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Krueger DR, Guenther KP, Deml MC, Perka C. Mechanical failure of 113 uncemented modular revision femoral components. Bone Joint J 2020; 102-B:573-579. [DOI: 10.1302/0301-620x.102b5.bjj-2019-1333.r2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aims We evaluated a large database with mechanical failure of a single uncemented modular femoral component, used in revision hip arthroplasty, as the end point and compared them to a control group treated with the same implant. Patient- and implant-specific risk factors for implant failure were analyzed. Methods All cases of a fractured uncemented modular revision femoral component from one manufacturer until April 2017 were identified and the total number of implants sold until April 2017 was used to calculate the fracture rate. The manufacturer provided data on patient demographics, time to failure, and implant details for all notified fractured devices. Patient- and implant-specific risk factors were evaluated using a logistic regression model with multiple imputations and compared to data from a previously published reference group, where no fractures had been observed. The results of a retrieval analysis of the fractured implants, performed by the manufacturer, were available for evaluation. Results There were 113 recorded cases with fracture at the modular junction, resulting in a calculated fracture rate of 0.30% (113/37,600). The fracture rate of the implant without signs of improper use was 0.11% (41/37,600). In 79% (89/113) of cases with a failed implant, either a lateralized (high offset) neck segment, an extralong head, or the combination of both were used. Logistic regression analysis revealed male sex, high body mass index (BMI), straight component design, and small neck segments were significant risk factors for failure. Investigation of the implants (76/113) showed at least one sign of improper use in 72 cases. Conclusion Implant failure at the modular junction is associated with patient- and implant-specific risk factors as well as technical errors during implantation. Whenever possible, the use of short and lateralized neck segments should be avoided with this revision system. Implantation instructions and contraindications need to be adhered to and respected. Cite this article: Bone Joint J 2020;102-B(5):573–579.
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Affiliation(s)
- D. R. Krueger
- Center for Musculoskeletal Surgery (CMSC), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - K-P. Guenther
- Center for Orthopaedic and Trauma Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M. C. Deml
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
| | - C. Perka
- Center for Musculoskeletal Surgery (CMSC), Charité – Universitätsmedizin Berlin, Berlin, Germany
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2
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Kahan M, Estes C. Failure at the femoral stem extension-condylar interface in a rotating hinge knee without radiographic evidence of loosening. Arthroplast Today 2020; 6:36-40. [PMID: 32211472 PMCID: PMC7083710 DOI: 10.1016/j.artd.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 10/04/2019] [Accepted: 11/05/2019] [Indexed: 11/19/2022] Open
Abstract
Modular stem extensions have become ubiquitous in revision total knee arthroplasty systems. Although stem extensions are valuable in addressing bone deficiencies and improving implant fixation, the stem extension-condylar interface may be a point of implant failure. We report a case of failure at the femoral stem extension-condylar interface in a Zimmer NexGen Rotating Hinge Knee (Zimmer, Warsaw, IN). Currently, several published case reports describe failure at the femoral stem extension-condylar interface but only 1 case describes loosening at a taper junction without evidence of set screw failure or taper fracture. Furthermore, no published cases describe this type of failure in the Zimmer NexGen Rotating Hinge Knee (Zimmer).
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Affiliation(s)
- Michael Kahan
- Department of Orthopedic Surgery, UPMC Pinnacle, Harrisburg, PA, USA
- Corresponding author. Department of Orthopedic Surgery, UPMC Pinnacle, 4300 Londonderry Road, Harrisburg, PA 17109, USA. Tel.: +1 775 378 6337.
| | - Christopher Estes
- Department of Orthopedic Surgery, Adventist Health, Aspire Orthopedic Institute, Portland, OR, USA
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Zheng J, Chen X, Jiang W, Zhang S, Chen M, Yang C. An innovative total temporomandibular joint prosthesis with customized design and 3D printing additive fabrication: a prospective clinical study. J Transl Med 2019; 17:4. [PMID: 30602388 PMCID: PMC6317245 DOI: 10.1186/s12967-018-1759-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/21/2018] [Indexed: 11/25/2022] Open
Abstract
Background Total temporomandibular joint (TMJ) prosthesis is an effective and reliable method of joint reconstruction. However, there is still an urgent need to design a new TMJ prosthesis because of no commercially available TMJ prosthesis appropriate for the clinical application on the Chinese population. This study was introduced to prospectively confirm the safety and effectiveness of a new TMJ prosthesis with customized design and 3D printing additive fabrication in clinical application. Methods Patients with unilateral end-stage TMJ osteoarthrosis were recruited in this study from Nov 2016 to Mar 2017. Computed tomography scans for all patients were obtained and transformed into three-dimensional (3D) reconstruction models. The customized TMJ prosthesis consisted of three components including the fossa, condylar head, and mandibular handle units, which were designed based on the anatomy of the TMJ and were fabricated using the 3D printing technology. The prominent characters of the prosthesis were the customized design of the fossa component with a single ultra-high-molecular-weight polyethylene and the connection mechanism between the condylar head (Co–Cr–Mo alloy) and mandibular handle components (Ti6Al4 V alloy). The clinical follow-up, radiographic evaluation and laboratory indices were all done to analyze the prosthesis’ outcomes in the clinical application. Results 12 consecutive patients were included in the study. There were no complications (infection of the surgical wound, damage of liver and kidney, displacement, breakage, or loosening of the prosthesis) found after surgery. Pain, diet, mandibular function, and maximal interincisal opening showed significant improvements after surgery. But the lateral movement was limited to the non-operated side and the mandible deviated towards the operated side on opening mouth following surgery. Conclusions The presented TMJ prosthesis is considered an innovative product in TMJ Yang’s system, which is unique compared to other prostheses for the special design and 3D printing additive manufacture. Moreover, the prosthesis is very safe and efficient for clinical use. Trial registration Prospective reports on Chinese customized total temporomandibular joint prosthesis reconstruction cases, ChiCTR-ONC-16009712. Registered 22 Nov 2016, http://www.chictr.org.cn/showproj.aspx?proj=16091
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Affiliation(s)
- JiSi Zheng
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - XuZhuo Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - WenBo Jiang
- Center of 3D-printing Translational Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - ShanYong Zhang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - MinJie Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Chi Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China.
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4
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Fink B. What can the surgeon do to reduce the risk of junction breakage in modular revision stems? Arthroplast Today 2018; 4:306-309. [PMID: 30186910 PMCID: PMC6123316 DOI: 10.1016/j.artd.2018.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022] Open
Abstract
Modular revision stems are very common in hip arthroplasty, but junction fracture remains a known failure mechanism. A review of the literature with description of cases with junction breakage of modular revision stems showed that in all 24 analyzed cases, there was a common finding: the combination of an effective osteointegration of the distal component and missing medial bone support of the proximal component. The result was a bending stress point of the stem construction in the region of the junction. A technique using the combination of short distal component and longer proximal components may alter this stress pattern, allow proximal implant support, and reduce the risk of junction fracture. Moreover, filling of gaps between the modular component and the medial region of the femoral calcar in endofemoral implantation, a double osteotomy in significant bowed femurs, and treating medial bone defects with structural allografts additionally can reduce the risk of junction breakage.
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Affiliation(s)
- Bernd Fink
- Corresponding author. Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany. Tel.: +49 7145 9153201.
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5
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Meng X, Du Z, Wang Y. Characteristics of wear particles and wear behavior of retrieved PEEK-on-HXLPE total knee implants: a preliminary study. RSC Adv 2018; 8:30330-30339. [PMID: 35546851 PMCID: PMC9085432 DOI: 10.1039/c8ra04661a] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/14/2018] [Indexed: 11/23/2022] Open
Abstract
Polyether-ether-ketone (PEEK) has been used clinically for intervertebral fusion and internal fixators in spine and trauma surgery because of its mechanical properties and bioinertness. The present study aimed to assess the suitability of PEEK as an alternative material to cobalt–chromium–molybdenum alloy in total knee arthroplasty (TKA) and evaluate the in vivo wear property on the contact surface of the PEEK-on-highly cross-linked polyethylene (HXLPE). PEEK prosthesis was designed and manufactured using injection molding based on the computed tomography data of a standard goat right hind limb. Fifteen goats underwent TKA using PEEK-on-HXLPE prosthesis on the right hind limb. The goats were sacrificed at 12, 24, and 48 weeks postoperatively. The mean surface roughness (Ra) of the retrieved components, proinflammatory cytokines in the synovial fluid, and characteristics of wear particles in the synovial membrane were investigated using laser confocal microscopy, ELISA and polarized light microscopy. The Ra of the femoral component was about 0.08, 0.1, 0.2, and 0.26 μm at pre-study, 12-, 24-, and 48 weeks in the retrievals, respectively. The Ra of the HXLPE bearing samples was approximately 0.38, 0.4, 0.1, and 0.42 μm at pre-study, 12-, 24-, and 48 weeks in the retrievals, respectively. The median size of the particles was 2.63 μm, 1.98 μm, and 3.00 μm at 12, 24, and 48 weeks, respectively. The particles ranged in size from 0.4 μm to 15 μm, and particles <1 μm accounted for 7–13%, those of size 2–5 μm accounted for 67–76%, and those >5 μm accounted for 11–22%. Levels of interleukin (IL)-6, IL-10, and tumor necrosis factor-α (TNF-α) were significantly increased in synovial fluids at 24- and 48 weeks after surgery. Wear occurred on the surfaces of the PEEK and HXLPE material and the size of most wear particles was 1–5 μm. This induced an inflammatory response in the synovial membrane and release of proinflammatory cytokines. A high polishing process may be necessary to lengthen the life of the PEEK prosthesis by reducing the wear and the generation of debris. The PEEK prosthesis as a new generation of artificial joints is promising to be used clinically in the future. Polyether-ether-ketone (PEEK) has been used clinically for intervertebral fusion and internal fixators in spine and trauma surgery because of its mechanical properties and bioinertness.![]()
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Affiliation(s)
- Xiangchao Meng
- Department of Bone and Joint Surgery
- Renji Hospital
- School of Medicine
- Shanghai Jiaotong University
- Shanghai
| | - Zhe Du
- Department of Bone and Joint Surgery
- Renji Hospital
- School of Medicine
- Shanghai Jiaotong University
- Shanghai
| | - You Wang
- Department of Bone and Joint Surgery
- Renji Hospital
- School of Medicine
- Shanghai Jiaotong University
- Shanghai
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Sukur E, Akman YE, Ozturkmen Y, Kucukdurmaz F. Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty. Open Orthop J 2016; 10:241-51. [PMID: 27499822 PMCID: PMC4951796 DOI: 10.2174/1874325001610010241] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/16/2016] [Accepted: 05/31/2016] [Indexed: 02/08/2023] Open
Abstract
Background: Inflammatory responses to wear debris cause osteolysis that leads to aseptic prosthesis loosening and hip arthroplasty failure. Although osteolysis is usually associated with aseptic loosening, it is rarely seen around stable implants. Aseptic implant loosening is a simple radiologic phenomenon, but a complex immunological process. Particulate debris produced by implants most commonly causes osteolysis, and this is called particle-associated periprosthetic osteolysis (PPO). Objective: The objective of this review is to outline the features of particle-associated periprosthetic osteolysis to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome. Methods: A thorough literature search was performed using available databases, including Pubmed, to cover important research published covering particle-associated PPO. Results: Although osteolysis causes bone resorption, clinical, animal, and in vitro studies of particle bioreactivity suggest that particle-associated PPO represents the culmination of several biological reactions of many cell types, rather than being caused solely by the osteoclasts. The biological activity is highly dependent on the characteristics and quantity of the wear particles. Conclusion: Despite advances in total hip arthroplasty (THA), particle-associated PPO and aseptic loosening continue to be major factors that affect prosthetic joint longevity. Biomarkers could be exploited as easy and objective diagnostic and prognostic targets that would enable testing for osteolysis after THA. Further research is needed to identify new biomarkers in PPO. A comprehensive understanding of the underlying biological mechanisms is crucial for developing new therapeutic interventions to reverse or suppress biological responses to wear particles.
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Affiliation(s)
- Erhan Sukur
- Sakarya Education and Research Hospital, 54100, Sakarya, Turkey
| | - Yunus Emre Akman
- Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, 34470, Istanbul, Turkey
| | - Yusuf Ozturkmen
- Istanbul Education and Research Hospital, 34100, Istanbul, Turkey
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Abstract
Corrosion of metallic implants in contact with body fluids is unavoidable, especially at interfaces where movement occurs or in gaps. Corrosion became clinically relevant with the introduction of large modular metal-on-metal total hip joint articulations (MoM THA) early in the 21st century. This review attempts to summarise the scientific knowledge about taper problems available at the time of introduction of these bearings, why this "disaster" could happen. It is speculated that changes to the taper connection made in the 1990s to increase the range of motion with small heads (28 and 32 mm) reduced the mechanical strength of this connection, which did not matter for small heads. With the use of large and very large metal heads in MoM articulations, which have a larger lever arm and can generate high friction in unfavourable situations, suddenly the taper interface exhibited corrosion problems on a previously unknown scale. It is speculated that due to the higher mechanical loading with larger heads, the taper connection became less forgiving with respect to assembly conditions, contamination, manufacturing tolerances and other factors, which are yet not known. Since no major clinical problems had been reported before the introduction of these bearings and the pre-clinical testing was very successful, the disaster took its course. The patient-implant-surgeon system is a very complex intrinsically hazardous system. Pre-clinical testing addresses few and defined factors and such, good results cannot be directly transferred to the clinical reality. A controlled stepwise introduction of innovations is required.
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8
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Pande K, Leong JF, Lo NN. Spontaneous Dissociation of Anatomic Medullary Locking A Plus (AML A Plus) Femoral Component at the Head-Neck Interface. J Orthop Case Rep 2016; 5:48-50. [PMID: 27299068 PMCID: PMC4719400 DOI: 10.13107/jocr.2250-0685.306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Innovations in the design of total hip arthroplasty components have been developed to address certain limitations with the use of standard monoblock prosthesis. With increasing use and long-term follow up, certain complications particularly related to fretting, corrosion and fatigue have been recognized. Case Report: A 31 year old active male patient presented with spontaneous dissociation of the Anatomic Medullary Locking A Plus (AML A Plus) Femoral Component at head and neck interface 10 years after surgery. At revision surgery, wear of the acetabular liner and head and neck taper was noted. Definitive treatment required complete revision of the femoral component and change of acetabular liner. Conclusion: While modularity allows change of worn out components, this case highlights the importance of various factors in avoiding this complication and the need for surgeon to be prepared to use ‘taper sleeves’ or revise the components if taper exchange fails particularly in cases with dissociation of head-neck interface which is usually associated with taper damage.
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Affiliation(s)
- Ketan Pande
- Department of Orthopaedics, Raja Isteri Pengiran Anak Saleha Hospital, Negara Brunei, Darussalam
| | - Juzaily Fekry Leong
- Department of Orthopaedics, Raja Isteri Pengiran Anak Saleha Hospital, Negara Brunei, Darussalam
| | - Ngai Nung Lo
- Department of Orthopaedics, Raja Isteri Pengiran Anak Saleha Hospital, Negara Brunei, Darussalam
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9
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Kent M, Edmondson M, Ebert J, Nivbrant N, Kop A, Wood D, De Steiger R. Stem Migration and Fretting Corrosion of the Antirotation Pin in the K2/Apex Hip System. J Arthroplasty 2016; 31:727-34. [PMID: 26723860 DOI: 10.1016/j.arth.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 09/29/2015] [Accepted: 10/13/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Many exchangeable neck hip systems have been withdrawn because of fretting corrosion at the neck/stem coupling. METHOD Our prospective randomized study evaluating stem stability (Roentgen stereophotogrammetric analysis, dual-energy x-ray absorptiometry) and clinical outcomes between the K2/Apex hip systems was ceased early because of a withdrawal of the stems which had an unfavorably high early revision rate reported in the Australian Orthopaedic Association National Joint Registry (9.3% at 3 years). RESULTS At 2 years, there are no clinical differences between the stems. Roentgen stereophotogrammetric analysis has identified a high proportion of potentially concerning subsidence and retroversion in both groups, more marked in the K2 stem, although mostly in asymptomatic patients. Dual-energy x-ray absorptiometry has shown similar bone density around the stems. Retrieval analysis of 3 study patients showed fretting corrosion of the antirotation pin and aseptic lymphocyte-dominated vasculitis-associated lesion, with no relationship to bearing type or size. Analysis of 7 further nonstudy K2/Apex stems confirmed similar corrosion. CONCLUSION This study shows potentially concerning subsidence of both stems and is the first to describe corrosion at the neck-stem interface and a relationship to metal-related pathology.
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Affiliation(s)
- Michael Kent
- Perth Orthopaedic Institute, Perth, Western Australia, Australia
| | - Mark Edmondson
- Perth Orthopaedic Institute, Perth, Western Australia, Australia
| | - Jay Ebert
- Perth Orthopaedic Institute, Perth, Western Australia, Australia
| | - Nils Nivbrant
- Perth Orthopaedic Institute, Perth, Western Australia, Australia
| | - Alan Kop
- CITRA (Centre for Implant Technology and Retrival Analysis) Medical Engineering and Physics, Perth, Western Australia, Australia
| | - David Wood
- Perth Orthopaedic Institute, Perth, Western Australia, Australia
| | - Richard De Steiger
- AOA National Joint Registry, Data Management & Analysis Centre, School of Population Health, University of Adelaide, Adelaide, South Australia, Australia
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10
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Trunnionosis: the latest culprit in adverse reactions to metal debris following hip arthroplasty. Skeletal Radiol 2015; 44:433-40. [PMID: 25109382 DOI: 10.1007/s00256-014-1978-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/27/2014] [Accepted: 07/30/2014] [Indexed: 02/02/2023]
Abstract
The imaging findings of periprosthetic soft tissue lesions (pseudotumours) have been typically defined in the context of newer second-generation metal-on-metal hip arthroplasty. More recently, similar findings have been described in the setting of non-metal-on-metal prostheses. Although uncommon, wear and corrosion between the metal surfaces at the head-neck ('trunnionosis') and neck-stem interfaces are the potential culprits. With modular junctions containing at least one cobalt chromium component frequently present in hip arthroplasty prostheses, the incidence of this mode of adverse wear may be higher than previously thought (irrespective of the specific bearing couple used). In the present report, we described a case of a severe adverse local tissue reaction secondary to suspected corrosion at the head-neck taper in a metal-on-polyethylene total hip arthroplasty and reviewed the literature. Knowledge of this topical entity should help radiologists facilitate early diagnosis and ensure early management of this potentially serious complication.
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Wirtz DC, Gravius S, Ascherl R, Forst R, Noeth U, Maus UM, Zeiler G, Moritz C D, Zeiler G, Deml MC. Uncemented femoral revision arthroplasty using a modular tapered, fluted titanium stem: 5- to 16-year results of 163 cases. Acta Orthop 2014; 85:562-9. [PMID: 25175667 PMCID: PMC4259034 DOI: 10.3109/17453674.2014.958809] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Due to the relative lack of reports on the medium- to long-term clinical and radiographic results of modular femoral cementless revision, we conducted this study to evaluate the medium- to long-term results of uncemented femoral stem revisions using the modular MRP-TITAN stem with distal diaphyseal fixation in a consecutive patient series. PATIENTS AND METHODS We retrospectively analyzed 163 femoral stem revisions performed between 1993 and 2001 with a mean follow-up of 10 (5-16) years. Clinical assessment included the Harris hip score (HHS) with reference to comorbidities and femoral defect sizes classified by Charnley and Paprosky. Intraoperative and postoperative complications were analyzed and the failure rate of the MRP stem for any reason was examined. RESULTS Mean HHS improved up to the last follow-up (37 (SD 24) vs. 79 (SD 19); p<0.001). 99 cases (61%) had extensive bone defects (Paprosky IIB-III). Radiographic evaluation showed stable stem anchorage in 151 cases (93%) at the last follow-up. 10 implants (6%) failed for various reasons. Neither a breakage of a stem nor loosening of the morse taper junction was recorded. Kaplan-Meier survival analysis revealed a 10-year survival probability of 97% (95% CI: 95-100). INTERPRETATION This is one of the largest medium- to long-term analyses of cementless modular revision stems with distal diaphyseal anchorage. The modular MRP-TITAN was reliable, with a Kaplan-Meier survival probability of 97% at 10 years.
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Affiliation(s)
- Dieter C Wirtz
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn
| | - Sascha Gravius
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn
| | - Rudolf Ascherl
- Department of Orthopaedic Surgery, Zeisigwald Hospital Bethanien, Chemnitz
| | - Raimund Forst
- Department of Orthopaedic Surgery, University Hospital Erlangen/Nürnberg, Erlangen
| | - Ulrich Noeth
- Department of Orthopaedic Surgery, University Hospital Würzburg, Würzburg
| | - Uwe M Maus
- Department of Orthopaedic Surgery, Pius-Hospital Oldenburg, Oldenburg
| | - Günther Zeiler
- Department of Orthopaedic Surgery, Rummelsberg Hospital, Schwarzenbruck, Germany.
| | - Deml Moritz C
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn
| | - Günther Zeiler
- Department of Orthopaedic Surgery, Rummelsberg Hospital, Schwarzenbruck, Germany
| | - Moritz C Deml
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn
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12
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Jauch S, Coles L, Ng L, Miles A, Gill H. Low torque levels can initiate a removal of the passivation layer and cause fretting in modular hip stems. Med Eng Phys 2014; 36:1140-6. [DOI: 10.1016/j.medengphy.2014.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 05/25/2014] [Accepted: 06/17/2014] [Indexed: 11/30/2022]
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13
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Design parameters and the material coupling are decisive for the micromotion magnitude at the stem–neck interface of bi-modular hip implants. Med Eng Phys 2014; 36:300-7. [DOI: 10.1016/j.medengphy.2013.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 11/04/2013] [Accepted: 11/17/2013] [Indexed: 11/20/2022]
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14
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Jauch SY, Huber G, Sellenschloh K, Haschke H, Baxmann M, Grupp TM, Morlock MM. Micromotions at the taper interface between stem and neck adapter of a bimodular hip prosthesis during activities of daily living. J Orthop Res 2013; 31:1165-71. [PMID: 23553890 DOI: 10.1002/jor.22354] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/05/2013] [Indexed: 02/04/2023]
Abstract
The stem-neck taper interface of bimodular hip endoprostheses bears the risk of micromotions that can result in ongoing corrosion due to removal of the passive layer and ultimately cause implant fracture. We investigated the extent of micromotions at the stem-neck interface and the seating behavior of necks of one design made from different alloys during daily activities. Modular hip prostheses (n = 36, Metha®, Aesculap AG, Germany) with neck adapters (CoCr29Mo6 or Ti6Al4V) were embedded in PMMA (ISO 7206-4) and exposed to cyclic loading with peak loads ranging from walking (Fmax = 2.3 kN) to stumbling (Fmax = 5.3 kN). Translational and rotational micromotions at the taper interface and seating characteristics during assembly and loading were determined using four eddy-current sensors. Seating during loading after implant assembly was dependent on load magnitude but not on material coupling. Micromotions in the stem-neck interface correlated positively with load levels (CoCr: 2.6-6.3 µm, Ti: 4.6-13.8 µm; p < 0.001) with Ti neck adapters exhibiting significantly larger micromotions than CoCr (p < 0.001). These findings explain why high body weights and activities related to higher loads could increase the risk of fretting-induced implant failures in clinical application, especially for Ti-Ti combinations. Still, the role of taper seating is not clearly understood.
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Affiliation(s)
- Sabrina Yvonne Jauch
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestr. 15, 21073, Hamburg, Germany.
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15
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Adverse tissue reactions in modular exchangeable neck implants: a report of two cases. J Arthroplasty 2013; 28:543.e13-5. [PMID: 23141863 DOI: 10.1016/j.arth.2012.07.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 06/11/2012] [Accepted: 07/02/2012] [Indexed: 02/08/2023] Open
Abstract
Dual-modular femoral stems with exchangeable necks theoretically allow optimization of hip joint biomechanics via selective restoration of femoral anteversion, offset, and limb length. A potential disadvantage is the possible generation of metal ions and debris by fretting and crevice corrosion at the additional stem-neck interface. We present 2 cases of early-onset adverse inflammatory tissue reactions as a result of accelerated corrosion at the stem-neck interface of a dual-modular implant, requiring subsequent revision of well-fixed components.
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Kop AM, Keogh C, Swarts E. Proximal component modularity in THA--at what cost? An implant retrieval study. Clin Orthop Relat Res 2012; 470:1885-94. [PMID: 22048865 PMCID: PMC3369081 DOI: 10.1007/s11999-011-2155-9] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND While modular femoral heads have been used in THA for decades, a recent innovation is a second neck-stem taper junction. Clinical advantages include intraoperative adjustment of leg length, femoral anteversion, and easier revision, all providing flexibility to the surgeon; however, there have been reports of catastrophic fracture, cold welding, and corrosion and fretting of the modular junction. QUESTIONS/PURPOSES We asked whether (1) the neck-stem junction showed the same degradation mechanisms, if any, as the head-neck junction, (2) the junction contributed to THA revision, (3) the alloy affected the degree of degradation, and (4) the trunion machine finish affected the degradation mechanisms. METHODS We compared 57 retrievals from seven total hip modular designs, three cobalt-chromium-molybdenum and four titanium based: Bionik(®) (four), GMRS(®) (four), Margron(®) (22), Apex(®) (five), M-series(®) (five), ZMR(®) (two), and S-ROM(®) (15). Macroscopic inspection, microscopy, and micro-CT were conducted to determine the effects of materials and design. RESULTS The cobalt-chromium-molybdenum components showed crevice corrosion and fretting of the neck-stem taper, whereas the titanium components had less corrosion; however, there were several cases of cold welding where disassembly could not be achieved in theater. CONCLUSIONS Even with modern taper designs and corrosion-resistant materials, corrosion, fretting, and particulate debris were observed to a greater extent in the second neck-stem junction. Titanium-based modular arthroplasty may lessen the degree of degradation, but cold welding of the components may occur. CLINICAL RELEVANCE Degradation of the second junction contributed to 8 cases of metallosis and two cases of aseptic lymphocyte-laminated vascular-associated lesions contributing to revision.
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Affiliation(s)
- A. M. Kop
- Department of Medical Engineering and Physics, Royal Perth Hospital, Wellington Street, Perth, 6000 Western Australia
| | - C. Keogh
- Department of Medical Engineering and Physics, Royal Perth Hospital, Wellington Street, Perth, 6000 Western Australia
| | - E. Swarts
- Department of Medical Engineering and Physics, Royal Perth Hospital, Wellington Street, Perth, 6000 Western Australia
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Gravius S, Randau T, Wirtz DC. [What can be done when hip prostheses fail? : New trends in revision endoprosthetics]. DER ORTHOPADE 2012; 40:1084-94. [PMID: 22109589 DOI: 10.1007/s00132-011-1844-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Revision surgery after total hip arthroplasty is increasing steadily in numbers. These procedures demand high performance from both the treating surgeon as well as the implants used. Novel developments from basic research and industrial partners extend the possibilities for treating affected patients. This article gives an overview of the state of the art in revision hip arthroplasty: new techniques and trends are outlined and presented.
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Affiliation(s)
- S Gravius
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
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Okazaki Y, Gotoh E. Comparison of fatigue strengths of biocompatible Ti-15Zr-4Nb-4Ta alloy and other titanium materials. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2011. [DOI: 10.1016/j.msec.2010.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dalmiglio M, Schaaff P, Holzwarth U, Chiesa R, Rondelli G. The effect of surface treatments on the fretting behavior of Ti‐6Al‐4V alloy. J Biomed Mater Res B Appl Biomater 2008; 86:407-16. [DOI: 10.1002/jbm.b.31034] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Schuh A, Zeller C, Holzwarth U, Kachler W, Wilcke G, Zeiler G, Eigenmann B, Bigoney J. Deep rolling of titanium rods for application in modular total hip arthroplasty. J Biomed Mater Res B Appl Biomater 2007; 81:330-5. [PMID: 16969829 DOI: 10.1002/jbm.b.30669] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Compressive residual stresses are commonly introduced into the near-surface regions of morse taper junctions of modular hip endoprostheses to prolong fatigue life. An increasing number of publications report that contamination of shot-peened surfaces can lead to enhanced corrosion and third body wear. This study evaluates deep rolling of titanium alloy rods as a possible alternative to shot peening. Ten rods of Ti6Al7Nb alloy with a diameter of 15 mm were deep rolled with various rolling parameters. The resulting surface topography and residual contamination was analyzed using a scanning electron microscope (SEM). The near-surface residual stress states after deep rolling were characterized by means of X-ray diffraction. The roughness of the surfaces before deep rolling was about R(z) = 14 microm, and after deep rolling surface roughness values of R(z) 0.4-7.5 microm were achieved. The results of the SEM and EDAX analyses of the sample surface showed no evidence of surface contamination by particles or abrasion products caused by any process. At a pressure of 300 bar, compressive stress reached the maximum of -1150 MPa at a depth of 0.1 mm. Deep rolling thus allows a smooth and particle-free surface to be obtained and therefore shows promise as a surface treatment for mating surfaces of morse tapers in modular hip endoprostheses.
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Affiliation(s)
- Alexander Schuh
- Orthopedic Hospital Rummelsberg, 90592 Schwarzenbruck, Germany.
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Schuh A, Uter W, Holzwarth U, Kachler W, Göske J, Zeiler G. [Comparative surface examinations of morse taper junctions of the MRP-Titan stem shot peened with glass beads]. BIOMED ENG-BIOMED TE 2005; 49:334-9. [PMID: 15655925 DOI: 10.1515/bmt.2004.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Shot peening is widely used for surface treatment of hip implants. Shot peening with steel balls followed by a cleaning process with glass beads is used for introduction of negative stress in the production of morse taper junctions of the MRP-Titan stem. An increasing number of publications in maxillofacial surgery and orthopaedic surgery show that there is a significant contamination of Alumina or glass blasted surfaces. Latest research suggested an association between contaminant particles with early loosening of endoprostheses (third body wear). The aim of this study is to evaluate the amount and the effects of surface contamination with glass particles on morse taper junctions of implants and explants of the MRP-Titan stem. MATERIAL AND METHOD The surface of morse taper junctions of the MRP-Titan stem (5 original-package implants and explants each) are analysed for glass particle contamination. A field emission scanning electron microscopy (LEO 1525) is used for the detection of the glass-particles on the implant surface with a backscattered electron detector. The relative surface area covered by particles was calculated by means of an image analyzing software (analySIS, Soft Imaging System GmbH). RESULTS The surface of the implants showed a considerable contamination with glass particles with a mean of 6.67 +/- 0.82% compared to 2.06 +/- 0.74% on the surface of the explants. The difference was statistically significant (p<0.0001). DISCUSSION The results of this study show that there is a relative high percentage of contamination with glass particles on shot peened morse taper junctions of the MRP-Titan stem. This contamination is significantly lower on the surface of the explants. With respect to third body wear and osteolysis in total hip arthroplasty further studies are necessary to minimize contamination while maintaining adequate surface quality.
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Affiliation(s)
- Alexander Schuh
- Orthopädische Klinik Rummelsberg, Rummelsberg 71, 90592 Schwarzenbruck
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Kennedy JG, Kearns SR, Quinlan WB. Dissociation of a Morse-taper stemmed tibial component following revision total knee arthroplasty. A case report. J Bone Joint Surg Am 2003; 85:536-8. [PMID: 12637444 DOI: 10.2106/00004623-200303000-00024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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