll Surg Engl 2022; 104:e128-e132. [PMID: 34939858 PMCID: PMC9773908 DOI: 10.1308/rcsann.2021.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Total hip arthroplasty, one of the most successful orthopaedic procedures, is influenced by several variables. Corrosion at the modular junction is known as trunnionosis. Despite being reported infrequently, corrosion between the femoral head and the Morse taper can result in severe complications. Fracture of the femoral component in primary metal-on-metal (MoM) total hip arthroplasty at the Morse taper is an extremely rare event and can be associated with several risk factors. We report a case of corrosion at the Morse taper in a hybrid primary MoM total hip arthroplasty, resulting in Morse taper fracture with consequent femoral head entrapment inside the acetabular component. We hypothesise that some risk factors, such as age over 60years, active male patients, body mass index above 30kg/m2, large femoral heads, high-offset stems, 9/10 Morse taper and MoM-bearing surfaces, are associated with this mode of failure.
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Affiliation(s)
- F Díaz-Dilernia
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - H Sanchez-Mele
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - G Zanotti
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - F Comba
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - F Piccaluga
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - M Buttaro
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
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29
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Long-term fretting corrosion performance of modular head-neck junctions with self-reinforced composite gaskets from PEEK and UHMWPE. J Mech Behav Biomed Mater 2022; 129:105149. [DOI: 10.1016/j.jmbbm.2022.105149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/12/2021] [Accepted: 02/27/2022] [Indexed: 01/11/2023]
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30
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Logroscino G, Saracco M, Maccauro G, Urbani A, Ciavardelli D, Consalvo A, Ferraro D, Falez F. Ceramic-on-metal coupling in THA: long term clinical and radiographic outcomes using two different short stems. BMC Musculoskelet Disord 2022; 22:1065. [PMID: 35193540 PMCID: PMC8864779 DOI: 10.1186/s12891-022-05077-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip prosthetic replacement surgery is the gold standard for patients affected by symptomatic osteoarthritis. The ceramic-on-metal hybrid hard-on-hard bearing was initially launched on the market with the purpose of reducing adhesive and corrosion wear, loss of metal debris and ions and risk of fracture and squeaking. However, this bearing was withdrawn from the market, in the apprehension of local and systemic toxicity. The aim of this study is to evaluate the reliability and safety of ceramic-on-metal bearing at long term follow-up. METHODS From 2 cohorts of patients suffering of hip osteoarthritis who underwent total hip arthroplasty using ceramic-on-metal bearing with two different short stems, 19 of the GROUP A and 25 of the GROUP B were suitable for this study. All patients were compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12P/M), and radiographically. Blood samples were collected in order to evaluate chromium and cobalt ions level. The two groups were compared in terms of metal ions blood levels, and finally all the implanted prostheses were compared with a healthy control group. RESULTS All the implanted stems were well-positioned and osseointegrated at a mean follow-up of 114 months. Improvements were observed for all clinical scores comparing preoperative and postoperative values in both groups. Radiographic evaluation showed a good ability to restore proper articular geometry. Chromium and cobalt ion analysis revealed values below the safety threshold except for 1 case in GROUP A (cup malposition) and 2 cases in GROUP B (6.1%). No revision occurred. CONCLUSIONS Ceramic-on-metal bearing is safe and reliable at long term follow-up in association to short stems arthroplasty, if the implant is correctly positioned. Chromium and cobalt metal ions blood levels evaluation should be performed annually.
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Affiliation(s)
- Giandomenico Logroscino
- Mininvasive and Computer-Assisted Orthopaedic Surgery, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michela Saracco
- Department of Orthopaedics, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito,1, 00168, Rome, Italy.
| | - Giulio Maccauro
- Department of Orthopaedics, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito,1, 00168, Rome, Italy
| | - Andrea Urbani
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Ciavardelli
- School of Medicine and Surgery, University "Kore" of Enna, Enna, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Ada Consalvo
- Center for Advanced Studies and Technology (C.A.S.T.), University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Daniele Ferraro
- Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital and S. Spirito Hospital, Rome, Italy
| | - Francesco Falez
- Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital and S. Spirito Hospital, Rome, Italy
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Wight CM, Schemitsch EH. In vitro testing for hip head-neck taper tribocorrosion: A review of experimental methods. Proc Inst Mech Eng H 2022; 236:9544119221074582. [PMID: 35139678 PMCID: PMC8915230 DOI: 10.1177/09544119221074582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In vitro test methods are challenged by the multi-factorial nature of head-neck taper connection tribocorrosion due to the consequences of simplification. Incorrect study design and misinterpretation of results has led to contradictory findings regarding important factors affecting head-neck taper tribocorrosion. This review seeks to highlight important considerations when developing in vitro test methods, to help researchers strengthen their study design and analyze the implications of others' design decisions. The advantages, disadvantages, limitations and procedural considerations for finite element analyses, electrochemical studies and in vitro simulations related to head-neck taper connection tribocorrosion are discussed. Finite element analysis offers an efficient method for studying large ranges of mechanical parameters. However, they are limited by neglecting electrochemical, biological and fluid flow factors. Electrochemical studies may be preferred if these factors are considered important. Care must be taken in interpreting data from electrochemical studies, particularly when different materials are compared. Differences in material valence and toxicity affect clinical translation of electrochemical studies' results. At their most complex, electrochemical studies attempt to simulate all aspects of headneck taper connection tribocorrosion in a bench top study. Effective execution requires in-depth knowledge of the tribocorrosion phenomenon, the involved mechanisms, and their measures such that each study design decision is fully informed.
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Affiliation(s)
- Christian M Wight
- Institute of Biomaterial and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Brusalis CM, Thacher RR, Baral E, Wright TM, Gulotta LV, Dines DM, Warren RF, Fu MC, Taylor SA. Tribocorrosion is Common, but Mild in Modular Humeral Components in Shoulder Arthroplasty: An Implant Retrieval Analysis. JSES Int 2022; 6:401-405. [PMID: 35572421 PMCID: PMC9091787 DOI: 10.1016/j.jseint.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Wear and corrosion at the junctions of modular implants are increasingly recognized issues in the design of hip and knee arthroplasty prostheses, yet less is known about their significance in shoulder arthroplasty. Methods A query of paired total shoulder implant specimens (eg, humeral head and stem components from the same patient) was performed using an institutional implant retrieval registry. Implants were examined under a stereomicroscope and evaluated for evidence of fretting and corrosion using the modified Goldberg scoring system. Available electronic medical records of included specimens were reviewed to report relevant clinical characteristics and identify potential associations with the presence of tribocorrosion. Results Eighty-three paired total shoulder implant specimens, explanted at a single institution between 2013 and 2020, were analyzed. Corrosion was identified in 52% (43/83) of humeral head components and 40% (33/83) of humeral stem components. Fretting was identified in 29% (24/83) of humeral head components and 28% (23/83) of humeral stem components. Of the 56 paired implants for which clinical data were available, the duration of implantation (DOI) was less than 2 years in 29% of paired implants and greater than 5 years in 36% of implants. The presence of corrosion or fretting was not associated with DOI, a male humeral head taper, or periprosthetic infection as the indication for revision. Conclusion Mild tribocorrosion was present in more than half of the retrieved humeral implant specimens. However, trunnionosis did not manifest as a clinical cause of revision surgery in our study.
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Gómez Taborda Y, Gómez Botero M, Castaño-González JG, Bermúdez-Castañeda A. Assessment of physical, chemical, and tribochemical properties of biomedical alloys used in explanted modular hip prostheses. Proc Inst Mech Eng H 2021; 236:9544119211061928. [PMID: 34931555 DOI: 10.1177/09544119211061928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During their service life, modular interfaces experience tribological, and corrosion phenomena that lead to deterioration, which in turn can cause a revision procedure to remove the failed prosthesis. To achieve a clearer understanding of the surface performance of those biomedical alloys and the role of the surface properties in the mechanical and chemical performance, samples were taken from retrieval implants made of Ti6Al4V and Co28Cr6Mo alloys. Polarization resistance and pin-on-disk tests were performed on these samples. Physical properties such as contact angle, roughness, microhardness, and Young's modulus were determined. A correlation between surface energy and evolution of the tribological contact was observed for both biomedical alloys. In tribocorrosion tests, titanium particles seem to remain in the surface, unlike what is observed in CoCr alloys. These metallic or oxidized particles could cause necrosis or adverse tissue reactions.
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Affiliation(s)
- Yesenia Gómez Taborda
- Centro de Investigación, Innovación y Desarrollo de Materiales - CIDEMAT, Universidad de Antioquia, Medellín, Colombia
| | - Maryory Gómez Botero
- Centro de Investigación, Innovación y Desarrollo de Materiales - CIDEMAT, Universidad de Antioquia, Medellín, Colombia
| | | | - Angela Bermúdez-Castañeda
- Diseño Sostenible en Ingeniería Mecánica - DSIM, Escuela Colombiana de Ingeniería Julio Garavito, Bogotá, Colombia
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Tucker K, Günther KP, Kjaersgaard-Andersen P, Lützner J, Kretzer JP, Nelissen RGHH, Lange T, Zagra L. EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty. EFORT Open Rev 2021; 6:982-1005. [PMID: 34909220 PMCID: PMC8631244 DOI: 10.1302/2058-5241.6.210080] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended. Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced). Within the EFORT ‘Implant and Patient Safety Initiative’, evidence- and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty. Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately. Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake. Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results. Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures. Cite this article: EFORT Open Rev 2021;6:982-1005. DOI: 10.1302/2058-5241.6.210080
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Affiliation(s)
- Keith Tucker
- Orthopaedic Data Evaluation Panel (ODEP), Norwich, UK
| | - Klaus-Peter Günther
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | | | - Jörg Lützner
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Toni Lange
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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35
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Wight CM, Whyne CM, Bogoch ER, Zdero R, Chapman RM, van Citters DW, Walsh WR, Schemitsch E. Effect of head size and rotation on taper corrosion in a hip simulator. Bone Jt Open 2021; 2:1004-1016. [PMID: 34825826 PMCID: PMC8636299 DOI: 10.1302/2633-1462.211.bjo-2021-0147.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIMS This study investigates head-neck taper corrosion with varying head size in a novel hip simulator instrumented to measure corrosion related electrical activity under torsional loads. METHODS In all, six 28 mm and six 36 mm titanium stem-cobalt chrome head pairs with polyethylene sockets were tested in a novel instrumented hip simulator. Samples were tested using simulated gait data with incremental increasing loads to determine corrosion onset load and electrochemical activity. Half of each head size group were then cycled with simulated gait and the other half with gait compression only. Damage was measured by area and maximum linear wear depth. RESULTS Overall, 36 mm heads had lower corrosion onset load (p = 0.009) and change in open circuit potential (OCP) during simulated gait with (p = 0.006) and without joint movement (p = 0.004). Discontinuing gait's joint movement decreased corrosion currents (p = 0.042); however, wear testing showed no significant effect of joint movement on taper damage. In addition, 36 mm heads had greater corrosion area (p = 0.050), but no significant difference was found for maximum linear wear depth (p = 0.155). CONCLUSION Larger heads are more susceptible to taper corrosion; however, not due to frictional torque as hypothesized. An alternative hypothesis of taper flexural rigidity differential is proposed. Further studies are necessary to investigate the clinical significance and underlying mechanism of this finding. Cite this article: Bone Jt Open 2021;2(11):1004-1016.
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Affiliation(s)
- Christian M. Wight
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Cari M. Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Earl R. Bogoch
- Department of Surgery, University of Toronto, Brookfield Chair in Fracture Prevention, Toronto, Ontario, Canada
| | - Radovan Zdero
- London Health Science Centre, Western University, London, Ontario, Canada
| | - Ryan M. Chapman
- London Health Science Centre, Western University, London, Ontario, Canada
| | - Douglas W. van Citters
- Thayer School of Engineering at Dartmouth College, Western University, Hanover, New Hampshire, USA
| | - William R. Walsh
- Surgical and Orthopaedic Research Laboratory, UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Emil Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Karaismailoglu B, Karaismailoglu TN. Femoral Head Perforation After Primary Hip Arthroplasty: Unseen Complication of Ceramic-on-Ceramic Interface: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00045. [PMID: 34319929 DOI: 10.2106/jbjs.cc.20.00551] [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: 11/14/2022]
Abstract
CASE A 33-year-old woman, who underwent bilateral ceramic-on-ceramic total hip arthroplasty 3 years previously, presented with right groin pain and mechanical grinding without a history of trauma. Radiographs revealed luxation of the femoral head, and computerized tomography showed perforation of the ceramic femoral head. The patient underwent revision with a metal-on-polyethylene articulation and retained femoral stem. Two years of follow-up yielded good clinical outcome with no evidence of osteolysis or polyethylene wear. CONCLUSION The perforation of a ceramic femoral head should be kept in mind as one of the possible implant failure mechanisms after primary hip arthroplasty.
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Affiliation(s)
- Bedri Karaismailoglu
- Orthopaedics and Traumatology Department, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, İstanbul, Turkey
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37
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El-Zein ZS, Gehrke CK, Croley JS, Siljander MP, Mallow MA, Flierl MA, Verner JJ, Baker EA. Assessing Taper Geometry, Head Size, Head Material, and Their Interactions in Taper Fretting Corrosion of Retrieved Total Hip Arthroplasty Implants. J Arthroplasty 2021; 36:S386-S394.e4. [PMID: 33832796 DOI: 10.1016/j.arth.2021.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Decreased fretting and corrosion damage at the taper interface of retrieved ceramic-on-polyethylene total hip arthroplasty (THA) implants has been consistently reported; however, resultant fretting corrosion as a function of femoral head size and taper geometry has not been definitively explained. METHODS Eight cohorts were defined from 157 retrieved THA implants based on femoral head composition (n = 95, zirconia-toughened alumina, ZTA vs n = 62, cobalt-chromium alloy, CoCr), head size (n = 56, 32mm vs n = 101, 36mm), and taper geometry (n = 84, 12/14 vs n = 73, V40). THA implants were evaluated and graded for taper fretting and corrosion. Data were statistically analyzed, including via a 23 factorial modeling. RESULTS Factorial-based analysis indicated the significant factors related to both resultant (summed) fretting and corrosion damage were head material and taper geometry; head material-taper geometry interaction was also a significant factor in resultant corrosion damage. Lower rates of moderate-to-severe fretting and corrosion damage were exhibited on ZTA heads (ZTA = 13%, CoCr = 38%), smaller heads (32mm = 18%, 36mm = 26%), and 12/14 tapers (12/14 = 13%, V40 = 35%). ZTA+32mm heads demonstrated the lowest rates of moderate-to-severe fretting and corrosion damage (12/14 = 2%, V40 = 7%), whereas CoCr heads with V40 tapers demonstrated the greatest rates of moderate-to-severe damage (32mm = 47%, 36mm = 59%). CONCLUSION In this series, retrieved implants with ZTA, 32-mm heads paired with 12/14 tapers exhibited lower rates of moderate-to-severe damage. Factorial analysis showed head material, taper geometry, and their interactions were the most significant factors associated with resultant damage grades. Isolating implant features may provide additional information regarding factors leading to fretting and corrosion damage in THA. LEVEL OF EVIDENCE IV (case series).
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Affiliation(s)
- Zein S El-Zein
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI
| | - Corinn K Gehrke
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI
| | - J Sawyer Croley
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI
| | | | - Murphy A Mallow
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI
| | - Michael A Flierl
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI; Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI
| | - James J Verner
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI; Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI
| | - Erin A Baker
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI; Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI
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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: 1] [Impact Index Per Article: 0.3] [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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Cadel ES, Topoleski LDT, Vesnovsky O, Anderson CR, Hopper RH, Engh CA, Di Prima MA. A comparison of metal/metal and ceramic/metal taper-trunnion modular connections in explanted total hip replacements. J Biomed Mater Res B Appl Biomater 2021; 110:135-143. [PMID: 34164932 PMCID: PMC9292311 DOI: 10.1002/jbm.b.34897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/28/2021] [Accepted: 06/13/2021] [Indexed: 12/27/2022]
Abstract
Corrosion and wear are commonly found at the taper-trunnion connection of modular total hip arthroplasty (THA) explanted devices. While metal/metal (M/M) modular taper-trunnion connections exhibit more wear/corrosion than ceramic/metal (C/M) modular taper-trunnion connections, damage is present in both, regardless of material. This study used a combination of assessment techniques including clinical data, visual scoring assessment, optical imaging, profilometry, and x-ray photoelectron microscopy (XPS), to investigate wear mechanisms and damage features at the modular taper-trunnion connection of 10 M/M and 8 C/M explanted THAs. No correlation was found between any demographic variable and corrosion wear and assessment scores. All assessment techniques demonstrated that the stem trunnions had more damage than head tapers for both explant groups and agreed that C/M explants had less corrosion and wear compared to M/M explants. However, visual assessment scores differed between assessment techniques when evaluating the tapers and trunnions within the two groups. Profilometry showed an increase (p <.05) in surface roughness for stem trunnions compared to head tapers for both explant groups. X-ray photoelectron spectroscopy performed on deposits from two M/M explants found chromium and molybdenum carbides beneath the surface while chromium sulfate and aged bone mineral were found on the surface suggesting that the debris is a result of corrosion rather than wear. These results indicate that taper-trunnion damage is more prevalent for M/M explants, but C/M explants are still susceptible to damage. More comprehensive analysis of damage is necessary to better understand the origins of taper-trunnion damage.
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Affiliation(s)
- Eileen S Cadel
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - L D Timmie Topoleski
- US Food and Drug Administration, Silver Spring, Maryland, USA.,University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Oleg Vesnovsky
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Robert H Hopper
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | - Charles A Engh
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
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40
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Wendler T, Prietzel T, Möbius R, Fischer JP, Roth A, Zajonz D. Quantification of assembly forces during creation of head-neck taper junction considering soft tissue bearing: a biomechanical study. ARTHROPLASTY 2021; 3:20. [PMID: 35236493 PMCID: PMC8796494 DOI: 10.1186/s42836-021-00075-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background All current total hip arthroplasty (THA) systems are modular in design. Only during the operation femoral head and stem get connected by a Morse taper junction. The junction is realized by hammer blows from the surgeon. Decisive for the junction strength is the maximum force acting once in the direction of the neck axis, which is mainly influenced by the applied impulse and surrounding soft tissues. This leads to large differences in assembly forces between the surgeries. This study aimed to quantify the assembly forces of different surgeons under influence of surrounding soft tissue. Methods First, a measuring system, consisting of a prosthesis and a hammer, was developed. Both components are equipped with a piezoelectric force sensor. Initially, in situ experiments on human cadavers were carried out using this system in order to determine the actual assembly forces and to characterize the influence of human soft tissues. Afterwards, an in vitro model in the form of an artificial femur (Sawbones Europe AB, Malmo, Sweden) with implanted measuring stem embedded in gelatine was developed. The gelatine mixture was chosen in such a way that assembly forces applied to the model corresponded to those in situ. A study involving 31 surgeons was carried out on the aforementioned in vitro model, in which the assembly forces were determined. Results A model was developed, with the influence of human soft tissues being taken into account. The assembly forces measured on the in vitro model were, on average, 2037.2 N ± 724.9 N, ranging from 822.5 N to 3835.2 N. The comparison among the surgeons showed no significant differences in sex (P = 0.09), work experience (P = 0.71) and number of THAs performed per year (P = 0.69). Conclusions All measured assembly forces were below 4 kN, which is recommended in the literature. This could lead to increased corrosion following fretting in the head-neck interface. In addition, there was a very wide range of assembly forces among the surgeons, although other influencing factors such as different implant sizes or materials were not taken into account. To ensure optimal assembly force, the impaction should be standardized, e.g., by using an appropriate surgical instrument.
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Affiliation(s)
- Toni Wendler
- ZESBO - Centre for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany. .,Institute of Anatomy, Leipzig University, Leipzig, Germany.
| | - Torsten Prietzel
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Zeisigwaldkliniken Bethanien, Chemnitz, Germany
| | - Robert Möbius
- ZESBO - Centre for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany.,Department of Neurosurgery, Leipzig University, Leipzig, Germany
| | - Jean-Pierre Fischer
- ZESBO - Centre for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany.,Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Andreas Roth
- Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Dirk Zajonz
- ZESBO - Centre for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany.,Department of Orthopaedics, Trauma and Reconstructive Surgery, Zeisigwaldkliniken Bethanien, Chemnitz, Germany.,Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
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Stockhausen KE, Riedel C, Belinski AV, Rothe D, Gehrke T, Klebig F, Gebauer M, Amling M, Citak M, Busse B. Variability in stem taper surface topography affects the degree of corrosion and fretting in total hip arthroplasty. Sci Rep 2021; 11:9348. [PMID: 33931680 PMCID: PMC8087796 DOI: 10.1038/s41598-021-88234-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 03/19/2021] [Indexed: 12/29/2022] Open
Abstract
Degradation at the modular head-neck interface in total hip arthroplasty (THA) is predominately expressed in the form of corrosion and fretting, potentially causing peri-prosthetic failure by adverse reactions to metal debris. This retrieval study aimed to quantify variations in stem taper surface topographies and to assess the influence on the formation of corrosion and/or fretting in titanium alloy stem tapers combined with metal and ceramic heads. Four hip stem designs (Alloclassic, CLS, Bicontact and SL-Plus) were characterized using high-resolution 3D microscopy, and corrosion and fretting were rated using the Goldberg scoring scheme. Quantification of the taper surface topographies revealed a high variability in surface characteristics between threaded stem tapers: Alloclassic and CLS tapers feature deeply threaded trapezoid-shaped profiles with thread heights over 65 µm. The sawtooth-shaped Bicontact and triangular SL-Plus taper are characterized by low thread heights below 14 µm. Significantly lower corrosion and fretting scores were observed in lightly threaded compared to deeply threaded tapers in ceramic head combinations. No significant differences in corrosion or fretting scores with thread height were found in pairings with metal heads. Understanding the relationship between stem taper surface topography and the formation of corrosion and fretting could help to improve the performance of modern THAs and lead to longer-lasting clinical results.
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Affiliation(s)
- Kilian Elia Stockhausen
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Christoph Riedel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Alex Victoria Belinski
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany.,Department of Mechanical Engineering, University of California, 6141 Etcheverry Hall, Berkeley, CA, USA
| | - Dorothea Rothe
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Felix Klebig
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Matthias Gebauer
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopedic Surgery, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Germany
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 55a, 22529, Hamburg, Germany. .,Interdisciplinary Competence Center for Interface Research (ICCIR), Martinistr. 52, 20251, Hamburg, Germany. .,Forum Medical Technology Health Hamburg (FMTHH), Butenfeld 34, 22529, Hamburg, Germany.
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Radzik B, Bijukumar D, Cheng KY, Badhe RV, Barba M, Mathew MT. The role of fretting-frequency on the damage modes of THR modular junction: In-vitro study. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 126:112128. [PMID: 34082945 DOI: 10.1016/j.msec.2021.112128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 12/28/2022]
Abstract
According to the National Center for Health Statistics, currently, more than 250,000 total hip replacements annually in the US alone, with an estimated increase to 500,000 by the year 2030. The usage of tapered junctions between the femoral neck and head gives the surgeon flexibility in implant assembly. However, these modular junctions are subjected to micro-motion that may cause chemical and fretting-corrosion at the modular junction. Therefore, it is imperative to study these forces to mitigate their effects. The current study aims to understand the effects of fretting-corrosion as a function of fretting frequencies caused by common physical activities in an in-vitro model of hip modular junctions. The fretting system has a tribological contact condition of flat-on-flat, mounted to a load frame. CoCrMo pins were polished and immersed in a synovial fluid-like electrolyte solution (Bovine calf serum 30 g/l). Electrochemical measurements were made using a potentiostat. Samples then undergo 3600 cycles at 50 μm (to simulate gross slips), with a horizontal load at 200 N, and a frequency of 0.5 Hz, 0.7 Hz, 1 Hz, and 1.5 Hz to simulate Sit Down-Stand Up, Stair Climb, Walking, and Jogging, respectively. Worn surfaces were then examined under optical and scanning electron microscopy. The evolution of free potential as a function of time for tested frequencies shows the initial potential drop and stabilized trend in the potential evolution. The sample group at a higher frequency displays a higher tendency of corrosion than a lower frequency; however, the dissipation energy decreases as a function of fretting frequency. Both electrochemical and mechanical responses correlate to the variation in the fretting frequencies. Organometallic complexes were found on the surfaces of the samples that were subjected to a slower frequency of fretting, whereas mechanical grooving was noticed on samples with a faster frequency. Hence, these preliminary studies suggest that implant failure rates may be altered based on fretting-frequencies induced by physical activity. Further studies will be required to verify the findings and explore the potential role of fretting frequency in the damage modes of the modular junction.
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Affiliation(s)
- Bartlomiej Radzik
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UIC College of Medicine at Rockford, IL, United States of America
| | - Divya Bijukumar
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UIC College of Medicine at Rockford, IL, United States of America
| | - Kai-Yuan Cheng
- Department of Civil and Material Engineering, College of Engineering, UIC, Chicago, United States of America
| | - Ravindra V Badhe
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UIC College of Medicine at Rockford, IL, United States of America
| | - Mark Barba
- OrthoIllinois, Rockford, IL, United States of America
| | - Mathew T Mathew
- Regenerative Medicine and Disability Research (RMDR) Lab, Department of Biomedical Sciences, UIC College of Medicine at Rockford, IL, United States of America; Department of Civil and Material Engineering, College of Engineering, UIC, Chicago, United States of America; Rush University Medical Center, Chicago, IL, United States of America.
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Bonnheim NB, Van Citters DW, Ries MD, Pruitt LA. Oxidized Zirconium Components Maintain a Smooth Articular Surface Except Following Hip Dislocation. J Arthroplasty 2021; 36:1437-1444. [PMID: 33246784 DOI: 10.1016/j.arth.2020.10.054] [Citation(s) in RCA: 4] [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: 09/06/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Oxidized zirconium (OxZr) offers theoretical advantages in total hip and knee arthroplasty (THA and TKA, respectively) relative to other biomaterials by combining the tribological benefits of ceramics with the fracture toughness of metals. Yet, some studies have found that OxZr does not improve outcomes or wear rates relative to traditional bearing materials such as cobalt-chromium (CoCr). Separately, effacement of the thin ceramic surface layer has been reported for OxZr components, though the prevalence and sequelae are unclear. METHODS To elucidate the in vivo behavior of OxZr implants, the articular surfaces of 94 retrieved THA and TKA femoral components (43 OxZr TKA, 21 OxZr THA, 30 CoCr THA) were analyzed using optical microscopy, non-contact profilometry, and scanning electron microscopy. RESULTS We found that OxZr components maintain a smooth articular surface except following hip dislocation. Three of four OxZr femoral heads revised following dislocation exhibited severe damage to the articular surface, including macroscopic regions of ceramic-layer effacement and exposure of the underlying metal substrate; these components were 23-32 times rougher than pristine OxZr controls. When revised for dislocation, OxZr femoral heads were substantially rougher than CoCr femoral heads (median Sa = 0.431 v. 0.020 μm, P = .03). In contrast, CoCr femoral heads exhibited low overall roughness values regardless of whether they dislocated (median Sa = 0.020 v. 0.008 μm, P = .09, CoCr dislocators v. non-dislocators). CONCLUSIONS Effacement of the ceramic surface layer and substantial articular surface roughening is not atypical following dislocation of OxZr femoral heads, making OxZr much less tolerant than CoCr to hip dislocation.
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Affiliation(s)
- Noah B Bonnheim
- Department of Mechanical Engineering, University of California, Berkeley, CA
| | | | | | - Lisa A Pruitt
- Department of Mechanical Engineering, University of California, Berkeley, CA
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Ouellette ES, Smith SM, Gilbert JL. Self-reinforced poly(ether ether ketone) and polyethylene composite gaskets for prevention of mechanically-assisted corrosion in modular taper junctions: Seating, micromotion and short-term fretting corrosion. J Mech Behav Biomed Mater 2021; 119:104454. [PMID: 33826987 DOI: 10.1016/j.jmbbm.2021.104454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
Abstract
Mechanically-assisted crevice corrosion (MACC) is a phenomenon known to cause complications in modular orthopedic implants, particularly at metal-metal taper junctions. Previous studies of the properties and corrosion performance of an interfacial polymeric self-reinforced composite (SRC) gaskets have shown its capability as a high-strength, insulating barrier against oxide abrasion and metal degradation of metal-metal (or metal-hard) contacts in MACC conditions. This study characterizes the short-term tribocorrosion performance of poly (ether ether ketone) SRCs (SRC-PEEK) and polyethylene SRC (SRC-PE) films under in vitro test conditions for head-neck modular junction designs in hip replacement devices. SRC films composed of SRC-PEEK and SRC-PE were seated between 9/10 femoral head bores and stem tapers as thin interfacial gaskets and tested against metal-metal controls under short-term cyclic loading conditions in a custom in vitro test setup. Head-neck seating mechanics were measured, followed by incremental cyclic fretting corrosion testing with monitoring of fretting current, force, and relative micromotion between head and neck components during cyclic loading. SRC-PEEK tapers had a seating subsidence that was approximately three times that of the SRC-PE tapers and nine times that of controls. SRC-PE tapers, likely due to low friction, partially failed to lock during seating resulting in a pushing up of the head on the taper. Average fretting currents were significantly lower for both SRC groups (less than 0.3 μA at 4000 N) compared to control tapers experiencing fretting corrosion currents between 1.7 μA and 32 μA, (p < 0.05). SRC-PEEK gaskets exhibited similar subsidence and micromotion performance as controls while SRC-PE tapers experienced over 240 μm of subsidence during seating and loading conditions. The SRC-PE low-friction properties likely caused insufficient taper locking, which may increase the risk of improper head seating or head disassociation. These results show that SRC-PEEK gaskets, unlike SRC-PE gaskets, can maintain adequate frictional locking at the taper junction and prevent the onset of MACC. SRC-PEEK gaskets improve the performance of modular taper junctions and could be considered as a potential solution to mitigate fretting corrosion.
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Affiliation(s)
- Eric S Ouellette
- Syracuse Biomaterials Institute, Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, NY, 13244, USA; Exponent, Inc, Philadelphia, PA, 19104, USA
| | - Stephanie M Smith
- Syracuse Biomaterials Institute, Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, NY, 13244, USA; Clemson Department of Bioengineering, USA; Clemson - Medical University of South Carolina Bioengineering Program, USA
| | - Jeremy L Gilbert
- Syracuse Biomaterials Institute, Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, NY, 13244, USA; Clemson Department of Bioengineering, USA; Clemson - Medical University of South Carolina Bioengineering Program, USA.
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45
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Kretzer JP, Uhler M, Jäger S, Bormann T, Sonntag R, Schonhoff M, Schröder S. [Tribology in hip arthroplasty : Benefits of different materials]. DER ORTHOPADE 2021; 50:259-269. [PMID: 33630110 DOI: 10.1007/s00132-021-04077-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
When it comes to total hip replacements, choosing the suitable material combination is of clinical relevance. The present review article examines the technical differences in wear and corrosion of the relevant material combinations of ceramics, metals, ceramized metals and various types of polyethylene. The material characteristics, which were often tested under standardized conditions in the laboratory, are compared with clinical results on the basis of evidence-graded clinical studies and on the basis of register studies. This article thus represents an up-to-date snapshot of the expectations and actual clinical outcomes of the present choice of material combinations. It shows that some tendencies from the field of materials research, e.g. with regard to cross-linked polyethylene, coincide with observations from practical clinical experience, while for other materials, a proven technical superiority has not yet been confirmed as an evident advantage in clinical practice.
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Affiliation(s)
- J Philippe Kretzer
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - Maximilian Uhler
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Sebastian Jäger
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Therese Bormann
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Robert Sonntag
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Mareike Schonhoff
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Stefan Schröder
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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Jennings JM, Czuczman GJ, Johnson RM, Dennis DA. Metal Artifact Reduction Sequence Magnetic Resonance Imaging Abnormalities in Asymptomatic Patients With a Ceramic-on-Ceramic Total Hip Replacement. J Arthroplasty 2021; 36:612-615. [PMID: 32950341 DOI: 10.1016/j.arth.2020.07.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) has recently gained increased utilization as a screening modality in patients with a total hip arthroplasty (THA). Fluid collections have been documented in asymptomatic patients with various bearing surfaces. The purpose of this study is to determine the frequency and types of MARS MRI-documented abnormalities in asymptomatic patients with a ceramic-on-ceramic (CoC) THA. METHODS Thirty-seven patients (42 hips) with a minimum 2-year follow-up after THA with CoC THA implants were enrolled in this study. The inclusion criteria were the absence of hip pain and the availability of appropriate follow-up radiographs. All patients underwent a MARS MRI. Abnormalities were documented using a previously described method. RESULTS Fluid collections were observed in 8 (19%) asymptomatic hips in this cohort. Four of the 8 hips demonstrated intracapsular synovitis, and 3 of these hips had a thickened synovium. Extra-articular fluid collections with direct intra-articular communication were identified in 4 hips, with 2 of these hips demonstrating synovial thickening. No signs of osteolysis were noted on radiographs or the MARS MRI scans. CONCLUSION Asymptomatic fluid collections occur in patients after CoC THA similar to other bearing surfaces. We continue to follow these patients in an effort to determine the clinical significance and natural history of these findings. LEVEL OF EVIDENCE Diagnostic Level IV.
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Affiliation(s)
- Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Denver, Denver, CO
| | | | | | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Denver, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN; Department of Orthopaedics, University of Colorado Health School of Medicine, Aurora, CO
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Eichler D, Barry J, Lavigne M, Massé V, Vendittoli PA. No radiological and biological sign of trunnionosis with Large Diameter Head Ceramic Bearing Total Hip Arthroplasty after 5 years. Orthop Traumatol Surg Res 2021; 107:102543. [PMID: 32276843 DOI: 10.1016/j.otsr.2019.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Trunnionosis of large diameter (LDH) metal-on-metal total hip arthroplasty (THA) was linked to high systemic chromium (Cr) and cobalt (Co) ion levels and local adverse reactions to metal debris (ARMD). The safety of CoC LDH THA is not yet available at mid-term. Measuring whole blood Ti level of ceramic on ceramic (CoC) LDH THA with a titanium (Ti) stem is an indirect way to assess the performance of its head-neck taper modular junction. Therefore, we wanted to determine: (1) if the whole blood Ti ion levels in patients with LDH CoC THA after a minimum of 5 years of implantation is within the expected values for similar well performing Ti THA, (2) if Ti level scientifically increases over time, which would suggest the presence of a progressive modular head/neck junction wear process, (3) if clinical or radiographical manifestations of implant dysfunction are present? HYPOTHESIS Ti blood levels of LDH CoC THA will indirectly reflect the expected levels due to passive corrosion of the implants and will be stable over time. PATIENTS AND METHODS We report the whole blood Ti, Cr, and Co levels at 5years minimum for 57 patients with unilateral primary LDH CoC THA with head sizes ranging from 36 to 48mm using Ti stem and acetabular component. To compare Ti ion levels modification over time, in 25 patients were a previous measurement (1-3years) was available, we compared it to their last follow-up results (>5 years). Mean Ti level in well performing Ti THAs is recognized to be around 2.0 ug/L. Although, there are no universally accepted Ti levels associated with problematic implant, we used safety threshold of 10 ug/L. Clinical and radiological outcomes were recorded at last follow-up. RESULTS At 79 months mean follow-up, all mean Ti levels were 1.9μg/L (min 1.2, max 4.4) and all subject had values below the safety threshold of 10ug/L. In the subgroup of 25 cases with a previous measurement, there was a decrease in mean Ti levels between 20 months and 78 months follow-up (2.2μg/L (1.6-3.9) versus 2.0μg/L (1.4-2.8), p=0.007). No statistically significant relation was observed between Ti level at last FU and bearing diameter (rho=0.046, p=0.0734) or the presence or absence of a Ti adaptor sleeve (p=0.454): 1.94ug/L (min 1.20, max 2.80) versus 1.90ug/L (min 1.20, max 4.40). At last follow up, no patients presented osteolysis signs on radiographs, clinical signs of ARMD or were reoperated. Most patients had excellent clinical with 98% of them reporting minor (29%) or no functional limitation (69%) and 44% perceive their THA as a natural hip joint. However, 3/57patients (5%) temporarily experienced hip squeaking and 18/57 (31%) reported clicking sound. CONCLUSION With the tested LDH CoC THA, Ti levels were low and related the uneventful and unavoidable passive corrosion of implant surfaces. Mid-term measurement of Ti in subjects with LDH CoC did not reveal any indirect signs of trunnionosis, which should already be observable by this time. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- David Eichler
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Janie Barry
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Martin Lavigne
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Vincent Massé
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada
| | - Pascal-André Vendittoli
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Department of Surgery, 5415, boulevard de l'Assomption, Montréal, QC H1T2M4, Canada.
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Mueller U, Bormann T, Schroeder S, Kretzer JP. Taper junctions in modular hip joint replacements: What affects their stability? J Mech Behav Biomed Mater 2021; 116:104258. [PMID: 33497961 DOI: 10.1016/j.jmbbm.2020.104258] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/09/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although taper junctions are beneficial in the reconstruction of hip joints, some clinical concerns like the formation of adverse local tissue reactions have recently emerged. These reactions are associated with wear and corrosion products from the interface of insufficient taper connections regarding strength. Commonly used tapers vary in their geometric and topographical design parameter. Therefore, this study aims to evaluate interactions between design and surgical related parameters to the taper connection strength. METHODS In this study, the effect of the taper contact situation, surface roughness and head material in combination with assembly force on the taper connection strength were assessed using torque-off tests. Furthermore, the type of use in terms of single-use or re-use of the stem taper was investigated. RESULTS The study showed that the impaction force is the predominant factor that determines the taper strength followed by the type of use and the head material. The contact situation seems to slightly influence the determined torque-off moment, whereas the surface topography of the stem taper obviously plays a minor role for the taper connection strength. CONCLUSION Clinical users should be aware that an increased assembly force will strengthen the stability of the taper junction, whereas care should be taken when reusing hip stems with metal heads as this may decrease their connection strength.
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Affiliation(s)
- Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Therese Bormann
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Porporati AA, Piconi C, Mettang M, Deisinger U, Reinhardt C, Pitto R. Ceramics for artificial joints: The relevance of material biocompatibility. BIOCERAMICS 2021:263-295. [DOI: 10.1016/b978-0-08-102999-2.00012-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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50
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Head-Neck Taper Corrosion in Metal-on-Polyethylene Total Hip Arthroplasty: Risk Factors, Clinical Evaluation, and Treatment of Adverse Local Tissue Reactions. J Am Acad Orthop Surg 2020; 28:907-913. [PMID: 32694319 DOI: 10.5435/jaaos-d-20-00475] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Adverse local tissue reaction (ALTR) associated with mechanically assisted crevice corrosion of metal-on-polyethylene (MoP) head-neck modular total hip arthroplasty (THA), similarly observed in the metal-on-metal bearing, is a growing concern in MoP THA patients. Given the complex pathogenesis as well as variable clinical presentation, the diagnosis can be challenging. This article focuses on providing surgeons with an evidence-based update on (1) implant, surgical, and patient risk factors associated with ALTRs; (2) clinical systematic evaluation; and (3) surgical management options for ALTRs in MoP THA patients based on the currently available evidence.
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