In Vivo Damage of the Head-Neck Junction in Hard-on-Hard Total Hip Replacements: Effect of Femoral Head Size, Metal Combination, and 12/14 Taper Design (original) (raw)
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Journal of Biomedical Materials Research Part B: Applied Biomaterials, 2017
Total hip replacement (THR) failure due to mechanically assisted crevice corrosion within modular head‐neck taper junctions remains a major concern. Several processes leading to the generation of detrimental corrosion products have been reported in first generation modular devices. Contemporary junctions differ in their geometries, surface finishes, and head alloy. This study specifically provides an overview for CoCrMo/CoCrMo and CoCrMo/Ti6Al4V head‐neck contemporary junctions. A retrieval study of 364 retrieved THRs was conducted which included visual examination and determination of damage scores, as well as the examination of damage features using scanning electron microscopy. Different separately occurring or overlapping damage modes were identified that appeared to be either mechanically or chemically dominated. Mechanically dominated damage features included plastic deformation, fretting, and material transfer, whereas chemically dominate damage included pitting corrosion, et...
Material loss at the taper junction of retrieved large head metal-on-metal total hip replacements
Journal of Orthopaedic Research, 2013
It has been speculated that material loss, either as corrosion or wear, at the head-stem taper junction is implicated in the high revision rates reported for metal-on-metal total hip replacements. We measured the volume of material loss from the taper and bearing surfaces of retrieved devices, and investigated the associations with blood metal ion levels and the diagnosis of a cystic or solid pseudotumor. The median volumes of material lost from the female and male taper surfaces were 2.0 and 0.29 mm 3 , respectively, while the median volumes of wear from the cup and head bearing surfaces were 1.94 and 3.44 mm 3 , respectively. Material loss from the female taper was similar to that from the acetabular bearing surface (p ¼ 0.55), but significantly less than that from the femoral bearing surface (p < 0.001). Material loss from the male taper was less than that from both bearing surfaces (p < 0.001). Multivariable analysis demonstrated no significant correlations between the volume of material lost from the taper surfaces and either blood cobalt or chromium ions, or the presence of pseudotumor. While a substantial volume of material is lost at the taper junction, the clinical significance of this debris remains unclear.
Clinical Orthopaedics and Related Research®, 2015
Background Fretting and corrosion at head-neck junctions of total hip arthroplasties (THAs) have been associated with adverse local tissue reactions in patients with both metal-onpolyethylene (MoP) and metal-on-metal (MoM) prostheses. Femoral head size contributes to the severity of fretting and corrosion in large-diameter MoM THAs, but its impact on such damage in MoP THAs remains unknown. Questions/purposes (1) Is femoral head size associated with increased fretting or corrosion at the head-neck junction in MoP total hips? (2) Is duration of implantation associated with increased fretting or corrosion? Methods The severity of fretting/corrosion on surfaces of head tapers and stem trunnions was visually examined in 154 MoP THAs retrieved as part of 3282 revision surgeries performed at our institution between January 1, 2007, and December 31, 2013. Fretting and corrosion damage were subjectively graded by two independent observers on a 1 to 4 scale, and their relations to head size, alloy combinations, taper/trunnion design, length of implantation (LOI), and location were investigated. Differences in scores never exceeded one grade, and this occurred in only 17% of examined implants. With the available implants, the study provided 88% power to detect differences of 0.5 in fretting or corrosion scores in these analyses. Results Fretting and corrosion of the tapers and the trunnions were not affected by head size (p = 0.247, p = 0.471, p = 0.837, and p = 0.868, respectively), although taper/trunnion design affected taper fretting (p = 0.005) and corrosion (p = 0.0031) and trunnion fretting (p = 0.0028). Head taper fretting (observed in 73% of heads) increased with LOI, but head taper corrosion (noted in 93% of heads) was not affected. Trunnion fretting (observed in 86% of stems) was more severe in mixed-alloy combinations and with increased LOI and was more severe proximally. Trunnion corrosion (noted in 72% of stems) was also location-dependent with greater corrosion distally. Conclusions Fretting and corrosion are regular occurrences in MoP THAs, but neither damage type was related to femoral head size. Conversely, taper design, LOI, and alloy combination affected the severity of both fretting and corrosion. Clinical Relevance Although it has been suggested that trunnion corrosion seen in MoP bearings is a function of larger diameter heads, our data suggest that larger femoral heads may be used for increased damage at the modular junction of MoP THAs.
Archives of Orthopaedic and Trauma Surgery
Introduction Breakage of exchangeable-neck (EN) and adverse local tissue reactions (ALTRs) to neck–stem junction (NSJ) damage products are responsible for increasing the revision rate of EN hip prostheses. We investigated the survivorship of an EN hip prosthesis including a NSJ with both components made of titanium alloy (Ti-alloy/Ti-alloy) to assess whether, and to what extent, EN breakage and NSJ damage affected implant survivorship. Materials and methods Using data from a hip replacement registry, we determined survivorship of 2857 EN prostheses. Long-offset configurations of head and EN were implanted in heavy (> 90 kg) patients only in 23 hips. We investigated under which conditions EN breakages or ALTRs occurred. We also measured titanium (Ti) and vanadium (V) blood concentrations in 24 patients with a unilateral well-working prosthesis. Results The 17-year survival rates for any reason and aseptic loosening of any component were 88.9% (95%CI 87.5–90.1; 857 hips at risk) an...
The Journal of Arthroplasty, 2013
It has been suggested that corrosion and fretting at the tapered, modular junctions of hip arthroplasties may contribute to implant failure. In this study the reliability of a commonly used peer-reviewed scoring system for visual assessment of corrosion and fretting at these junctions was evaluated. Volumetric material loss at the tapered head surface was measured and associations with the visual scores were investigated. We found that the inter-observer reproducibility and single-observer repeatability of the corrosion scores were substantial using Cohen's weighted Kappa statistic (k = 0.64-0.71). The reproducibility and repeatability of the fretting scores however were slight to fair (k = 0.18-0.31). Taper corrosion scores were significantly and moderately correlated with the volume of material loss measured (Spearman's r = 0.59; P b 0.001). We recommend the continued use of this scoring system but it should not be a substitute for measurement of material loss.
Surface Topography: Metrology and Properties, 2015
Measuring the amount of material loss in the case of revised hip replacements is considered to be a prerequisite of understanding and assessing the true in vivo performance of the implant. This paper outlines a method developed by the authors for quantifying taper material loss as well as more general taper interface parameters. Previous studies have mostly relied on visual inspection to assess the material loss at the taper interface, whereas this method aims to characterize any surface and form changes through the use of an out-of-roundness measurement machine. Along with assessing the volumetric wear, maximum linear penetration and taper contact length can also be determined. The method was applied to retrieved large head metal-on-metal femoral heads in order to quantify the material loss at this junction. Material loss from the female femoral head taper can be characterized as a localized area that is in contact with the stem taper surface. The study showed that this method has good repeatability and a low level of interoperability variation between operators.
Factors Associated With Trunnionosis in the Metal-on-Metal Pinnacle Hip
The Journal of arthroplasty, 2016
Trunnionosis of the tapered head-stem junction of total hip arthroplasties, either through corrosion or mechanical wear, has been implicated in early implant failure. Retrieval analysis of large numbers of failed implants can help us better understand the factors that influence damage at this interface. In this study, we examined 120 retrieved total hip arthroplasties of one bearing design, the 36-mm diameter metal-on-metal, DePuy Pinnacle, that had been paired with 3 different stems. We measured material loss of the bearing and head-trunnion taper surfaces and collected clinical and component data for each case. We then used multiple linear regression analysis to determine which factors influenced the rate of taper material loss. We found 4 significant variables: (1) longer time to revision (P = .004), (2) the use of a 12/14 taper for the head-trunnion junction (P < .001), (3) decreased bearing surface wear (P = .003), and (4) vertical femoral offset (P = .05). These together ex...
This study study was conducted on 20 patients undergoing total hip replacements due to various hip pathologies in adults aged from 20 to 55 years . All patients who had undergone noncemented THR using 36-mm ceramic femoral heads and highly cross-linked polyethylene liners were identified . Indications for use of a ceramic femoral head were young (aged 55 years or younger) and/or active patients. The study excluded any patient with any dislocations, acetabular fractures, infections, or any revision or reoperation as indications for hip joint replacement. All the patients of the study were subjected to the following after an informed consent 1) Full history taking. 2) Clinical assessment , To correlate radiographic readings with patient satisfaction and clinical symptoms, the patients answered a questionnaire, concerning pain and patient satisfaction according to Harris hip score. 3) Radiographic assessment. Duration of the study was 18 months, Preoperative clinical assessment and harris hip score and radiological evaluation and the same protocol for each visit post operatively The results showed that The Harris Hip Score increased from a preoperative mean of 38.2 points to 94.2 points.And range of motion improved from mean 122.35 to 204.15? after 18 months follow-up. These values are higher than those of two other comparable running studies with 28 mm femoral head. Increasing the femoral head size increase the stability and range of motion of the hip joint in THA but with convensional bearing surfaces this cause increased wear rate and decrease the longivity of the prothesis. With new articulatig bearing surfaces as ceramic on highly cross linked poly ethylene we can get the benefit of increasing the head size and increase the longivity of the joint prothesis specially in young adults.