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Spece H, Ouellette ES, Klein GR, Mont MA, Kurtz SM. Are Corrosion and Material Loss a Threat for Titanium-Titanium Tapers in Total Hip Arthroplasty Modular Acetabular Components? J Arthroplasty 2024; 39:1602-1608. [PMID: 38070717 DOI: 10.1016/j.arth.2023.12.001] [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: 07/26/2023] [Revised: 11/09/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Extensive research has reported on fretting corrosion and material loss for a variety of metal taper interfaces in orthopedic devices. For modular acetabular shell-liner constructs, the interfaces studied thus far have consisted of mixed-metal pairings, and the risk of fretting corrosion and material loss for the all-titanium (Ti) shell-liner taper junction in one ceramic-on-ceramic (COC) design remains poorly understood. We asked: do Ti shell-liner taper interfaces in COC total hip arthroplasty devices show in vivo evidence of (1) fretting and/or corrosion, and (2) quantifiable potential material loss? METHODS We examined 22 shell-liner pairs and 22 single liners from retrieved COC components. The taper interface surfaces were assessed for fretting corrosion using a semiquantitative scoring method and imaged with scanning electron microscopy. A subcohort of components was measured with a coordinate measuring machine, and volumetric material loss and maximum wear depth were calculated. RESULTS Fretting corrosion at the taper interfaces was minimal to mild for 95% of liners and 100% of shells. Imaging revealed fretting marks within a band of corrosion on some implants and evidence of corrosion not in the proximity of mechanical damage. Estimated material loss ranged from 0.2 to 1.3 mm3 for liners, and 0.5 to 1.1 mm3 for shells. Maximum wear depth for all components was 0.03 mm or less. CONCLUSIONS Our results indicate that, compared to other taper junctions in total joint arthroplasty, the risk of corrosion and material loss may be minimal for Ti shell-liner interfaces.
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Affiliation(s)
- Hannah Spece
- Implant Research Core, School of Biomedical Science, Engineering, and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | | | - Gregg R Klein
- Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, New Jersey
| | - Michael A Mont
- Department of Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Steven M Kurtz
- Implant Research Core, School of Biomedical Science, Engineering, and Health Systems, Drexel University, Philadelphia, Pennsylvania
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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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Terhune EB, Serino J, Hall DJ, Nam D, Della Valle CJ, Jacobs JJ, Pourzal R. Fretting and Tribocorrosion of Modular Dual Mobility Liners: Role of Design, Microstructure, and Malseating. J Arthroplasty 2024:S0883-5403(24)00368-1. [PMID: 38640966 DOI: 10.1016/j.arth.2024.04.045] [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: 10/29/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Modular dual mobility (DM) bearings have a junction between a cobalt chrome alloy (CoCrMo) liner and titanium shell, and the risk of tribocorrosion at this interface remains a concern. The purpose of this study was to determine whether liner malseating and liner designs are associated with taper tribocorrosion. METHODS We evaluated 28 retrieved modular DM implants with a mean in situ duration of 14.6 months (range, 1 to 83). There were 2 manufacturers included (12 and 16 liners, respectively). Liners were considered malseated if a distinct divergence between the liner and shell was present on postoperative radiographs. Tribocorrosion was analyzed qualitatively with the modified Goldberg Score and quantitatively with an optical coordinate-measuring machine. An acetabular shell per manufacturer was sectioned for metallographic analysis. RESULTS There were 6 implants (22%) that had severe grade 4 corrosion, 6 (22%) had moderate grade 3, 11 (41%) had mild grade 2, and 5 (18.5%) had grade 1 or no visible corrosion. The average volumetric material loss at the taper was 0.086 ± 0.19 mm3. There were 7 liners (25%) that had radiographic evidence of malseating, and all were of a single design (P = .01). The 2 liner designs were fundamentally different from one another with respect to the cobalt chrome alloy type, taper surface finish, and shape deviations. Malseating was an independent risk factor for increased volumetric material loss (P = .017). CONCLUSIONS DM tribocorrosion with quantifiable material loss occurred more commonly in malseated liners. Specific design characteristics may make liners more prone to malseating, and the interplay between seating mechanics, liner characteristics, and patient factors likely contributes to the shell/liner tribocorrosion environment. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- E Bailey Terhune
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joseph Serino
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Deborah J Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Denis Nam
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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English RT, Munro JT, Monk AP. Increasing femoral head size from 32 mm to 36 mm does not increase the revision risk for total hip replacement: a New Zealand joint registry study. Hip Int 2024; 34:66-73. [PMID: 37932243 DOI: 10.1177/11207000231210487] [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: 11/08/2023]
Abstract
BACKGROUND The use of larger femoral heads in total hip replacement (THR) has increased over the last decade. While the relationship between increasing head size and increased stability is well known, the risk of revision with increasing head size remains poorly understood. The aim of this study was to compare the outcome of total hip joint replacement with 32-mm and 36-mm heads. METHODS We carried out a 20-year retrospective analysis of prospective data from the New Zealand Joint Registry (NZJR). All primary total hip replacements registered between January 1999 and December 2018 were included. We compared the rate of revision of 32-mm and 36-mm heads in THR. Sub-group analysis included comparisons of bearing type and all-cause revision. RESULTS 60,051 primary THRs met our inclusion criteria. The revision rate per 100 component years was significantly higher with a 36-mm head than with a 32-mm head (0.649 vs. 0.534, p < 0.001). Subgroup analysis of bearing type showed no significant differences in revision rates for all combinations of 36-mm heads when compared to 32-mm (p = 0.074-0.92), with the exception of metal-on-metal (MoM); p = 0.038. When MoM was removed there was no significant difference in revision rates per 100 component years between 32-mm and 36-mm heads, 0.528 versus 0.578 (p = 0.099). CONCLUSIONS Increasing head size from 32 mm to 36 mm results in no significant increase in revision in all bearing combinations except MoM.
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Affiliation(s)
- Robert Tr English
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Jacob T Munro
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
- University of Auckland, New Zealand
| | - Andrew P Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
- University of Auckland, New Zealand
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McCarthy CJ, Moore J, Condon F. Large head metal-on-metal bearing surface with a TMZF titanium alloy femoral stem with high rates of revision and trunnion failure. J Orthop 2023; 46:164-168. [PMID: 38031627 PMCID: PMC10682508 DOI: 10.1016/j.jor.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Background Mechanically assisted crevice corrosion at the head-neck interface puts implants at risk of trunnionosis, femoral head dissociation, implant failure and the development of metallosis. Metal-on-Metal bearings have very low wear rates, significantly lower than metal-on-polytethylene, but their wear results in cobalt and chromium ion systemic distribution. This is a study of the MITCH metal-on-metal bearing surface coupled with an Accolade TMZF stem. Methods This was a retrospective review of 24 total hip replacements 21 patients in that underwent MITCH TRH/Accolade TMZF implantation at a minimum of 12 years post operatively. The primary outcome of this study was all-cause revision with particular attention to revision due to trunnion failure and/or cobalt and chromium ion level. Results There was a revision rate of 66.7 % (n = 16) at a minimum of twelve years post operatively. Most notably there were six revisions for a gross trunnion failure. Two cases were revised for impending trunnion failure. There were seven cases revised for elevated serum cobalt and chromium levels and one was revised for unexplained pain. Discussion Patients in our study that underwent TMZF alloy cementless stems coupled with large cobalt chromium alloy heads are at high risk of catastrophic trunnion failure. The high rate of trunnnionosis in this implant combination is thought to be related to a significantly different Young's modulus due to a material mismatch coupled with galvanic corrosion.
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Affiliation(s)
- Cathal J McCarthy
- University Hospital Limerick, Limerick, Ireland
- Croom Orthopaedic Hospital, Limerick, Ireland
| | - Joss Moore
- University Hospital Limerick, Limerick, Ireland
- Croom Orthopaedic Hospital, Limerick, Ireland
| | - Finbarr Condon
- University Hospital Limerick, Limerick, Ireland
- Croom Orthopaedic Hospital, Limerick, Ireland
- University of Limerick, Limerick, Ireland
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Høl PJ, Hallan G, Furnes O, Fenstad AM, Indrekvam K, Kadar T. Similarly low blood metal ion levels at 10-years follow-up of total hip arthroplasties with Oxinium, CoCrMo, and stainless steel femoral heads. Data from a randomized clinical trial. J Biomed Mater Res B Appl Biomater 2023; 111:821-828. [PMID: 36356214 PMCID: PMC10099800 DOI: 10.1002/jbm.b.35193] [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: 04/27/2022] [Revised: 09/21/2022] [Accepted: 10/29/2022] [Indexed: 11/12/2022]
Abstract
The use of inert head materials such as ceramic heads has been proposed as a method of reducing wear and corrosion products from the articulating surfaces in total hip arthroplasty, as well as from the stem-head taper connection. The aim of the present study was to compare the blood metal ion levels in patients with Oxinium and CoCrMo modular femoral heads, as well as monoblock stainless steel Charnley prostheses at 10 years postoperatively. The 150 patients with osteoarthritis of the hip joint included in a randomized clinical trial were grouped according to femoral head material. One group (n = 30) had received the Charnley monoblock stainless steel stem (DePuy, UK). The other patients (n = 120) received a Spectron EF CoCrMo stem with either a 28 mm CoCrMo or Oxinium modular head (Smith & Nephew, USA). After 10 years, 38 patients had withdrawn, 19 deceased, 7 revised due to aseptic loosening and 5 revised due to infection. The 81 patients with median age of 79 years (70-91) were available for whole blood metal ion analysis. The levels of Co, Cr, Ni and Zr in the blood were generally low with all the head materials (medians <0.3 micrograms/L) and no statistical difference between the groups were found (p = .2-.8). Based on the low blood metal ion values in our study groups, no indication of severe trunnion corrosion in patients with CoCrMo heads was observed, neither was there any beneficial reduction in metal ion exposure with the Oxinium femoral heads.
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Affiliation(s)
- Paul Johan Høl
- Biomatlab, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Geir Hallan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,The Coastal Hospital at Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kari Indrekvam
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Coastal Hospital at Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Thomas Kadar
- Physical Medicine and Rehabilitation, Clinic of Habilitation and Rehabilitation, Haukeland University Hospital, Bergen, Norway
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Poly (Ether-Ether-Ketone) for Biomedical Applications: From Enhancing Bioactivity to Reinforced-Bioactive Composites-An Overview. Polymers (Basel) 2023; 15:polym15020373. [PMID: 36679253 PMCID: PMC9861117 DOI: 10.3390/polym15020373] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/21/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023] Open
Abstract
The global orthopedic market is forecasted to reach US$79.5 billion by the end of this decade. Factors driving the increase in this market are population aging, sports injury, road traffic accidents, and overweight, which justify a growing demand for orthopedic implants. Therefore, it is of utmost importance to develop bone implants with superior mechanical and biological properties to face the demand and improve patients' quality of life. Today, metallic implants still hold a dominant position in the global orthopedic implant market, mainly due to their superior mechanical resistance. However, their performance might be jeopardized due to the possible release of metallic debris, leading to cytotoxic effects and inflammatory responses in the body. Poly (ether-ether-ketone) (PEEK) is a biocompatible, high-performance polymer and one of the most prominent candidates to be used in manufacturing bone implants due to its similarity to the mechanical properties of bone. Unfortunately, the bioinert nature of PEEK culminates in its diminished osseointegration. Notwithstanding, PEEK's bioactivity can be improved through surface modification techniques and by the development of bioactive composites. This paper overviews the advantages of using PEEK for manufacturing implants and addresses the most common strategies to improve the bioactivity of PEEK in order to promote enhanced biomechanical performance.
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Metal-on-metal versus metal-on-plastic artificial discs in two-level anterior cervical disc replacement: a meta-analysis with follow-up of 5 years or more. Spine J 2021; 21:1830-1838. [PMID: 33940171 DOI: 10.1016/j.spinee.2021.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although highlighted in joint arthroplasty studies, long-term outcomes between differing biomaterial composites, such as metal-on-metal (MoM) and metal-on-plastic (MoP) in anterior cervical disc replacement (ACDR) have not been thoroughly investigated. PURPOSE The purpose of this study was to evaluate the patient-reported clinical outcomes, overall reoperation rates, complications, and rates of ASD of MoM versus MoP artificial discs in two-level ACDR for the treatment of cervical DDD. STUDY DESIGN/SETTING Meta-analysis and systematic review. PATIENT SAMPLE Nine hundred eighty patients (442 MoM, 538 MoP) across seven studies. OUTCOME MEASURES Patient reported clinical outcomes (NDI, VAS-n, VAS-a), overall reoperation rates, complications, and rates of ASD. METHODS A systematic search strategy of three electronic databases (PubMed, CINAHL Plus, and SCOPUS) was conducted utilizing terms related to two-level ACDR. All studies included had a sample size of >10 patients, had a minimum 5-year follow-up, and reported data on adjacent segment disease. Cadaver studies, non-English manuscripts, articles with less than 5-year follow-up and studies in which only single-level ACDR was investigated were excluded. A total of seven studies were included in this analysis. Studies were analyzed for demographic data, clinical outcome scores (NDI, VAS-neck, and VAS-arm), overall reoperation rates, complications, and rates of ASD. A random-effects model of meta-analysis was used for groups that were determined to be heterogenous and a fixed-effects model was utilized for groups that were not. An overlap of 95% confidence intervals suggests no statistically significant difference at the p<.05 level. RESULTS Seven studies were included with data on 980 patients (442 MoM, 538 MoP). The study population was 52.84% female, with a mean age of 48.01 years, and a mean follow-up of 85.66 months. The mean improvement in NDI was 34.42 (95% CI, 32.49-36.36) and 29.72 (95% CI, 27.15-32.29) for the MoM and MoP groups, respectively. The mean improvement in VAS-neck was 11.20 (95% CI, 10.69-11.70) and 8.78 (95% CI, 7.81-9.74) for the MoM and MoP groups, respectively. The mean improvement in VAS-arm was 10.73 (95% CI, 9.83-11.63) and 8.49 (95% CI, 7.59-9.39) for the MoM and MoP groups, respectively. 3.85% (95% CI, 2.40-6.10) of patients who underwent ACDR with a MoM implant required reoperation compared to 5.33% (95% CI, 3.68-7.65) of patients with a MoP implant. Heterotopic ossification and dysphagia were the most common complications in both groups. The MoM cohort showed a higher incidence of HO (72.62% vs. 21.07%), but a lower incidence of dysphagia (0.96% vs. 16.31%) compared to the MoP cohort. The MoM cohort had a larger proportion of patients with ASD who underwent subsequent surgery at an adjacent level (7.89% MoM versus 1.91% MoP). CONCLUSIONS Our present meta-analysis suggests that the use of MoM artificial discs in two-level ACDR results in superior clinical outcome score improvement, but higher rates of ASD requiring secondary surgery compared to MoP discs after a follow-up period of 5 years or more.
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Torre M, Genova Gaia L, Calevo MG, Wong M, Raso M, Barco S, Di Gaudio F, Cangemi G. Blood metal levels after minimally invasive repair of pectus excavatum. Interact Cardiovasc Thorac Surg 2021; 33:76-81. [PMID: 33686408 DOI: 10.1093/icvts/ivab052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/01/2020] [Accepted: 12/12/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Minimally invasive repair of pectus excavatum (MIRPE) is the most popular surgical approach for paediatric patients with pectus excavatum. A substernal stainless still bar is inserted and left in place for 3 years and then removed. Our goal was to investigate blood metal levels after MIRPE and to correlate them with surgical details, such as the numbers of bars and stabilizers and the length of time the bar was in place. METHODS Blood levels of iron, chromium, manganese, molybdenum and nickel were analysed in 130 teenagers (108 boys and 22 girls) who had MIRPE using inductively coupled plasma mass spectrometry. A total of 62 patients were operated on using MIRPE (study group) and 68 patients were evaluated at implant time (control group). Differences between the numbers of bars implanted and the presence or absence of stabilizers were also considered. RESULTS Significant increases in the levels of abnormal chromium were found in patients in the study group compared with the controls (P = 0.02). When we compared the group of patients with 2 or more bars with the group with 1 bar, the percentage of patients with a value above the threshold increased by 29 (P = 0.05). A significant increase in chromium levels was observed in patients with stabilizers (P = 0.03). Above-threshold levels of molybdenum were found in 5.1% of patients in the control group, but the number was not statistically significant (P = 0.09). CONCLUSIONS We demonstrated that stainless steel devices used in MIRPE can elevate blood metal levels in paediatric patients. Moreover, we demonstrated that the use of metal stabilizers is associated with higher metal levels, probably due to increased dispersion.
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Affiliation(s)
- Michele Torre
- Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Department of Pediatric Surgery, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Luca Genova Gaia
- Department of Pediatric Surgery, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Michela Wong
- Department of Pediatric Surgery, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maria Raso
- Chromatography and Mass Spectrometry Section, Quality Control and Chemical Risk (CQRC), Department PROMISE, University Palermo, Palermo, Italy
| | - Sebastiano Barco
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analyses, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Di Gaudio
- Chromatography and Mass Spectrometry Section, Quality Control and Chemical Risk (CQRC), Department PROMISE, University Palermo, Palermo, Italy
| | - Giuliana Cangemi
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analyses, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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10
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Baker E, French C, Brian P, Thomas J, Davis CM. Impending Trunnion Failure: An Uncommon Radiographic Presentation of Total Hip Arthroplasty Failure. Arthroplast Today 2021; 7:230-234. [PMID: 33614874 PMCID: PMC7878964 DOI: 10.1016/j.artd.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/17/2023] Open
Abstract
Trunnionosis is emerging as an early mode of failure in conventional metal-on-polyethylene total hip arthroplasty. It is defined as wear or corrosion at the trunnion, the taper at the femoral head-neck interface. Trunnion wear can result in a variety of negative sequelae and, in severe cases, necessitate revision arthroplasty. We describe a 64-year-old man with a metal-on-polyethylene total hip arthroplasty who presented with a sensation of clunking in the hip. Initial imaging and laboratory studies were inconclusive, and the decision was made to monitor. Two years later, trunnion wear was detected on radiographs, presenting as an abnormal alignment of the femoral neck relative to the femoral head. Several case reports and series describe catastrophic total hip arthroplasty failure due to trunnionosis. However, few describe the radiographic signs of wear at the trunnion before gross failure. This early presentation is important to recognize to minimize patient morbidity and aid surgical planning.
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Affiliation(s)
- Emma Baker
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Corresponding author. 500 University Dr, Hershey, PA 17033, USA. Tel.: +1 240 620 6937.
| | - Cristy French
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Pamela Brian
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jonelle Thomas
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Charles M. Davis
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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11
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Büchner M, Cook RB, Dommann-Scherrer C, Meier C, Dommann A, Wahl P. It's worth cleaning - The examination of the female taper could identify a particular cause of trunnionosis at revision 16 years after total hip arthroplasty. J Mech Behav Biomed Mater 2021; 115:104304. [PMID: 33445103 DOI: 10.1016/j.jmbbm.2020.104304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/28/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
Adverse reaction to metal debris (ARMD) is an issue in metal-on-metal (MoM) total hip replacements (THR). It mainly affects large-head MoM THR, whereas 28-32 mm MoM pairings are associated with low long-term revision rates. However, the bearing surface is not necessarily the only cause of metal debris. This report documents with advanced analysis of the retrievals a particular cause of trunnionosis in late failure of a small diameter MoM THR and illustrates the importance of cleaning of the taper when seating the head in THR. A 65-year-old patient was revised due to ARMD 16 years after small diameter MoM THR. Debridement and exchange of the inlay and the head had been performed through an anterior approach. While the cup and the outer surface of the head were accessible to direct analysis by an optical coordinate measuring machine, the female taper had to be analysed indirectly by measuring an imprint. Wear from the cup and the head was within expected low ranges. The analysis of the female taper identified bone fragments, which contributed to trunnionosis. Failure due to ARMD after MoM THR is not necessarily caused by the bearing, but can be due to trunnionosis. Bone fragments within the taper contact in this case highlight the importance of meticulous cleaning of the taper before seating the head, to avoid trunnionosis.
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Affiliation(s)
- Mara Büchner
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Richard B Cook
- National Centre for Advanced Tribology at Southampton, University of Southampton, Southampton, United Kingdom
| | | | - Christoph Meier
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Alex Dommann
- EMPA Swiss Federal Laboratories for Material Science and Technology, St. Gallen, Switzerland; ARTORG Centre for Biomedical Engineering Research, University of Berne, Berne, Switzerland
| | - Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
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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: 7] [Impact Index Per Article: 1.8] [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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Kolz JM, Wyles CC, Van Citters DW, Chapman RM, Trousdale RT, Berry DJ. In Vivo Corrosion of Modular Dual-Mobility Implants: A Retrieval Study. J Arthroplasty 2020; 35:3326-3329. [PMID: 32600814 DOI: 10.1016/j.arth.2020.05.075] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Modular dual-mobility (MDM) total hip arthroplasty (THA) implants have an additional metal-metal interface between the metal liner and outer metal shell that poses a risk of corrosion. The purpose of this study is to evaluate retrieved MDM liners to evaluate qualitative and quantitative damage and corrosion patterns at this interface. METHODS Twelve MDM implants of one design with a mean in situ duration of 26 months (range, 1-57 months) were evaluated. Six implants (50%) were from primary THAs and 6 (50%) from revision THAs. The taper region of the liner at risk of damage was qualitatively graded using modified Goldberg criteria while quantitative dimensional assessment was performed with a validated coordinate measurement machine. RESULTS Among the retrieved implants, 2 (17%) demonstrated severe grade 4 corrosion, 5 (42%) moderate grade 3 corrosion, 4 (33%) mild grade 2 corrosion, and 1 (8%) grade 1 (no visible corrosion). Mean maximum linear corrosion depth at the taper interface measured 35.5 microns (range, 8.4-176.2 microns). All implants had a maximum linear corrosion depth >7 microns, a threshold suggestive of potentially clinically significant material loss. Three corrosion patterns were identified: generalized corrosion, a stripe of corrosion about the middle of the taper region, and focal areas of corrosion at the portion of the taper closest to the joint surface. CONCLUSION Visual and dimensional analysis of all 12 retrieved MDM implants demonstrated identifiable corrosion/wear of the cobalt-chromium metal liner taper of varying severity. These implants should be used judiciously until larger series with clinical correlation can be completed.
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Affiliation(s)
- Joshua M Kolz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Ryan M Chapman
- Thayer School of Engineering, Dartmouth College, Hanover NH
| | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Abstract
Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them.Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare.Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm.Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement.The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe. Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002.
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Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
| | - Soren Overgaard
- The Danish Hip Arthroplasty Register, Aarhus, Denmark
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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What Is the Risk of THA Revision for ARMD in Patients with Non-metal-on-metal Bearings? A Study from the Australian National Joint Replacement Registry. Clin Orthop Relat Res 2020; 478:1244-1253. [PMID: 32345846 PMCID: PMC7319380 DOI: 10.1097/corr.0000000000001277] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are increasing reports of corrosion between the femoral head and trunnion in primary conventional THA, resulting in metal particulate release often termed trunnionosis. There may be heightened awareness of this condition because of severe soft-tissue reactions initially thought to be solely attributable to prostheses with a metal-on-metal (MoM) bearing surface. It is unclear what percentage of revisions for THA with non-MoM bearing surfaces can be attributed to trunnionosis and to what extent adverse reaction to metal debris (ARMD) seen with MoM bearings may also be seen with other bearing surfaces in THA. QUESTIONS/PURPOSES We analyzed data from a large national registry to ask: (1) What is the revision risk for the indication of ARMD in patients with conventional THA and modern non-MoM bearing surfaces such as metal or ceramic-on-cross-linked polyethylene (XLPE) or ceramic-on-ceramic? (2) What prosthesis factors are associated with an increased risk of such revision? (3) What is the relative revision risk for ARMD in THAs with large-head MoM bearings, small-head MoM bearings, and non-MoM modern bearing surfaces? METHODS The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) longitudinally maintains data on all primary and revision joint arthroplasties, with nearly 100% capture. The study population included all THAs using modern bearing surfaces (defined as metal or ceramic heads-on-XLPE and ceramic-on-ceramic bearing couples) revised because of ARMD between September 1999 and December 2018. Prostheses with modular necks were excluded. The cumulative percent revision (CPR) because of ARMD was determined. The study group consisted of 350,027 THAs with a modern bearing surface, 15,184 THAs with a large-head MoM bearing (≥ 36 mm), and 5474 THAs with a small head MoM bearing (≤ 32 mm). The patients in the group who received the modern bearing surfaces were slightly older than the patients in the groups who received the large- and small-head bearing surfaces, with a mean age 68 years (SD 12) versus a mean age 63 years (SD 12), and a mean age 62 years (SD 11), respectively. There was a higher proportion of women in the modern bearing surface group; 55% (193,312 of 350,027), compared with 43% (6497 of 15,184) in the large-head MoM group and 50% (2716 of 5474) in the small-head MoM group. The outcome measure was the CPR, which was defined using Kaplan-Meier estimates of survivorship to describe the time to the first revision for ARMD at 17 years. Hazard ratios (HR) from Cox proportional hazards models, adjusting for age and sex, were performed to compare the revision rates among groups. The registry defines a revision as a reoperation of a previous hip arthroplasty in which one or more of the prosthetic components is replaced or removed, or one or more components is added. RESULTS The CPR for ARMD for patients with a modern bearing surface at 17 years was 0.1% (95% confidence interval 0.0 to 0.1). After controlling for age and sex, we found that cobalt chrome heads, two specific prostheses (Accolade® I and M/L Taper), and head sizes ≥ 36 mm were associated with an increased risk of revision for ARMD. Metal-on-XLPE had a higher risk of revision for ARMD than ceramic-on-ceramic or ceramic-on-XLPE (HR 3.4 [95% CI 1.9 to 6.0]; p < 0.001). The Accolade 1 and the M/L Taper stems had a higher risk of revision than all other stems (HR, 8.3 [95% CI 4.7 to 14.7]; p < 0.001 and HR 14.4 [95% CI 6.0 to 34.6]; p < 0.001, respectively). Femoral stems with head sizes ≥ 36 mm had a higher rate of revision for ARMD than stems with head sizes ≤ 32 mm (HR 3.2 [95% CI 1.9 to 5.3]; p < 0.001).Large-head MoM bearings had a greater increase in revision for ARMD compared with modern bearing surfaces. The CPR for patients with a large-head MoM bearing at 17 years for ARMD was 15.5% (95% CI 14.5 to 16.6) and it was 0.1% for modern bearing surfaces (HR 340 [95% CI 264.2 to 438.0]; p < 0.001). Modern bearing surfaces likewise had a lower HR for revision for ARMD than did THAs with small-head MoM bearings, which had a 0.9% (95% CI 0.7 to 1.4) CPR compared with modern bearings from 0 to 9 years (HR 10.5 [95% CI 6.2 to 17.7]; p < 0.001). CONCLUSIONS The revision risk for ARMD with modern bearing surfaces in THA is low. The Accolade 1 and the M/L Taper stem have a higher risk of revision for ARMD and cobalt-chrome heads, and head sizes ≥ 36 mm have a higher rate of revision than ≤ 32 mm head sizes. ARMD is a rare failure mode for THA with non-MoM bearings, but in patients presenting with unexplained pain with no other obvious cause, this diagnosis should be considered and investigated further. LEVEL OF EVIDENCE Level III, therapeutic study.
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Comparison of Harris Hip Scores and Revision Rates in Metal-on-Metal Versus Non-Metal-on-Metal Total Hip Arthroplasty. J Am Acad Orthop Surg 2020; 28:e422-e426. [PMID: 31415300 DOI: 10.5435/jaaos-d-19-00251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study compares functional outcome scores and revision rates between metal-on-metal (MoM) and non-MoM total hip arthroplasty patients. METHODS A cohort of 75 patients who underwent implantation of the same dual modular hip arthroplasty between the years of 2004 and 2010 was enrolled. Patients were subsequently evaluated in 2015 to 2017 for joint revision history and functionality, as measured by the Harris hip score (HHS). Patients requiring a revision arthroplasty were not included in the HHS analysis. RESULTS A total of 49 patients had MoM implants (65.3%), and 26 patients had non-MoM implants (34.8%). At a mean follow-up of 7.6 years, 10.2% (5/49) of MoM prostheses required revision, whereas 3.8% (1/26) of non-MoM prostheses required revision (P = 0.334). The mean HHS in the MoM cohort was 89.8, compared with 88.1 in the non-MoM cohort (P = 0.69). CONCLUSION HHSs were not notably different between cohorts. The MoM cohort had three times as many revisions as the non-MoM cohort, but given the numbers available, this difference did not reach significance. Given the clinical importance of these revision data, further study is warranted to determine survivorship of the MoM versus non-MoM total hip arthroplasty at long-term follow-up.
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Bansal T, Aggarwal S, Dhillon MS, Patel S. Gross trunnion failure in metal on polyethylene total hip arthroplasty-a systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2020; 44:609-621. [PMID: 31900575 DOI: 10.1007/s00264-019-04474-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/23/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Multiple cases of dissociation of the head from the neck termed as gross trunnion failure (GTF) in total hip replacement have been described. Very little quantitative data is available for patient and implant factors associated and predisposing to this complication. STUDY PURPOSE To systematically review and analyze all studies which have gross trunnion failure in case of metal on polyethylene (MoP) total hip replacement. METHODS PubMed database was searched. We also performed a secondary search by pearling bibliography of all full text articles obtained. Predefined inclusion and exclusion criteria were used for abstract screening by two independent observers. A total 46 cases met our inclusion criteria. These were included in the final analysis and data was pooled. RESULTS Till date, 46 cases of GTF in MoP THR have been reported. The mean age at time of revision was 70.13 years (range 50 to 89 years). The mean time to revision surgery was 8.24 years (range 4.7 to 14 years). 91.4% cases were male. BMI was ≥ 25 in 38/41 cases and ≥ 30 in 21/41 cases. Pain (95.5%) and difficulty or inability to walk (97.7%) were the most common symptoms. A total of 19/44 cases described varying sounds like click, clunk, and pop before dislocation. Accolade TMZF/TMZF plus was the most common stem used in 34/46 cases. The stem neck angle was 127 degrees in 97% cases (32/33 cases). A positive neck offset of 4 mm or more was used in 91.1% cases (40/44 cases). The head size ≥ 36 mm in approximately 90% cases. The head material was cobalt chromium in all 45 cases, where data was available. Among the intra-operative findings, the most common findings were metallosis (41/44), black or brow coloured synovial fluid (21/44), pseudotumour (19/44), synovial hypertrophy (18/44), damage to the abductor musculature (17/44), proximal femoral osteolysis (5/44 cases), and heterotrophic ossification (2/44 cases). Histopathological analysis was available in 11 cases and was suggestive of fibrous tissue with chronic cellular infiltrate in all cases. The serum cobalt and chromium concentrations were raised above normal in 86.4% (19/22) and 21.7% cases (5/23) respectively. CONCLUSIONS Gross trunnion failure may not be as uncommon as was previously thought. A number potential associations and predisposing factors of this complication have been highlighted in this review. But due to small sample size and weak level of evidence, further studies are needed in this field.
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Affiliation(s)
- Tungish Bansal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sameer Aggarwal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Patel
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Does the Femoral Head Size in Hip Arthroplasty Influence Lower Body Movements during Squats, Gait and Stair Walking? A Clinical Pilot Study Based on Wearable Motion Sensors. SENSORS 2019; 19:s19143240. [PMID: 31340548 PMCID: PMC6679514 DOI: 10.3390/s19143240] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
A hip prosthesis design with larger femoral head size may improve functional outcomes compared to the conventional total hip arthroplasty (THA) design. Our aim was to compare the range of motion (RoM) in lower body joints during squats, gait and stair walking using a wearable movement analysis system based on inertial measurement units (IMUs) in three age-matched male groups: 6 males with a conventional THA (THAC), 9 with a large femoral head (LFH) design, and 8 hip- and knee-asymptomatic controls (CTRL). We hypothesized that the LFH design would allow a greater hip RoM, providing movement patterns more like CTRL, and a larger side difference in hip RoM in THAC when compared to LFH and controls. IMUs were attached to the pelvis, thighs and shanks during five trials of squats, gait, and stair ascending/descending performed at self-selected speed. THAC and LFH participants completed the Hip dysfunction and Osteoarthritis Outcome Score (HOOS). The results showed a larger hip RoM during squats in LFH compared to THAC. Side differences in LFH and THAC groups (operated vs. non-operated side) indicated that movement function was not fully recovered in either group, further corroborated by non-maximal mean HOOS scores (LFH: 83 ± 13, THAC: 84 ± 19 groups, vs. normal function 100). The IMU system may have the potential to enhance clinical movement evaluations as an adjunct to clinical scales.
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Bordini B, Stea S, Castagnini F, Busanelli L, Giardina F, Toni A. The influence of bearing surfaces on periprosthetic hip infections: analysis of thirty nine thousand, two hundred and six cementless total hip arthroplasties. INTERNATIONAL ORTHOPAEDICS 2019; 43:103-109. [PMID: 30099642 DOI: 10.1007/s00264-018-4097-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Periprosthetic hip infection (PHI) is a devastating complication. The association between PHI and bearing surfaces as well as patient-related factors has been recently investigated, with contradictive outcomes. The dataset of Emilia-Romagna region Registry for Orthopaedic Prosthetic Implants (RIPO) has been assessed to investigate, if the bearing choice influenced the risk of septic loosening occurrence. METHODS RIPO data about 39,206 cementless total hip arthroplasties (THA), collected since 2003, were analysed. Age, gender, BMI, diabetes and bearing surfaces were evaluated. The end point of the study was the revision of at least a single component due to sepsis. RESULTS Adjusted and unadjusted survival rates showed that ceramic-on-ceramic (COC) implants had the lower incidence of PHIs, whereas metal-on-metal (MOM) THAs were significantly more prone to infection. In MOM cohort, stemmed implants were involved in 28 out of 30 cases. Among the demographical features and comorbid conditions, only diabetes statistically influenced the rate of sepsis. CONCLUSIONS Bearing surfaces influenced the rate of PHI; in particular, stemmed MOM implants were at higher risk, probably due to metal debris consequent to taperosis. Despite the preliminary results, stemmed MOM THAs should be used with care, and diabetic patients should be warned about increased septic risks.
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Affiliation(s)
- Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 10, 40136, Bologna, Italy
| | - Susanna Stea
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 10, 40136, Bologna, Italy
| | - Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Luca Busanelli
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Federico Giardina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Aldo Toni
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 10, 40136, Bologna, Italy
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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Gascoyne TC, Turgeon TR, Burnell CD. Retrieval Analysis of Large-Head Modular Metal-on-Metal Hip Replacements of a Single Design. J Arthroplasty 2018; 33:1945-1952. [PMID: 29402714 DOI: 10.1016/j.arth.2017.12.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/23/2017] [Accepted: 12/31/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are limited publications examining modular metal-on-metal (MoM) total hip implants in which a comprehensive analysis of retrieved components is performed. This study examines 24 retrieved modular MoM implants from a single manufacturer and compares retrieval analytics; bearing surface damage, wear, and modular taper corrosion against patient, surgical and implant characteristics to elucidate significant associations. METHODS Clinical, patient, and surgical data were collected including age, body mass index, blood metal ion levels, and cup inclination. Damage assessment was performed visually in addition to surface profilometry. Acetabular liners and femoral heads were measured for volumetric wear. Femoral head taper bores were similarly measured for material removal due to corrosion and fretting. RESULTS Patients with MoM-related reasons for revision showed significantly higher levels of blood metal ion levels. Bearing wear was strongly associated with blood metal ion levels and was significantly increased in cups placed more vertically. Younger patients tended to have higher body mass indices as well as poorer cup placement. CONCLUSION This work details a broad range of analyses on a series of modular MoM total hip implants from a single manufacturer of which there are few published studies. Acetabular cup inclination angle was deemed a primary cause of revision surgery through increased MoM wear, high metal ion levels in the blood, and subsequent adverse local tissue reactions. Heavy patients can increase the surgical difficulty which was shown to be related to poor cup placement in this cohort.
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Affiliation(s)
| | - Thomas R Turgeon
- Concordia Joint Replacement Group, Winnipeg, Manitoba, Canada; Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Colin D Burnell
- Concordia Joint Replacement Group, Winnipeg, Manitoba, Canada; Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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21
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Abstract
The use of larger femoral head size in total hip arthroplasty (THA) has increased during the past decade; 32 mm and 36 mm are the most commonly used femoral head sizes, as reported by several arthroplasty registries.The use of large femoral heads seems to be a trade-off between increased stability and decreased THA survivorship.We reviewed the literature, mainly focussing on the past 5 years, identifying benefits and complications associated with the trend of using larger femoral heads in THA.We found that there is no benefit in hip range of movement or hip function when head sizes > 36 mm are used.The risk of revision due to dislocation is lower for 36 mm or larger bearings compared with 28 mm or smaller and probably even with 32 mm.Volumetric wear and frictional torque are increased in bearings bigger than 32 mm compared with 32 mm or smaller in metal-on-cross-linked polyethylene (MoXLPE) THA, but not in ceramic-on-XLPE (CoXLPE).Long-term THA survivorship is improved for 32 mm MoXLPE bearings compared with both larger and smaller ones.We recommend a 32 mm femoral head if MoXLPE bearings are used. In hips operated on with larger bearings the use of ceramic heads on XLPE appears to be safer. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170061.
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Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Peter Cnudde
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
- Department of Orthopaedics, Prince Philip Hospital, HDUHB, Wales
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland
- Finnish Arthroplasty Register, Helsinki, Finland
| | - Johan Kärrholm
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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