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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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2
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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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3
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López RE, Pelayo de Tomás JM, Morales Suárez Varela M, Rodrigo Pérez JL. Evolution of chromium and cobalt serum levels after the use of a modular neck stem in primary total hip arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:26-34. [PMID: 37270057 DOI: 10.1016/j.recot.2023.05.013] [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: 02/06/2023] [Revised: 03/23/2023] [Accepted: 05/29/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Modular neck primary stems were introduced with the theoretical advantage of restoring the hip anatomy more precisely. However, the presence of a second junction has been associated with increased corrosion and release of metal debris. The objective of our study is to quantify of chromium and cobalt serum values, and to analyze their temporal evolution during five years. MATERIAL AND METHODS We present a prospective series of 61 patients who underwent primary total hip arthroplasty by implantation of the HMAX-M® stem (Limacorporate, San Daniele, Italy). Serum chromium and cobalt determinations were performed at six months, two years and five years. RESULTS Our series shows a progressive elevation in chromium levels with a significant difference between chromium values at six months (0.35±0.18) and five years (0.52±0.36), P=.01. Regarding cobalt, a statistically significant elevation is observed between six months and two years and a subsequent stabilization of values between two and five years, with a cobalt mean at six months (1.17±0.8) significantly lower than at two (2.63±1.76) and five years (2.84±2.1), P=.001. CONCLUSION Elevated serum cobalt levels have been observed in patients who underwent modular neck stem implantation. The results obtained in this study have limited the use of stems with a modular neck in our clinical practice.
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Affiliation(s)
- R E López
- Hospital Universitario Doctor Peset, Valencia, España.
| | - J M Pelayo de Tomás
- Hospital Universitario Doctor Peset, Valencia, España; Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - M Morales Suárez Varela
- Unidad de Salud Pública, Higiene y Sanidad Ambiental, Departamento de Medicina Preventiva, Facultad de Farmacia, Universidad de Valencia, Burjassot, Valencia, España; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, España
| | - J L Rodrigo Pérez
- Hospital Universitario Doctor Peset, Valencia, España; Facultad de Medicina, Universidad de Valencia, Valencia, España
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4
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López RE, Pelayo de Tomás JM, Morales Suárez Varela M, Rodrigo Pérez JL. [Translated article] Evolution of chromium and cobalt serum levels after the use of a modular neck stem in primary total hip arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T26-T34. [PMID: 37992863 DOI: 10.1016/j.recot.2023.11.010] [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: 02/06/2023] [Accepted: 05/29/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Modular neck primary stems were introduced with the theoretical advantage of restoring the hip anatomy more precisely. However, the presence of a second junction has been associated with increased corrosion and release of metal debris. The objective of our study is to quantify of chromium and cobalt serum values, and to analyse their temporal evolution during five years. MATERIAL AND METHODS We present a prospective series of 61 patients who underwent primary total hip arthroplasty by implantation of the H MAX-M® stem (Limacorporate, San Daniele, Italy). Serum chromium and cobalt determinations were performed at six months, two years and five years. RESULTS Our series shows a progressive elevation in chromium levels with a significant difference between chromium values at six months (0.35±0.18) and five years (0.52±0.36), p=.01. Regarding cobalt, a statistically significant elevation is observed between six months and two years and a subsequent stabilisation of values between two and five years, with a cobalt mean at six months (1.17±0.8) significantly lower than at two (2.63±1.76) and five years (2.84±2.1), p=.001. CONCLUSION Elevated serum cobalt levels have been observed in patients who underwent modular neck stem implantation. The results obtained in this study have limited the use of stems with a modular neck in our clinical practice.
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Affiliation(s)
- R E López
- Hospital Universitario Doctor Peset, Valencia, Spain.
| | - J M Pelayo de Tomás
- Hospital Universitario Doctor Peset, Valencia, Spain; Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - M Morales Suárez Varela
- Unidad de Salud Pública, Higiene y Sanidad Ambiental, Departamento de Medicina Preventiva, Facultad de Farmacia, Universidad de Valencia, Burjassot, Valencia, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - J L Rodrigo Pérez
- Hospital Universitario Doctor Peset, Valencia, Spain; Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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5
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DeRuyter MT, Mansy LN, Krumme JW, Cheng AL, Dubin JR, Cil A. Risk of Recall for Total Joint Arthroplasty Devices Over 10 Years. J Arthroplasty 2023:S0883-5403(23)00088-8. [PMID: 36773660 DOI: 10.1016/j.arth.2023.01.068] [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: 10/14/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Orthopaedic devices comprise nearly 20% of devices on the market and 12% to 20% of these devices undergo a recall within 10 years. More than 95% of these devices are approved without supporting clinical data through the Food and Drug Administration's 510(k) pathway. The risk of recall of orthopaedic arthroplasty devices approved through the 510(k) pathway has not been previously studied. METHODS The FDA 510(k) database was queried for orthopaedic devices approved between January 01, 2008 and December 31, 2018 and subsequently codified to hip and knee arthroplasty devices using product codes. The database included 904 arthroplasty devices during the study period, with hip and knee making up 53.7% (485) and 46.3% (419) of devices, respectively. Information regarding numbers, dates, and reasons for recall were recorded. Cumulative incidence function was conducted to compare the risk of recall between hip and knee arthroplasty. RESULTS In total, 94 (19.4%) hip and 85 (20.3%) knee devices were recalled. The hazard of recall by 10 years for hip and knee arthroplasty devices was approximately 24%, with no statistical differences between each region. The most common causes of recall were process control and device design, accounting for 29.6% and 26.3% of recalls, respectively, with no significant difference between study groups. CONCLUSION The risk of recall for arthroplasty devices is more than that previously understood. Improved postmarket surveillance strategies along with increased physician participation in detecting and reporting device safety issues are necessary to strengthen patient safety.
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Affiliation(s)
| | | | | | | | | | - Akin Cil
- University of Missouri, Kansas City, Missouri
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Schwartz Y, Sherwood DJ, Kamara E. Atypical Presentation of Periprosthetic Joint Infection With Pseudotumor With a Modular-Neck Stem Implant. Cureus 2022; 14:e28862. [PMID: 36225483 PMCID: PMC9537095 DOI: 10.7759/cureus.28862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
A 64-year-old male with a recalled modular-neck stem implant presented with a soft tissue mass in the lateral thigh. Preoperative testing revealed no signs of infection by the 2018 periprosthetic joint infection criteria. MRI revealed a large soft tissue mass around the implant consistent with a pseudotumor, and we performed revision surgery of the femoral component for trunnionosis. One intraoperative culture was positive for infection, and the patient was placed on antibiotics. Six weeks following revision surgery of the femoral component, the patient presented with acute drainage and was diagnosed with an acute on chronic periprosthetic joint infection and underwent explantation of the femoral and acetabular components with the placement of an antibiotic spacer. Cultures revealed identical bacteria from the index procedure. Given the clinical course, this case likely represents adverse local tissue reaction with an atypical presentation of periprosthetic joint infection. This is the first case presentation of an adverse local tissue reaction and superimposed periprosthetic joint infection with normal infection workup, representing an important consideration when differentiating between pseudotumor and periprosthetic joint infection in modular-neck femoral stem implants.
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Pruitt BP, Mears SC, Apple AE, Stambough JB, Barnes CL, Stronach BM. Catastrophic Trunnion Failure in an Anatomic Titanium Alloy Stem. Geriatr Orthop Surg Rehabil 2022; 13:21514593221142726. [DOI: 10.1177/21514593221142726] [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: 11/29/2022] Open
Abstract
Introduction Certain titanium alloy stems have been shown to be susceptible to failure at the neck with catastrophic trunnion failure. Failure has been particularly noted in the single wedge Accolade 1 stem design. Other stems also used this alloy including the anatomic designed Citation stem. Methods This case series details 3 catastrophic failures of the TMZF version of the Citation femoral stem. Results Each of these failures appear to be attributed to cyclical wear of the TMZF trunnion against the cobalt chromium femoral head. Wear resulted in ultimate implant failure and significant metal debris in the joint capsule at the time of revision surgery. Discussion While surgeons are aware of the risk of catastrophic failure for the Accolade 1 stem, failure may similarly happen in the TMZF Citation stem. Surgeons should monitor these implants with care and discuss the potential for trunnion failure with their patients.
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Affiliation(s)
- Benjamin P. Pruitt
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Andrew E. Apple
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jeffrey B. Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C. Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin M. Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Solarino G, Vicenti G, Carrozzo M, Ottaviani G, Moretti B, Zagra L. Modular neck stems in total hip arthroplasty: current concepts. EFORT Open Rev 2021; 6:751-758. [PMID: 34667646 PMCID: PMC8489472 DOI: 10.1302/2058-5241.6.200064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Modular neck (MN) implants can restore the anatomy, especially in deformed hips such as sequelae of development dysplasia. Early designs for MN implants had problems with neck fractures and adverse local tissue, so their use was restricted to limited indications. Results of the latest generation of MN prostheses seem to demonstrate that these problems have been at least mitigated. Given the results of the studies presented in this review, surgeons might consider MN total hip arthroplasty (THA) for a narrower patient selection when a complex reconstruction is required. Long MN THA should be avoided in case of body mass index > 30, and should be used with extreme caution in association with high offset femoral necks with long or extra-long heads. Cr-Co necks should be abandoned, in favour of a titanium alloy connection. Restoring the correct anatomic femoral offset remains a challenge in THA surgeries. MN implants have been introduced to try to solve this problem. The MN design allows surgeons to choose the appropriate degree and length of the neck for desired stability and range of motion.
Cite this article: EFORT Open Rev 2021;6:751-758. DOI: 10.1302/2058-5241.6.200064
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Affiliation(s)
- Giuseppe Solarino
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Giovanni Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Massimiliano Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Guglielmo Ottaviani
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Biagio Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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Manfreda F, Bufi E, Florio EF, Ceccarini P, Rinonapoli G, Caraffa A, Antinolfi P. Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities. World J Orthop 2021; 12:768-780. [PMID: 34754833 PMCID: PMC8554354 DOI: 10.5312/wjo.v12.i10.768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Among the various complications associated with total hip arthroplasty (THA) periprosthetic osteolysis and wear phenomena due to the release of metal particles, are two of the most common and have been reported to be correlated because of inflammatory responses directed towards released particles that generally activate macrophagic osteolytic effects. Therein, new masses known as pseudotumors can appear in soft tissues around a prosthetic implant. To date, there is paucity of reliable data from studies investigating for any association between the above mentioned adverse events.
AIM To investigate for the existence of any association between serum and urine concentrations of metal-ions released in THA and periprosthetic osteolysis for modular neck and monolithic implants.
METHODS Overall, 76 patients were divided into three groups according to the type of hip prosthesis implants: Monoblock, modular with metal head and modular with ceramic head. With an average f-up of 4 years, we conducted a radiological evaluation in order to detect any area of osteolysis around the prosthesis of both the femur and the acetabulum. Moreover, serum and urinary tests were performed to assess the values of Chromium and Cobalt released. Statistical analysis was performed to determine any association between the ion release and osteolysis.
RESULTS For the 3 study groups, the monolithic, modular ceramic-headed and modular metal-headed implants had different incidences of osteolysis events, which were higher for the modular implants. Furthermore, the most serious of these (grade 3) were detected almost exclusively for the modular implants with metal heads. A mapping of the affected areas was performed revealing that the highest incidences of osteolysis were evidenced in the pertrochanteric region at the femur level, and in the supero-external region at the acetabular level. Regarding the evaluation of the release of metals-ions from wear processes, serum and urinary chromium and cobalt values were found to be higher in cases of modularity, and even more so for those with metal head. Statistical linear correlation test results suggested positive correlations between increasing metal concentrations and incidences areas of osteolysis. However, no cases of pseudo-tumor were detected.
CONCLUSION Future studies are needed to identify risk factors that increase peri-prosthetic metal ion levels and whether these factors might be implicated in the triggering of local events, including osteolysis and aseptic loosening.
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Affiliation(s)
- Francesco Manfreda
- Division of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia 06100, Italy
- Department of Orthopedics and Traumatology, University of Perugia, Perugia 06100, Italy
| | - Egzon Bufi
- Department of Orthopedics and Traumatology, University of Perugia, Perugia 06100, Italy
| | - Enrico Francesco Florio
- Department of Orthopaedic and Traumatology, Infermi Hospital, AUSL Romagna, Rimini 47921, Italy
| | - Paolo Ceccarini
- Department of Orthopedics and Traumatology, University of Perugia, Perugia 06100, Italy
| | | | - Auro Caraffa
- Department of Orthopedics and Traumatology, University of Perugia, Perugia 06100, Italy
| | - Pierluigi Antinolfi
- Department of Orthopedics and Traumatology, University of Perugia, Perugia 06100, Italy
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Perino G, De Martino I, Zhang L, Xia Z, Gallo J, Natu S, Langton D, Huber M, Rakow A, Schoon J, Gomez-Barrena E, Krenn V. The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty. EFORT Open Rev 2021; 6:399-419. [PMID: 34267931 PMCID: PMC8246109 DOI: 10.1302/2058-5241.6.210013] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The histopathological examination of the periprosthetic soft tissue and bone has contributed to the identification and description of the morphological features of adverse local tissue reactions (ALTR)/adverse reactions to metallic debris (ARMD). The need of a uniform vocabulary for all disciplines involved in the diagnosis and management of ALTR/ARMD and of clarification of the parameters used in the semi-quantitative scoring systems for their classification has been considered a pre-requisite for a meaningful interdisciplinary evaluation. This review of key terms used for ALTR/ARMD has resulted in the following outcomes: (a) pseudotumor is a descriptive term for ALTR/ARMD, classifiable in two main types according to its cellular composition defining its clinical course; (b) the substitution of the term metallosis with presence of metallic wear debris, since it cannot be used as a category of implant failure or histological diagnosis; (c) the term aseptic lymphocytic-dominated vasculitis- associated lesion (ALVAL) should be replaced due to the absence of a vasculitis with ALLTR/ALRMD for lymphocytic-predominant and AMLTR/AMRMD for macrophage-predominant reaction. This review of the histopathological classifications of ALTR/ARMD has resulted in the following outcomes: (a) distinction between cell death and tissue necrosis; (b) the association of corrosion metallic debris with adverse local lymphocytic reaction and tissue necrosis; (c) the importance of cell and particle debris for the viscosity and density of the lubricating synovial fluid; (d) a consensus classification of lymphocytic infiltrate in soft tissue and bone marrow; (e) evaluation of the macrophage infiltrate in soft tissues and bone marrow; (f) classification of macrophage induced osteolysis/aseptic loosening as a delayed type of ALTR/ARMD; (g) macrophage motility and migration as possible driving factor for osteolysis; (h) usefulness of the histopathological examination for the natural history of the adverse reactions, radiological correlation, post-marketing surveillance, and implant registries. The review of key terms used for the description and histopathological classification of ALTR/ARMD has resulted in a comprehensive, new standard for all disciplines involved in their diagnosis, clinical management, and long-term clinical follow-up.
Cite this article: EFORT Open Rev 2021;6:399-419. DOI: 10.1302/2058-5241.6.210013
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Affiliation(s)
- Giorgio Perino
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lingxin Zhang
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Canada
| | - Zhidao Xia
- Centre for Nanohealth, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, Czech Republic
| | - Shonali Natu
- Department of Pathology, University Hospital of North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - David Langton
- Orthopaedic Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Monika Huber
- Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Austria
| | - Anastasia Rakow
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Janosch Schoon
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Enrique Gomez-Barrena
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik-GmbH, Trier, Germany
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11
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Lex JR, Welch MD, See A, Edwards TC, Stavropoulos NA, Babis GC. Systematic review of primary total hip arthroplasty using titanium-titanium modular-neck prostheses: the true risk of revision. Hip Int 2021; 31:295-303. [PMID: 32297561 DOI: 10.1177/1120700020916870] [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] [Indexed: 02/04/2023]
Abstract
AIMS Modular-neck femoral implants are used to enable more variability in femoral neck version, offset and length. It has been reported that these implants carry a higher rate of revision. The aim of this review was to assess the overall and cause-specific revision rate of titanium-titanium alloy modular-neck implants in primary total hip arthroplasty (THA). METHODS A systematic review was conducted following PRISMA guidelines and utilising multiple databases. All results were screened for eligibility. Studies published from 2000 onwards, using a current-generation, titanium-titanium, modular-neck implant were included. Overall and cause-specific revision rates were analysed, comparing to fixed-neck prostheses where applicable. RESULTS 920 studies were screened. After applying exclusion criteria, 23 were assessed in full and 14 included. These consisted of 12 case series and 2 joint registry analyses. 21,841 patients underwent a modular-neck implant with a weighted mean follow-up of 5.7 years, mean age of 62.4 years, and average body mass index (BMI) of 28.4kg/m2. The overall revision rate was 3.95% and 2.98% for modular and fixed-neck prostheses, respectively. For studies with >5 years follow-up the mean revision rate was 3.08%. There was no difference in cause-specific revision rates by implant design. Mean improvement in Harris Hip Score was 41.9. CONCLUSIONS At medium-term, revision rates for titanium-titanium primary modular-neck THA are acceptable. These prostheses are a sensible management option in patients with considerable anatomical hip deformity not amenable to correction with standard fixed-neck implants. Patients of male gender, high BMI and requiring prostheses with a larger neck, offset or head are at higher risk of implant failure.
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Affiliation(s)
- Johnathan R Lex
- Oxford Foundation School, Oxford, UK.,Royal Orthopaedic Hospital, Birmingham, UK
| | - Matthew D Welch
- Oxford Foundation School, Oxford, UK.,Oxford University Clinical Academic Graduate School, Oxford, UK
| | - Abbas See
- Oxford Foundation School, Oxford, UK
| | | | - Nikolaos A Stavropoulos
- 2nd Department of Orthopaedic Surgery, Konstantopouleio General Hospital, National and Kapodistrian University of Athens, Athens Medical School, Athens, Greece.,Department of Orthopaedic Surgery, General Hospital of Karpenissi, Karpenissi, Greece
| | - George C Babis
- 2 Department of Orthopaedic Surgery, Konstantopouleio General Hospital, National and Kapodistrian University of Athens, Athens Medical School, Athens, Greece
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Evaluation of femoral anteversion, hip rotation, and lateral patellar tilt after total hip arthroplasty using a changeable neck system. J Artif Organs 2021; 24:492-497. [PMID: 33899127 DOI: 10.1007/s10047-021-01269-1] [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: 02/15/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
In patients with secondary osteoarthritis due to acetabular dysplasia, femoral anteversion has many variations. A changeable neck system is one useful option to adjust the femoral anteversion. Retroverted necks can effectively adjust anatomical anteversion (AA), femoral rotational angle (FRA), and functional anteversion (FA); however, effectiveness of anteverted necks for these adjustments has not been investigated. Moreover, although the lateral patellar tilt after total hip arthroplasty (THA) has been reported to externally rotate, the influence on lateral patellar tilt using a changeable neck system remains unknown. To clarify the effectiveness of anteverted necks in THA, 96 consecutive patients (111 hips) who underwent THA using anatomical short stem with a changeable neck system were retrospectively investigated using pre- and post-operative computed tomography. Patients were divided into the straight (ST) group using straight and 4-mm-high-offset neck (N = 34) and the anteverted (AV) group using 15°-anteverted and 15°-anteverted/3-mm-high-offset neck (N = 34) after age, body mass index, and surgical approach were matched using propensity scores. AA did not change in the ST group, while it increased by 14.0° in the AV group. FRA decreased after surgery in both groups. FA decreased after surgery in the ST group, while it did not change in the AV group. Lateral patella tilt did not significantly change in both groups between pre- and post-operative position. In conclusion, with a changeable neck system, straight and anteverted necks can adjust AA to achieve pre-operative planning while not influencing lateral patellar tilt.
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McAleese T, Feeley I, Hughes A, Sheehan E, Merghani K, Niall D. Bilateral Mechanically-Assisted Crevice Corrosion Resulting in Femoral Stem-Head Dissociation in Metal-on-Polyethylene Total Hip Arthroplasty. Arthroplast Today 2021; 8:35-39. [PMID: 33718553 PMCID: PMC7921711 DOI: 10.1016/j.artd.2020.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022] Open
Abstract
There are emerging reports of complications related to corrosion in modular femoral components. We report a unique case describing an 83-year-old man with bilateral mechanically-assisted crevice corrosion in hip replacements performed 10 years previously, by the same surgeon using the same size 3 Accolade TMZF stem and same 44-mm CoCr LFIT V40 head (Stryker Orthopedics, Mahwah NJ). Our patient presented with complete femoral stem-head complex dissociation of his right hip and elevated serum cobalt and chromium levels. He subsequently underwent right hip revision arthroplasty while his contralateral hip is monitored closely as an outpatient. This case helps to define the poorly understood mechanisms and component design factors implicated in this emerging issue. We also hope to provoke discussions about guidelines for monitoring and revising failing metal-on-polyethylene arthroplasty systems.
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Affiliation(s)
- Timothy McAleese
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
- Corresponding author. Tullamore Hospital, Arden Road, Tullamore, Co Offaly, Ireland.
| | - Iain Feeley
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
| | - Andrew Hughes
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
| | - Eoin Sheehan
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
- Medical School, University of Limerick, Limerick, Ireland
| | - Khalid Merghani
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
- Medical School, University of Limerick, Limerick, Ireland
| | - Dorothy Niall
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
- Medical School, University of Limerick, Limerick, Ireland
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Talmo CT, Robbins CE, Siddiqi A, Nandi S, Bono JV, Ward DM. Revision of a dual-modular stem in patients with adverse tissue reaction. Hip Int 2020; 30:452-456. [PMID: 31390922 DOI: 10.1177/1120700019869616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dual-modular femoral components with exchangeable cobalt-chrome neck segments have had higher than expected failure rates due to corrosion and adverse local tissue reaction (ALTR). Complications, survival rates and early clinical outcomes of revision surgery for the treatment of corrosion and ALTR as a result of these implants are underreported. METHODS We identified 44 cases of revision THA for corrosion and ALTR resulting from the same dual modular stem. All revision procedures were performed using a modular tapered fluted titanium stem, ceramic heads and highly cross-linked polyethylene. RESULTS Complications included: dislocation, infection, reoperation, and chronic pain. Mean Harris Hip Score was 84 following revision surgery. CONCLUSIONS Patients undergoing revision surgery for ALTR related to this prosthesis should be aware of the risk of postoperative dislocation and other complications and the potential long-term risk of some chronic pain.
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Affiliation(s)
- Carl T Talmo
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Claire E Robbins
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Ahmed Siddiqi
- Philadelphia College of Osteopathic Medicine, PA, USA
| | - Sumon Nandi
- Department of Orthopaedic Surgery, University of Toledo, OH, USA
| | - James V Bono
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Daniel M Ward
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
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15
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Frandsen J, Duensing I, Anderson L, Gililland J. Disassociation of a Cold-Welded Bimodular Titanium Femoral Stem by Intraoperative Ice Cooling. Arthroplast Today 2020; 6:457-462. [PMID: 32637516 PMCID: PMC7329910 DOI: 10.1016/j.artd.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 11/24/2022] Open
Abstract
Modularity in total hip arthroplasty allows a surgeon to have intraoperative versatility, allowing for fine adjustments of the femoral offset, leg length, and version. However, modularity can be a source of multiple complications. This case report describes a novel intraoperative solution for the problem of cold welding of a neck-stem junction using sterile ice to cryogenically disengage the modular components.
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Affiliation(s)
- Jeff Frandsen
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, UT, USA
| | - Ian Duensing
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, UT, USA
| | - Lucas Anderson
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, UT, USA
| | - Jeremy Gililland
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, UT, USA
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16
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Inoue D, Restrepo C, Nourie B, Restrepo S, Hozack WJ. Patients With Modular-Neck Total Hip Arthroplasty: A Brief Five-Year Follow-Up Study. J Arthroplasty 2020; 35:S268-S272. [PMID: 32199762 DOI: 10.1016/j.arth.2020.02.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We have previously reported the early clinical results of a modular-neck stem identifying an early 2-year revision rate of 13% due to neck-stem corrosion. This report updates our findings to a midterm mean follow-up of 5 years. METHODS This is a consecutive retrospective review of 186 modular-neck hips in 175 patients with a mean follow-up period was 60.1 ± 22.9 months (range 24-100). We reviewed clinical findings, routine radiographs, detailed imaging (metal artifact reduction software-magnetic resonance imaging, ultrasound), and serum ion levels of cobalt and chromium. We performed a survival analysis with the endpoint defined as revision total hip arthroplasty due to neck-stem corrosion. RESULTS We revised 41 hips (22.0%) for neck-stem corrosion. Clinical symptoms (groin pain ± local swelling) were consistently present in those that came for revision. Mean serum cobalt ion levels increased as time passed in all patients. Detailed image findings showed that larger fluid collections and local soft tissue masses were seen predominately in symptomatic patients. However, 14% of patients who underwent revision did not have positive magnetic resonance imaging or ultrasound findings. The survival rate was 87% (95% confidence interval 81-92) at 3 years postoperatively and 72% (95% confidence interval 64-80) at 7 years postoperatively. CONCLUSION The revision rate for this modular-neck stem due to neck-stem corrosion at mid-term follow-up almost doubled in comparison to previous short-term results. It seems reasonable to consider clinical follow-up alone as symptoms, rather than blood testing for ion levels, seem to be the defining characteristic of failure.
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Affiliation(s)
- Daisuke Inoue
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA; Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Camilo Restrepo
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Blake Nourie
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Santiago Restrepo
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| | - William J Hozack
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA
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17
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Jonker RC, van Beers LWAH, van der Wal BCH, Vogely HC, Parratte S, Castelein RM, Poolman RW. Can dual mobility cups prevent dislocation without increasing revision rates in primary total hip arthroplasty? A systematic review. Orthop Traumatol Surg Res 2020; 106:509-517. [PMID: 32278733 DOI: 10.1016/j.otsr.2019.12.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dislocation is one of the leading causes for early revision surgery after total hip arthroplasty (THA). To address this problem, the dual mobility (DM) cup was developed in the 1970s by the French. Despite the increased and, in some countries, broad use of DM cups, high quality evidence of their effectiveness compared to traditional unipolar (UP) cups is lacking. There are a few well-conducted literature reviews, but the level of evidence of the included studies was moderate to low and the rates of revision were not specifically investigated. Therefore, we did a systematic review to investigate whether there is a difference in the rate of dislocations and revisions after primary THA with a DM cup or a UP cup. METHODS We conducted a systematic literature search in PubMed, Embase and Cochrane databases in July 2019. The articles were selected based upon their quality, relevance and measurement of the predictive factor. We used the MINORS criteria to determine the methodological quality of all studies. RESULTS The initial search resulted in 702 citations. After application of the inclusion and exclusion criteria, eight articles met our eligibility criteria and were graded. Included studies were of medium to low methodological quality with a mean score of 14/24 (11-16) points following the MINORS criteria. In the case-control studies, a total of 549 DM cups and 649 UP cups were included. In the registry studies, a total of 5.935 DM cups and 217.362 UP cups were included. In the case-control studies, one (0.2%) dislocation was reported for the DM cups and 46 (7.1%) for the UP cup (p=0.009, IQR=0.00-7.00). Nine (1.6%) revisions, of which zero due to dislocation, were reported for the DM cup and 39 (6.0%), of which 30 due to dislocation, for the UP cup (p=0.046, CI=-16.93-5.73). In the registry studies 161 (2.7%) revisions were reported for the DM cup, of which 14 (8.7%) due to dislocation. For the UP cup, 3.332 (1.5%) revisions were reported (p=0.275, IQR=41.00-866.25), of which 1.093 (32.8%) due to dislocation (p=0.050, IQR=3.50-293.25). CONCLUSION This review suggests lower rates of dislocation and lower rates of revision for dislocation in favor of the DM cups. Concluding, DM cups might be an effective solution to reduce dislocation in primary THA. To evaluate the efficacy of DM cups compared to UP cups, an economic evaluation alongside a randomized controlled trial is needed focusing on patient important endpoints. LEVEL OF EVIDENCE III, systematic review of level III studies.
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Affiliation(s)
- Ragna C Jonker
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Loes W A H van Beers
- Department of Orthopaedic Surgery, OLVG, PO Box 95500, 1090 HM Amsterdam, The Netherlands
| | - Bart C H van der Wal
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - H Charles Vogely
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Sebastien Parratte
- Department of Orthopedic Surgery and Traumatology, St. Marguerite Hospital Marseille, 270 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, OLVG, PO Box 95500, 1090 HM Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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18
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Grupp TM, Baxmann M, Jansson V, Windhagen H, Heller KD, Morlock MM, Knaebel HP. How to proceed with asymptomatic modular dual taper hip stems in the case of acetabular revision. MATERIALS 2020; 13:ma13051098. [PMID: 32121627 PMCID: PMC7084958 DOI: 10.3390/ma13051098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
How to proceed with a clinically asymptomatic modular Metha® Ti alloy stem with dual taper CoCr neck adapter in case of acetabular revision? To systematically answer this question the status of research and appropriate diagnostic methods in context to clinically symptomatic and asymptomatic dual taper stem-neck couplings has been evaluated based on a systematic literature review. A retrieval analysis of thirteen Metha® modular dual taper CoCr/Ti alloy hip stems has been performed and a rational decision making model as basis for a clinical recommendation was developed. From our observations we propose that in cases of acetabular revision, that for patients with a serum cobalt level of > 4 µg/L and a Co/Cr ratio > 3.6, the revision of the modular dual taper stem may be considered. Prior to acetabular revision surgery a systematic diagnostic evaluation should be executed, using specific tests such as serum metal (Co, Cr) ion analysis, plain antero-posterior and lateral radiographs and cross-sectional imaging modalities (Metal Artefact Reduction Sequence Magnetic Resonance Imaging). For an asymptomatic Metha® dual taper Ti alloy/CoCr stem-neck coupling at the stage of acetabular revision careful clinical decision making according to the proposed model should be followed and overreliance on any single examination should be avoided, considering the complete individual differential diagnosis and patient situation.
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Affiliation(s)
- Thomas M. Grupp
- Aesculap AG Research & Development, 78532 Tuttlingen, Germany;
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern Ludwig Maximilians University Munich, 81377 Munich, Germany;
- Correspondence: ; Tel.: +49-7461-95-2667; Fax: +49-7461-95-382667
| | - Marc Baxmann
- Aesculap AG Research & Development, 78532 Tuttlingen, Germany;
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern Ludwig Maximilians University Munich, 81377 Munich, Germany;
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany;
| | - Karl-Dieter Heller
- Department of Orthopaedic Surgery, Herzogin-Elisabeth-Hospital, 38124 Braunschweig, Germany;
| | - Michael M. Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, 21073 Hamburg, Germany;
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Elsheikh MFH, Gul R. Femoral head disengagement from Accolade femoral stem in MOM Arthroplasty: a case study and literature review. SICOT J 2019; 5:30. [PMID: 31430251 PMCID: PMC6701877 DOI: 10.1051/sicotj/2019030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/19/2019] [Indexed: 11/14/2022] Open
Abstract
Background: Metal on Metal Hip arthroplasty was commonly used until the last decade. However Hip Arthroplasty registries of many countries showed increased revision rates of MOM Hips – these high rates of revision caused by trunnionosis, adverse tissue reactions (ALTRs) and Pseudotumor formation. The Case: Our Case is 73 years old gentleman who had left MOM THR in 2008, and was doing fine till the beginning of 2018 when his left leg stuck while getting out of the car. Despite he heard the pop and his leg was shortened and externally rotated, but he was still walking on it for a while. On reviewing him in our orthopedic clinic and after getting the CT-scan showed that he had dislocated femoral head from the stem.
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Affiliation(s)
- Mohamed F H Elsheikh
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork, Republic of Ireland
| | - Rehan Gul
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork, Republic of Ireland
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20
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Swiatkowska I, Martin N, Hart AJ. Blood titanium level as a biomarker of orthopaedic implant wear. J Trace Elem Med Biol 2019; 53:120-128. [PMID: 30910194 DOI: 10.1016/j.jtemb.2019.02.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/18/2019] [Accepted: 02/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Joint replacement implants are usually manufactured from cobalt-chromium or titanium alloys. After the device is implanted, wear and corrosion generate metal particles and ions, which are released into local tissue and blood. The metal debris can cause a range of adverse local and systemic effects in patients. RESEARCH PROBLEM In the case of cobalt and chromium, a blood level exceeding 7 μg L-1 indicates potential for local toxicity, and a failing implant. It has been repeatedly suggested in the literature that measurement of titanium could also be used to assess implant function. Despite an increasing interest in this biomarker, and growing use of titanium in orthopaedics, it is unclear what blood concentrations should raise concerns. This is partly due to the technical challenges involved in the measurement of titanium in biological samples. AIM This Review summarises blood/serum titanium levels associated with well-functioning and malfunctioning prostheses, so that the prospects of using titanium measurements to gain insights into implant performance can be evaluated. CONCLUSION Due to inter-laboratory analytical differences, reliable conclusions regarding "normal" and "abnormal" titanium levels in patients with orthopaedic implants are difficult to draw. Diagnosis of symptomatic patients should be based on radiographic evidence combined with blood/serum metal levels.
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Affiliation(s)
- Ilona Swiatkowska
- Institute of Orthopaedics and Musculoskeletal Science, University College London, HA7 4LP, Stanmore, UK.
| | - Nicholas Martin
- Trace Element Laboratory, Clinical Biochemistry, Charing Cross Hospital, W6 8RF, London, UK
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, HA7 4LP, Stanmore, UK; Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
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21
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Falkenberg A, Drummen P, Morlock MM, Huber G. Determination of local micromotion at the stem-neck taper junction of a bi-modular total hip prosthesis design. Med Eng Phys 2019; 65:31-38. [PMID: 30679024 DOI: 10.1016/j.medengphy.2019.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/26/2022]
Abstract
High rates of clinical complications with bi-modular hip prostheses are attributed to failure of the stem-neck taper junction. Taper wear analyses have shown extensive material loss as a result of corrosion, potentially initiated by micromotion. The purpose of the study was to determine the amount of micromotion at this junction for different loading, assembly and material conditions. Micromotion between the neck adapter (CoCr29Mo6-alloy) and the stem (TiMo12Zr6Fe2-alloy; both Rejuvenate, Stryker) within the taper junction of a bi-modular hip stem were determined by image matching analysis of consecutively recorded images through windows in the stem component. A finite element model was used to determine the micromotion in the taper regions outside the windows and validated with the measured micromotion. With the model, the influence of the load amplitude, assembly force and component materials were then investigated. Determined micromotion (14-79 µm) by far exceeded critical values (5 µm) associated with the onset of fretting corrosion. Increasing assembly forces achieved a significant reduction in micromotion. The numerical model revealed insufficient assembly to cause the neck to perform rocking motions under load, repetitively changing taper contact in combination with gap opening, which facilitates fluid ingress into the junction. Changing the stem material to a stiffer Ti-alloy achieved a reduction of the micromotion of about 30%. This study emphasises the high importance of material selection, assembly force and loading on the susceptibility of bi-modular hip stems to fretting and crevice corrosion. These findings can serve to explain the increased rate of clinically reported problems with this particular prosthesis design.
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Affiliation(s)
- Adrian Falkenberg
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Denickestrasse 15, Hamburg 21073, Germany.
| | - Paul Drummen
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Denickestrasse 15, Hamburg 21073, Germany
| | - Michael M Morlock
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Denickestrasse 15, Hamburg 21073, Germany
| | - Gerd Huber
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Denickestrasse 15, Hamburg 21073, Germany
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22
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Spiegelberg BG, Lanting BA, Howard JL, Teeter MG, Naudie DD. Surface integrity of polyethylene liners following trunnionosis of a dual modular neck total hip implant. Hip Int 2018; 28:629-635. [PMID: 29756511 DOI: 10.1177/1120700018754336] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND There has been a trend in the evolution of total hip arthroplasty towards increased modularity; with this increase in modularity come some potentially harmful consequences. Modularity at the neck shaft junction has been linked to corrosion, adverse reaction to metal debris and pseudotumour formation. AIM The aim of this retrieval study is to assess whether the surface integrity of the polyethylene (PE) liner is affected by metal wear debris in a single implant design series of THA revised for trunnionosis. METHODS A retrieval analysis of thirty dual-taper modular neck hip prostheses was performed; the mean time from implantation to revision was 2.7 years (1.02-6.2). PE liners were analysed using a scanning electron microscope with an energy dispersive spectrometer to assess for metal particles embedded on the liner surface. Serum metal ion levels and inflammatory markers were also analysed. RESULTS There were small numbers of metal particles present on the PE liners. The mean number of metal particles per liner was four and the particles varied in size from 0.5 µm to 122 µm mean 16 µm. All patients had elevated metal ion levels: cobalt 6.02 µg/l, chromium 1.22 µg/l, titanium 3.11 µg/l. The cobalt:chromium ratio was 7.55:1. Inflammatory markers were also marginally raised (ESR 17; CRP 10). CONCLUSION These results suggest that retention of PE liners may be reasonable when performing isolated revision of the femoral component in cases of failure at the modular neck stem junction, especially when the inner diameter of the liner is already optimised for head size and stability.
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Affiliation(s)
- Ben Gi Spiegelberg
- 1 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Brent A Lanting
- 1 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - James L Howard
- 1 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Matthew G Teeter
- 2 Medical Biophysics and Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Douglas Dr Naudie
- 1 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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23
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Di Laura A, Hothi HS, Henckel J, Kwon YM, Skinner JA, Hart AJ. Retrieval Findings of Recalled Dual-Taper Hips. J Bone Joint Surg Am 2018; 100:1661-1672. [PMID: 30277996 PMCID: PMC6211785 DOI: 10.2106/jbjs.17.00790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The recent high-profile recalls of several dual-taper hip designs pose questions regarding why those designs perform poorly. We aimed to characterize taper damage in 1 recalled design to understand failure mechanisms to inform surgeons on which patients should be considered at risk of revision and when to revise. METHODS High-precision measurement equipment was used to characterize the metal loss from the neck-stem interface of 116 retrieved Rejuvenate femoral stems (Stryker Howmedica Osteonics) revised because of an adverse reaction to metal debris. Head-neck taper surfaces were also investigated, and clinical and laboratory data were examined. RESULTS The neck-stem junction of each implant was moderately to severely corroded and showed a characteristic wear pattern on both male and female taper surfaces. The severity of taper damage was positively correlated with time to revision (coefficient, 0.040 [95% confidence interval (CI), 0.028 to 0.051]; p < 0.0001) and with serum cobalt concentration (coefficient, 0.02 [95% CI, 0.01 to 0.02]; p < 0.0001) and serum chromium concentration (coefficient, 0.04 [95% CI, 0.009 to 0.070]; p = 0.0142). CONCLUSIONS A forensic examination of the retrieved components that failed secondary to an adverse reaction to metal debris showed, in all cases, visible corrosion. Of the implant and patient factors investigated, we did not identify any predictors of corrosion. The severity of damage was found to increase with time; cobalt was significantly elevated over chromium. CLINICAL RELEVANCE Surgeons should scrupulously follow and consider revision for patients with this implant design to avoid extensive tissue excision. Blood metal ion tests may aid in identifying the mechanisms of taper corrosion.
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Affiliation(s)
- Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom,E-mail address for A. Di Laura:
| | - Harry S. Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Young-Min Kwon
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John A. Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Alister J. Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Kiran M, Makridis KG, Armstrong C, Kapoor B, Kumar G, Peter V. Withdrawn: A Randomized Controlled Trial Comparing Modular and Nonmodular Neck Versions of a Titanium Stem. J Arthroplasty 2018:S0883-5403(18)30820-9. [PMID: 30316623 DOI: 10.1016/j.arth.2018.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 02/01/2023] Open
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Manish Kiran
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Konstantinos G Makridis
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Catherine Armstrong
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Birender Kapoor
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Gunasekaran Kumar
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Viju Peter
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
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Hasegawa M, Wakabayashi H, Sudo A. A case of bone necrosis with pseudotumor following metal-on-metal total hip arthroplasty. Arthroplast Today 2018; 4:291-294. [PMID: 30186907 PMCID: PMC6123320 DOI: 10.1016/j.artd.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 11/30/2022] Open
Abstract
A case of bone necrosis with a pseudotumor following metal-on-metal total hip arthroplasty is presented. The patient showed no abnormal magnetic resonance findings 2 years postoperatively, but serum metal ion levels were elevated. The patient developed hip pain 3.5 years postoperatively, and bone necrosis with a pseudotumor was found. The present patient emphasized the fact that tissue necrosis associated with failed metal-on-metal bearing hip might not be limited to soft tissues, but bone necrosis could occur.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Frisch NB, Lynch JR, Pourzal R, Banglmaier RF, Silverton CD. Dual-taper modular hip implant: Investigation of 3-dimensional surface scans for component contact, shape, and fit. Arthroplast Today 2018; 4:370-375. [PMID: 30186924 PMCID: PMC6123237 DOI: 10.1016/j.artd.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/24/2018] [Accepted: 06/04/2018] [Indexed: 11/25/2022] Open
Abstract
Background The etiology of wear particle generation and subsequent corrosion in modular total hip arthroplasty implants likely begins with mechanical fretting. The purpose of this study was to determine geometric features of the male and female taper surfaces that drive stability within the neck-stem junction. Methods Eighteen modular hip components received 3-dimensional surface scans to examine the neck-stem taper junction using an optical scanner. The normal distance between the surfaces of the neck taper as seated in the stem slot was measured and produced a color map of the contact proximity. Contour plots identified surface shape variation and contact. Angle measurements and neck seated depth were analyzed by regression. Results The typical features observed were (1) a vertical line of contact at one end of the transition from the flat surface to the radius surface; (2) a vertical line of contact in the radius surface just past the centerline; (3) a concavity along the flat surface between the neck and stem components; and (4) one of the neck flat surfaces was closer to its mating surface on the stem. The seated depth of the neck was dependent on the taper angles in the flat section of the neck (R2 = 0.5000, P = .0332). Conclusions The shape of the neck and stem tapers deviate from ideal design dimensions, contributing to relative motions between the neck and stem. While these processes are not proven to directly cause implant failure, they may place the implants at higher risk for failure.
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Affiliation(s)
| | - Jonathan R Lynch
- Henry Ford Health System Department of Orthopaedic Surgery, Detroit, MI, USA
| | - Robin Pourzal
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, IL, USA
| | | | - Craig D Silverton
- Henry Ford Health System Department of Orthopaedic Surgery, Detroit, MI, USA
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Pelayo-de-Tomás JM, Rodrigo-Pérez JL, Novoa-Parra CD, Lizaur-Utrilla A, Morales-Suárez-Varela M, Blas-Dobón JA. Cementless modular neck stems: are they a safe option in primary total hip arthroplasty? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:463-469. [PMID: 29082427 DOI: 10.1007/s00590-017-2071-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/14/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE The objective was to assess aseptic complications and functional outcome using a primary total hip arthroplasty with modular neck. METHODS Prospective cohort of 317 consecutive patients. The mean age was 61.1 (range, 41-84) years. The H-Max-M model (Lima, Italy) system was used in all patients. The functional assessment was made by the Harris Hip Score, Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index and visual analogue scale for pain. Radiological outcomes were also assessed, and adverse events and complications were noted. RESULTS The mean follow-up was 6.1 (range, 2-8) years. Functional outcome significantly improved in most patients. There were 3 deep infections (0.9%) and 17 aseptic complications (5.3%) including 1 intraoperative acetabular fracture, 3 later periprosthetic femoral fractures, 1 broken ceramic insert, 1 acetabular loosening, 3 femoral loosening and 1 broken titanium modular neck in a obese patient. No pseudotumors or elevated serum levels of metal ions were found among the patients with radiolucent lines or aseptic loosening. CONCLUSIONS The findings in the present study showed that the H-MAX-M stem provided satisfactory functional outcome in most patients with a low rate of complications attributable to the modular neck design. We consider that using this novel modular neck-stem coupling design can be an alternative to the conventional monoblock stems in patients without overweight.
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Affiliation(s)
- José M Pelayo-de-Tomás
- Department of Orthopaedic Surgery, Doctor Peset University Hospital, Av Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - José L Rodrigo-Pérez
- Department of Orthopaedic Surgery, Doctor Peset University Hospital, Av Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - Carlos D Novoa-Parra
- Department of Orthopaedic Surgery, Doctor Peset University Hospital, Av Gaspar Aguilar, 90, 46017, Valencia, Spain.
| | | | - María Morales-Suárez-Varela
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - José Antonio Blas-Dobón
- Department of Orthopaedic Surgery, Doctor Peset University Hospital, Av Gaspar Aguilar, 90, 46017, Valencia, Spain
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28
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Collet T, Atanasiu JP, de Cussac JB, Oufroukhi K, Bothorel H, Saffarini M, Badatcheff F. Midterm outcomes of titanium modular femoral necks in total hip arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:395. [PMID: 29152495 DOI: 10.21037/atm.2017.07.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Modular femoral necks present surgical and biomechanical advantages in total hip arthroplasty (THA), but their benefits remain controversial due to risks of corrosion and fracture at the additional junction. This study aimed to report 10-year survival and clinical outcomes of a titanium femoral stem with a titanium modular neck in consecutive series. Methods The authors reviewed the records of 97 patients (99 THAs) using uncemented modular stem and ceramic-on-ceramic acetabular components. Patients were evaluated at minimum follow-up of 5 years using the Harris Hip Score (HHS) and Postel Merle-D'Aubigné score (PMA). Survival was calculated using the Kaplan-Meier (KM) method with any reoperation or revision as endpoint. Results From the original cohort, 14 patients died, 6 were lost to follow-up, and 5 had revision operations with exchange of the femoral stem. The KM survival at 10 years was 94.2% (CI, 86.5-97.5). Clinical assessment was performed on 67 of the 72 patients (69 of the 74 hips) presently living with their original THA components. At mean follow-up of 9.4±1.0 years (median, 10; range, 5-11), the HHS was 93.6±8.2 and the PMA score 17.0±1.6. The X-rays revealed no signs of adverse reactions or bone loss. Conclusions The uncemented titanium hip stem with modular titanium neck provided a satisfactory 10-year survival and clinical outcomes. Neck modularity enabled restoration of patient-specific femoral offset and limb length thanks to five possible neck configurations, though greater follow up is required to confirm the long-term benefits and safety of this design concept.
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Affiliation(s)
- Thurial Collet
- Polyclinique de l'Europe, Unité de chirurgie orthopédique réparatrice et sportive, St Nazaire, France
| | - Jean-Pierre Atanasiu
- Chirurgie Orthopédique et Traumatologique, Polyclinique de Poitiers, Poitiers Cedex, France
| | - Jean-Baptiste de Cussac
- Polyclinique de l'Europe, Unité de chirurgie orthopédique réparatrice et sportive, St Nazaire, France
| | - Kamal Oufroukhi
- Clinique Chirurgicale de la Loire, Rue des Rolletières, Saumur, France
| | | | - Mo Saffarini
- Medical Technology, ReSurg SA, Nyon, Switzerland
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Di Laura A, Quinn PD, Panagiotopoulou VC, Hothi HS, Henckel J, Powell JJ, Berisha F, Amary F, Mosselmans JFW, Skinner JA, Hart AJ. The Chemical Form of Metal Species Released from Corroded Taper Junctions of Hip Implants: Synchrotron Analysis of Patient Tissue. Sci Rep 2017; 7:10952. [PMID: 28887488 PMCID: PMC5591307 DOI: 10.1038/s41598-017-11225-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/21/2017] [Indexed: 02/08/2023] Open
Abstract
The mechanisms of metal release from the articulation at the head cup bearing and the tapered junctions of orthopaedic hip implants are known to differ and the debris generated varies in size, shape and volume. Significantly less metal is lost from the taper junction between Cobalt-Chromium-Molybdenum (CoCrMo) and Titanium (Ti) components (fretting-corrosion dominant mechanism), when compared to the CoCrMo bearing surfaces (wear-corrosion dominant mechanism). Corrosion particles from the taper junction can lead to Adverse Reactions to Metal Debris (ARMD) similar to those seen with CoCrMo bearings. We used synchrotron methods to understand the modes underlying clinically significant tissue reactions to Co, Cr and Ti by analysing viable peri-prosthetic tissue. Cr was present as Cr2O3 in the corroded group in addition to CrPO4 found in the metal-on-metal (MoM) group. Interestingly, Ti was present as TiO2 in an amorphous rather than rutile or anatase physical form. The metal species were co-localized in the same micron-scale particles as result of corrosion processes and in one cell type, the phagocytes. This work gives new insights into the degradation products from metal devices as well as guidance for toxicological studies in humans.
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Affiliation(s)
- Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
| | - Paul D Quinn
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, United Kingdom
| | - Vasiliki C Panagiotopoulou
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Jonathan J Powell
- Biomineral Research Group, Dept Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Fitim Berisha
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Fernanda Amary
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - J Fred W Mosselmans
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, United Kingdom
| | - John A Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Colas S, Allalou A, Poichotte A, Piriou P, Dray-Spira R, Zureik M. Exchangeable Femoral Neck (Dual-Modular) THA Prostheses Have Poorer Survivorship Than Other Designs: A Nationwide Cohort of 324,108 Patients. Clin Orthop Relat Res 2017; 475:2046-2059. [PMID: 28194710 PMCID: PMC5498370 DOI: 10.1007/s11999-017-5260-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/19/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Exchangeable neck stems, defined as those with a dual taper (that is, a modular junction between the femoral head and the femoral neck and an additional junction between the neck and the stem body), were introduced in THA to improve restoration of joint biomechanics (restoring anteversion, offset, and limb length) and reduce the risk of dislocation. However exchangeable necks have been reported to result in adverse effects such as stem fractures and acute local tissue reaction. Whether they result in a net improvement to or impairment of reconstructive survivorship remains controversial. QUESTIONS/PURPOSES (1) To compare the prosthetic survivorship and all-cause revision risk of exchangeable femoral neck THAs versus fixed neck THAs, taking known prosthetic revision risk factors into account; and (2) to compare the cause-specific revision risk of exchangeable femoral neck THAs versus fixed neck THAs, adjusting for known prosthetic risk factors. METHODS Using French national health-insurance databases, we identified all French patients older than 40 years who underwent primary THA from 2009 through 2012. To ensure accuracy of the data, we considered only beneficiaries of the general insurance scheme (approximately 77% of the population). Characteristics of the prosthesis and the patients receiving an exchangeable femoral neck THA were compared with those receiving a fixed femoral neck THA (defined as femoral stem with only the head being exchangeable). Revision was the event of interest. Followup started on the date the THA was performed, until the patient experienced revision, died, was lost to followup, or until the followup period ended (December 31, 2014), whichever came first. Competing risk THA survivorship was calculated and compared (purpose 1), as were cause-specific Cox regression models (purpose 2). The study cohort included 324,108 individuals with a mean age of 77 years. A total of 24% underwent THA for acute trauma, and 3% of the group received an exchangeable neck THA. During the median 45-month followup (mean, 42 months; minimum, 1 day; maximum, 6 years), 11,968 individuals underwent prosthetic revision. RESULTS The cumulative revision incidence was 6.5% (95% CI, 5.8%-7.3%) for exchangeable neck THAs versus 4.7% (95% CI, 4.6%-4.8%) for fixed neck THAs (p < 0.001). After controlling for potential confounding variables including age, sex, comorbidities, indication for THA, cementation, bearing surface, and the characteristics of the center where the implantation was performed, we found that the exchangeable femoral neck THA was associated with an increased hazard ratio (HR) of revision of 1.26 (95% CI, 1.14-1.38; p < 0.001) compared with the fixed neck THA. When dealing with cause-specific revision, exchangeable neck THAs had a higher incidence of revision for implant failure or periprosthetic fracture, and for mechanical complications; adjusted HRs were, respectively, 1.68 (95% CI, 1.24-2.27; p < 0.001) and 1.27 (95% CI, 1.13-1.43; p < 0.001), for exchangeable neck THAs compared with fixed ones. CONCLUSIONS Exchangeable neck THAs had poorer survivorship independent of other prosthetic revision risk factors. Accordingly, expected anatomic and functional benefits should be carefully assessed before choosing this design. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Sandrine Colas
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Assia Allalou
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | | | | | - Rosemary Dray-Spira
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Mahmoud Zureik
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
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Gofton WT, Illical EM, Feibel RJ, Kim PR, Beaulé PE. A Single-Center Experience With a Titanium Modular Neck Total Hip Arthroplasty. J Arthroplasty 2017; 32:2450-2456. [PMID: 28479057 DOI: 10.1016/j.arth.2017.03.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 03/07/2017] [Accepted: 03/10/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Added modular junction has been associated with implant-related failures. We report our experience with a titanium-titanium modular neck-stem interface to assess complications, possible clinical factors influencing use of neck modularity, and whether modularity reduced the incidence of dislocation. METHODS A total of 809 total hip arthroplasties completed between 2005 and 2012 from a prospectively collected database were reviewed. The mean follow-up interval was 5.7 years (3.3-10.3 years). Forty-five percent were male (360 of 809), and 55% were female (449 of 809). All stems were uncemented PROFEMUR TL (titanium, flat-tapered, wedge) or PROFEMUR Z (titanium, rectangular, dual-tapered) with a titanium neck. RESULTS Increased modularity (anteverted/retroverted and anteverted/retroverted varus/valgus (anteverted/retroverted + anteverted/retroverted varus/valgus) was used in 39.4% (135 of 343) of cases using the posterior approach compared with 6.8% (20 of 293) of anterior and 23.7% (41 of 173) of lateral approaches. Four males sustained neck fractures at a mean of 95.5 months (69.3-115.6 months) after primary surgery. Overall dislocation rate was 1.1% (9 of 809). The posterior approach had both the highest utilization of increased modularity and the highest dislocation rate (2.3%), of which the most were recurrent. The anterior (0.3%) and lateral (0%) approaches had lower dislocation rates with no recurrences. CONCLUSION At a mean 5.7 years, our experience demonstrates a low neck fracture (0.5%) and a low dislocation rate (1.1%). Use of increased modularity may not improve dislocation risk for the posterior approach. Continued surveillance of this group will be necessary to determine long term survivorship of this modular titanium implant.
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Affiliation(s)
- Wade T Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada
| | - Emmanuel M Illical
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, New York
| | - Robert J Feibel
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada
| | - Paul R Kim
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada
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Cooper HJ. CORR Insights ®: Exchangeable Femoral Neck (Dual-Modular) THA Prostheses Have Poorer Survivorship than Other Designs: A Nationwide Cohort of 324,108 Patients. Clin Orthop Relat Res 2017; 475:2060-2062. [PMID: 28236083 PMCID: PMC5498374 DOI: 10.1007/s11999-017-5291-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 01/31/2023]
Affiliation(s)
- H. John Cooper
- 0000 0001 2285 2675grid.239585.0Department of Orthopedic Surgery, Division of Hip & Knee Reconstruction, Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032 USA
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Matharu GS, Judge A, Murray DW, Pandit HG. Outcomes following revision surgery performed for adverse reactions to metal debris in non-metal-on-metal hip arthroplasty patients: Analysis of 185 revisions from the National Joint Registry for England and Wales. Bone Joint Res 2017; 6:405-413. [PMID: 28710154 PMCID: PMC5539305 DOI: 10.1302/2046-3758.67.bjr-2017-0017.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/11/2016] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Few studies have assessed outcomes following non-metal-on-metal hip arthroplasty (non-MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD). We assessed outcomes following non-MoMHA revision surgery performed for ARMD, and identified predictors of re-revision. METHODS We performed a retrospective observational study using data from the National Joint Registry for England and Wales. All non-MoMHAs undergoing revision surgery for ARMD between 2008 and 2014 were included (185 hips in 185 patients). Outcome measures following ARMD revision were intra-operative complications, mortality and re-revision surgery. Predictors of re-revision were identified using Cox regression. RESULTS Intra-operative complications occurred in 6.0% (n = 11) of the 185 cases. The cumulative four-year patient survival rate was 98.2% (95% CI 92.9 to 99.5). Re-revision surgery was performed in 13.5% (n = 25) of hips at a mean time of 1.2 years (0.1 to 3.1 years) following ARMD revision. Infection (32%; n = 8), dislocation/subluxation (24%; n = 6), and aseptic loosening (24%; n = 6) were the most common re-revision indications. The cumulative four-year implant survival rate was 83.8% (95% CI 76.7 to 88.9). Multivariable analysis identified three predictors of re-revision: multiple revision indications (hazard ratio (HR) = 2.78; 95% CI 1.03 to 7.49; p = 0.043); selective component revisions (HR = 5.76; 95% CI 1.28 to 25.9; p = 0.022); and ceramic-on-polyethylene revision bearings (HR = 3.08; 95% CI 1.01 to 9.36; p = 0.047). CONCLUSIONS Non-MoMHAs revised for ARMD have a high short-term risk of re-revision, with important predictors of future re-revision including selective component revision, multiple revision indications, and ceramic-on-polyethylene revision bearings. Our findings may help counsel patients about the risks of ARMD revision, and guide reconstructive decisions. Future studies attempting to validate the predictors identified should also assess the effects of implant design (metallurgy and modularity), given that this was an important study limitation potentially influencing the reported prognostic factors.Cite this article: G. S. Matharu, A. Judge, D. W. Murray, H. G. Pandit. Outcomes following revision surgery performed for adverse reactions to metal debris in non-metal-on-metal hip arthroplasty patients: Analysis of 185 revisions from the National Joint Registry for England and Wales. Bone Joint Res 2017;6:405-413. DOI: 10.1302/2046-3758.67.BJR-2017-0017.R2.
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Affiliation(s)
- G S Matharu
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
| | - A Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, and MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
| | - H G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine; University of Leeds and Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Rd, Leeds LS7 4SA, and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
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Su SL, Koch CN, Nguyen TM, Burket JC, Wright TM, Westrich GH. Retrieval Analysis of Neck-Stem Coupling in Modular Hip Prostheses. J Arthroplasty 2017; 32:2301-2306. [PMID: 28262451 DOI: 10.1016/j.arth.2017.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Dual-taper modular stems have suffered from high revision rates caused by adverse local tissue reactions secondary to fretting and corrosion. We compared the fretting and corrosion behavior of a group of modular neck designs to that of a design that had been recalled for risks associated with fretting and corrosion at the modular neck junction. METHODS We previously analyzed fretting and corrosion on 60 retrieved Rejuvenate modular neck-stem implants. Here we compare those results to results from 26 retrieved implants from 7 other modular neck designs. For the 26 additional cases, histology slides of tissue collected at revision were reviewed and graded for aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). Multivariate analyses were performed to assess differences in fretting and corrosion, adjusting for confounding factors (eg, length of implantation). RESULTS The Rejuvenate design had higher damage and corrosion scores than the other 7 designs (P < .01). Histologic samples from the recalled design were 20 times more likely to show ALVAL than samples from the other designs (P < .01). Mixed metal couples had higher fretting (P < .01) and corrosion (P = .02) scores than non-mixed metal couples. CONCLUSION Fretting and corrosion occurred on all modular neck-stem retrievals regardless of design. However, mixed metal couples suffered more corrosion than homogenous couples. This may be due to the lower modulus of the titanium alloy used for the stem, allowing for increased metal transfer and surface damage when loaded against a cobalt alloy modular neck, which in turn could account for the higher ALVAL and corrosion scores. Due to increased corrosion risk with mixed metals and increased neck fracture risk with non-mixed metal stem and necks, we suggest that clinicians avoid implantation of modular neck-stem systems.
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Affiliation(s)
- Sherwin L Su
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Chelsea N Koch
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Thu M Nguyen
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Jayme C Burket
- Healthcare Research Institute, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
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Buente D, Bryant M, Ward M, Neville A, Morlock M, Huber G. The taper corrosion pattern observed for one bi-modular stem design is related to geometry-determined taper mechanics. Med Eng Phys 2017. [PMID: 28647286 DOI: 10.1016/j.medengphy.2017.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bi-modular primary hip stems exhibit high revision rates owing to corrosion at the stem-neck taper, and are associated with local adverse tissue reactions. The aim of this study was to relate the wear patterns observed for one bi-modular design to its design-specific stem-neck taper geometry. Wear patterns and initial geometry of the taper junctions were determined for 27 retrieved bi-modular primary hip arthroplasty stems (Rejuvenate, Stryker Orthopaedics) using a tactile coordinate-measuring device. Regions of high-gradient wear patterns were additionally analyzed via optical and electron microscopy. The determined geometry of the taper junction revealed design-related engagement at its opening (angle mismatch), concentrated at the medial and lateral apexes (axes mismatch). A patch of retained topography on the proximal medial neck-piece taper apex was observed, surrounded by regions of high wear. On the patch, a deposit from the opposing female stem taper-containing Ti, Mo, Zr, and O-was observed. High stress concentrations were focused at the taper apexes owing to the specific geometry. A medial canting of the components may have augmented the inhomogeneous stress distributions in vivo. In the regions with high normal loads interfacial slip and consequently fretting was inhibited, which explains the observed pattern of wear.
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Affiliation(s)
- Dennis Buente
- TUHH Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany.
| | - Michael Bryant
- University of Leeds, Faculty of Engineering Institute of Materials and Research/Functional Surfaces, Leeds LS2 9JT, UK.
| | - Michael Ward
- University of Leeds, Faculty of Engineering Institute of Materials and Research/Functional Surfaces, Leeds LS2 9JT, UK.
| | - Anne Neville
- University of Leeds, Faculty of Engineering Institute of Materials and Research/Functional Surfaces, Leeds LS2 9JT, UK.
| | - Michael Morlock
- TUHH Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany.
| | - Gerd Huber
- TUHH Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany.
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Surface and subsurface changes as a result of tribocorrosion at the stem-neck interface of bi-modular prosthesis. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.biotri.2017.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Barlow BT, Ortiz PA, Boles JW, Lee YY, Padgett DE, Westrich GH. What Are Normal Metal Ion Levels After Total Hip Arthroplasty? A Serologic Analysis of Four Bearing Surfaces. J Arthroplasty 2017; 32:1535-1542. [PMID: 28190644 DOI: 10.1016/j.arth.2016.11.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/27/2016] [Accepted: 11/14/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The recent experiences with adverse local tissue reactions have highlighted the need to establish what are normal serum levels of cobalt (Co), chromium (Cr), and titanium (Ti) after hip arthroplasty. METHODS Serum Co, Cr, and Ti levels were measured in 80 nonconsecutive patients with well-functioning unilateral total hip arthroplasty and compared among 4 bearing surfaces: ceramic-on-ceramic (CoC); ceramic-on-polyethylene (CoP); metal-on-polyethylene (MoP), and dual mobility (DM). The preoperative and most recent University of California, Los Angeles (UCLA) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were compared among the different bearing surfaces. RESULTS No significant difference was found among serum Co and Cr levels between the 4 bearing surface groups (P = .0609 and P = .1577). Secondary analysis comparing metal and ceramic femoral heads demonstrated that the metal group (MoP, modular dual mobility (Stryker Orthopedics, Mahwah, NJ) [metal]) had significant higher serum Co levels compared with the ceramic group (CoC, CoP, MDM [ceramic]) (1.05 mg/L ± 1.25 vs 0.59 mg/L ± 0.24; P = .0411). Spearman coefficient identified no correlation between metal ion levels and patient-reported outcome scores. CONCLUSION No serum metal ion level differences were found among well-functioning total hip arthroplasty with modern bearing couples. Significantly higher serum Co levels were seen when comparing metal vs ceramic femoral heads in this study and warrants further investigation. Metal ion levels did not correlate with patient-reported outcome measures.
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Affiliation(s)
- Brian T Barlow
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Philippe A Ortiz
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - John W Boles
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Yuo-Yu Lee
- Epidemiology and Biostatistics Core, Hospital for Special Surgery, New York, New York
| | - Douglas E Padgett
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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Canham CD, Muradov PI, Simpson JB, Incavo SJ. Corrosion and adverse local tissue reaction after total hip arthroplasty with a modular titanium alloy femoral neck. Arthroplast Today 2017; 3:211-214. [PMID: 29204482 PMCID: PMC5712034 DOI: 10.1016/j.artd.2017.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 02/08/2023] Open
Abstract
This report describes a case of mechanically assisted crevice corrosion and secondary adverse local tissue reaction in a patient following a total hip arthroplasty, utilizing a modular neck (bi-modular) femoral component. Radiographic evaluation demonstrated a well-positioned, stable, cementless arthroplasty. Upon further evaluation, the patient had elevated serum cobalt and chromium levels, and magnetic resonance imaging demonstrated a periprosthetic pseudotumor. Corrosion of both the neck-stem and head-neck junctions was suspected. At the time of surgery, the neck-body junction was pristine; however, the head-neck junction of the implant demonstrated severe corrosive wear, a problem that has been reported only once previously with this particular bi-modular implant. This serves as a reminder that any modular junction may be susceptible to corrosion and not all bi-modular designs behave similarly.
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Affiliation(s)
| | | | | | - Stephen J. Incavo
- Corresponding author: 6445 Main St., Suite 2500, Houston, TX 77030, USA. Tel.: +1 713 441 3569.6445 Main St.Suite 2500HoustonTX77030USA
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Sensitivity and Specificity of Metal Ion Levels in Predicting "Pseudotumors" due to Taper Corrosion in Patients With Dual Taper Modular Total Hip Arthroplasty. J Arthroplasty 2017; 32:996-1000. [PMID: 27776907 DOI: 10.1016/j.arth.2016.08.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Currently, no serum metal ion threshold exists to identify adverse tissue reactions in total hip arthroplasty (THA) patients with taper corrosion. Our study aims to investigate the sensitivity and specificity of serum metal ions in detecting taper corrosion related pseudotumors in patients with dual taper modular THA. METHODS A total of 148 patients with dual taper modular THA were investigated: (1) 90 patients with pseudotumors detected with metal artifact reduction sequence-magnetic resonance imaging (MARS-MRI) and (2) 58 patients without pseudotumors on MARS-MRI. Receiver operating characteristic curves were constructed to determine the sensitivity and specificity using different metal ion thresholds. The severity of intraoperative tissue damage was correlated with preoperative metal ion levels. RESULTS Pseudotumor was associated with higher cobalt (5.0 μg/L vs 3.7 μg/L, P < .01) and Co/Cr ratio (6.0 vs 3.7, P < .01). The sensitivity and specificity for cobalt level of 2.8 μg/L and Co/Cr ratio of 3.8 in detecting taper corrosion-related pseudotumors on MARS-MRI was 88% and 32% and 70% and 50%, respectively. Higher intraoperative tissue damage grades demonstrated significantly higher Co/Cr ratios (8.6 vs 3.4, P = .03). CONCLUSION Although metal ion levels alone should not be relied on as the sole parameter to determine revision surgery, cobalt level >2.8 μg/L and the Co/Cr ratio >3.8 are useful clinical diagnostic adjuncts in the systematic clinical evaluation for taper corrosion-related adverse tissue reactions in patients with dual modular taper THA.
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Metal ion levels in ceramic-on-ceramic THR with cobalt-chrome modular necks: analysis of cobalt and chromium serum levels in 23 healthy hip patients. Hip Int 2017; 27:21-25. [PMID: 27791242 DOI: 10.5301/hipint.5000430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Modular necks in total hip replacement (THR) can be a source of metal ion release. METHODS We measured the level of cobalt (Co) and chromium (Cr) ions in the serum of 23 healthy volunteers with a well-functioning ceramic-on-ceramic THR of a particular design, containing a cobalt-chrome (Co-Cr) stem and a Co-Cr modular neck. RESULTS Average Co in serum was 1,71 µg/l; median Co was 1.50 µg/l. No patient had Co levels higher than 3.70 µg/l. Average Cr level was 0.49 µg/l; in all but one patient Cr was below the detection limit (<0.50 µg/l). Co was higher for varus necks compared to all other subtypes: 2.14 µg/l vs 1.58 µg/l (p<0.05). The same system with Titanium modular necks shows lower Co serum levels: 1.26 µg/l (p<0.01 ). In conclusion, the hybrid THR Profemur Xm® - Procotyle L® with a Co-Cr modular neck on a Co-Cr stem design shows very low Cr ion serum levels in a randomly selected group of well-functioning hip patients. CONCLUSIONS Co ion serum levels are low, but significantly higher for 8° varus necks, and Co levels are significantly higher than values of this system with a Titanium modular neck.
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Modular neck total hip arthroplasty - a perfect storm. Hip Int 2017; 26:128-31. [PMID: 26868119 DOI: 10.5301/hipint.5000327] [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] [Accepted: 10/20/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE This study was aimed to highlight neck notching as a potential cause of failure in modular neck total hip arthroplasty. It aimed to identify both the combination of modular components that place patients at greatest risk of failure and the potential mechanism for failure. METHODS This study involved a retrospective review of 301 total hip arthroplasties (THA) using Kinectiv modular neck Technology (Zimmer, Warsaw, Indiana). The primary outcome was the presence of neck notching requiring revision. Patient records, operative notes and postoperative radiographs were reviewed. A statistical analysis was performed. RESULTS A total of 301 THA were performed on 290 patients. There were 7 failures (2.3%). All 7 failures involved a modular combination of an anteverted neck, extended offset and length code -8 (failure rate of 36.8%, p<0.001). CONCLUSIONS We identified femoral neck notching as a potential cause of failure in modular neck THA. The combination of an anteverted neck, extended offset and length code -8 was associated with a high rate of neck notching using the Kinectiv modular neck Technology (Zimmer, Warsaw, Indiana). Based on our experience with this prosthesis we advise caution when using this particular combination of implants.
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Matharu GS, Pandit HG, Murray DW, Judge A. Adverse reactions to metal debris occur with all types of hip replacement not just metal-on-metal hips: a retrospective observational study of 3340 revisions for adverse reactions to metal debris from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. BMC Musculoskelet Disord 2016; 17:495. [PMID: 27955657 PMCID: PMC5153685 DOI: 10.1186/s12891-016-1329-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/03/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adverse reactions to metal debris (ARMD) have resulted in the high short-term failure rates observed with metal-on-metal hip replacements. ARMD has recently been reported in non-metal-on-metal total hip replacements (non-MoM THRs) in a number of small cohort studies. However the true magnitude of this complication in non-MoM THRs remains unknown. We used a nationwide database to determine the risk of ARMD revision in all non-MoM THRs, and compared patient and surgical factors associated with ARMD revision between non-MoM and MoM hips. METHODS We performed a retrospective observational study using data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. All primary hip replacements undergoing revision surgery for ARMD were included (n = 3,340). ARMD revision risk in non-MoM THRs was compared between different commonly implanted bearing surfaces and femoral head sizes (Chi-squared test). Differences in patient and surgical factors between non-MoM hips and MoM hips revised for ARMD were also analysed (Chi-squared test and unpaired t-test). RESULTS Of all ARMD revisions, 7.5% (n = 249) had non-MoM bearing surfaces. The relative risk of ARMD revision was 2.35 times (95% CI 1.76-3.11) higher in ceramic-on-ceramic bearings compared with hard-on-soft bearings (0.055 vs. 0.024%; p < 0.001), and 2.80 times (95% CI 1.74-4.36) higher in 36 mm metal-on-polyethylene bearings compared to 28 mm and 32 mm metal-on-polyethylene bearings (0.058 vs. 0.021%; p < 0.001). ARMD revisions were performed earlier in non-MoM hips compared to MoM hips (mean 3.6-years vs. 5.6-years; p < 0.0001). Non-MoM hips had more abnormal findings at revision (63.1 vs. 35.7%; p < 0.001), and more intra-operative adverse events (6.4 vs. 1.6%; p < 0.001) compared to MoM hips. CONCLUSIONS Although the overall risk of ARMD revision surgery in non-MoM THRs appears low, this risk is increasing, and is significantly higher in ceramic-on-ceramic THRs and 36 mm metal-on-polyethylene THRs. ARMD may therefore represent a significant clinical problem in non-MoM THRs.
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Affiliation(s)
- Gulraj S. Matharu
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7LD UK
| | - Hemant G. Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7LD UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
| | - David W. Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7LD UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7LD UK
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK
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Kwon YM, Antoci V, Eisemon E, Tsai TY, Yan Y, Liow MHL. "Top-Out" Removal of Well-Fixed Dual-Taper Femoral Stems: Surgical Technique and Radiographic Risk Factors. J Arthroplasty 2016; 31:2843-2849. [PMID: 27444847 DOI: 10.1016/j.arth.2016.05.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/29/2016] [Accepted: 05/23/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Contemporary "dual-taper" modular femoral neck-stem designs have been associated with taper corrosion-related adverse local tissue reaction (ALTR) requiring revision surgery and stem removal. Extended trochanteric osteotomy is recognized as the workhorse procedure for revision hip surgery. The aim of our study is to describe our "top-out" stem removal surgical technique and identify preoperative radiographic risk factors associated with periprosthetic fractures when using this technique. METHODS This is a single-center, single-surgeon, retrospective case series. Operative and clinic records were reviewed for patients with dual-taper modular femoral neck-stem junction who underwent revision surgery for taper tribocorrosion-related ALTR. RESULTS Eighty-three patients (36 men and 47 women; mean age, 61.8 ± 10.3; body mass index, 30.2 ± 8.6) were revised using the top-out technique. Significant improvements in postoperative Harris hip score (P = .004), EuroQol 5-dimension questionnaire (EQ-5D; P < .001), and EQ-5D US-adjusted scores (P < .001) were observed at 19-months follow-up. Our study reports periprosthetic fracture incidence of 14% and reoperation rate of 7%. Periprosthetic fractures were positively correlated with radiographic parameters such as overhang distance (R = 0.376; P = .002) and overhang ratio (R = 0.312; P = .01) and negatively correlated with radiographic implant medial calcar prominence (R = -0.299; P = .01). CONCLUSION Removal of well-fixed femoral components can be challenging, and the burden of revision surgery for taper tribocorrosion-related ALTR of these femoral stems is likely to rise. A top-out technique with systematic preoperative planning with radiographs provides a viable, alternative surgical option to remove well-fixed femoral component while preserving the femoral bony envelope.
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Affiliation(s)
- Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Valentin Antoci
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric Eisemon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yu Yan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Jauch-Matt SY, Miles AW, Gill HS. Effect of trunnion roughness and length on the modular taper junction strength under typical intraoperative assembly forces. Med Eng Phys 2016; 39:94-101. [PMID: 27913177 DOI: 10.1016/j.medengphy.2016.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 10/15/2016] [Accepted: 11/13/2016] [Indexed: 01/24/2023]
Abstract
Modular hip implants are at risk of fretting-induced postoperative complications most likely initiated by micromotion between adjacent implant components. A stable fixation between ball head and stem-neck taper is critical to avoid excessive interface motions. Therefore, the aim of this study was to identify the effect of trunnion roughness and length on the modular taper strength under typical intraoperative assembly forces. Custom-made Titanium trunnions (standard/mini taper, smooth/grooved surface finish) were assembled with modular Cobalt-chromium heads by impaction with peak forces ranging from 2kN to 6kN. After each assembly process these were disassembled with a materials testing machine to detect the pull-off force as a measure for the taper strength. As expected, the pull-off forces increased with rising peak assembly force (p < 0.001). For low and moderate assembly forces, smooth standard tapers offered higher pull-off forces compared to grooved tapers (p < 0.038). In the case of an assembly force of 2kN, mini tapers showed a higher taper strength than standard ones (p=0.037). The results of this study showed that smooth tapers provided a higher strength for taper junctions. This higher taper strength may reduce the risk of fretting-related complications especially in the most common range of intraoperative assembly forces.
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Affiliation(s)
- S Y Jauch-Matt
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, United Kingdom.
| | - A W Miles
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, United Kingdom.
| | - H S Gill
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, United Kingdom.
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Elmallah RK, Cherian JJ, Meneghini RM, Hozack WJ, Westrich GH, Mont MA. How to Approach a Recalled Dual Modular Hip Implant: An Update. J Arthroplasty 2016; 31:2646-2652. [PMID: 27542855 DOI: 10.1016/j.arth.2016.06.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/08/2016] [Accepted: 06/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study was to provide an update on the "Modular taper junction corrosion and failure: how to approach a recalled total hip arthroplasty implant" (Pivec et al JOA 2014) publication. METHODS We performed a comprehensive review of the literature in English, with search terms referencing to the diagnosis, management, and outcomes of patients who underwent total hip arthroplasty with a recalled dual modular hip implant. RESULTS Based on this review and the new guidelines by the American Academy of Orthopedic Surgeons and the Hip Society, we propose an updated algorithm for the diagnosis and management of patients with these recalled implants. CONCLUSION When encountering patients with these prostheses, it is imperative to take a step-by-step approach to evaluate whether patients are having potential complications. We hope that this has further clarified the appropriate steps that need to be carried out when confronted with these recalled devices.
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Affiliation(s)
- Randa K Elmallah
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeffrey J Cherian
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Robert M Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - William J Hozack
- Department of Orthopedic surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Geoffrey H Westrich
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Michael A Mont
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Incavo SJ. Goals and Challenges of Identifying Asymptomatic Pseudotumors in Patients Treated with Total Hip Arthroplasty: Commentary on an article by Young-Min Kwon, MD, PhD, et al.: "Asymptomatic Pseudotumors in Patients with Taper Corrosion of a Dual-Taper Modular Femoral Stem: MARS-MRI and Metal Ion Study". J Bone Joint Surg Am 2016; 98:e93. [PMID: 27869634 DOI: 10.2106/jbjs.16.00688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Kwon YM, Khormaee S, Liow MHL, Tsai TY, Freiberg AA, Rubash HE. Asymptomatic Pseudotumors in Patients with Taper Corrosion of a Dual-Taper Modular Femoral Stem: MARS-MRI and Metal Ion Study. J Bone Joint Surg Am 2016; 98:1735-1740. [PMID: 27869625 DOI: 10.2106/jbjs.15.01325] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Modularity in total hip arthroplasty facilitates intraoperative restoration of patient anatomy. Although dual-taper modular total hip arthroplasty offers potential advantages for optimizing the hip center of rotation, it has been associated with modular taper corrosion. This corrosion has led to adverse local tissue reactions (pseudotumors) at the neck-stem junction and elevated metal-ion levels. However, the occurrence of taper-corrosion-related pseudotumors in patients who remain asymptomatic following total hip arthroplasty with a dual-taper modular femoral stem remains largely unknown. The aims of this study were (1) to determine the prevalence of asymptomatic pseudotumors by utilizing metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) and (2) compare serum metal-ion levels between symptomatic and asymptomatic patients with a dual-taper modular stem total hip replacement. METHODS We performed a retrospective cross-sectional study of 97 consecutive patients who had been treated with a dual-taper modular femoral stem total hip arthroplasty. Eighty-three patients were stratified into symptomatic and asymptomatic groups and evaluated with MARS-MRI, measurement of serum metal-ion levels, and the University of California at Los Angeles (UCLA) functional hip score. RESULTS The prevalence of pseudotumors as determined with MARS-MRI was 15% in our asymptomatic patients and 36% in the overall cohort. The median serum cobalt level and cobalt/chromium ratio were significantly higher in patients with a pseudotumor than in those without a pseudotumor (8.0 versus 2.0 μg/L [p = 0.004] and 10.3 versus 2.4 μg/L [p = 0.012], respectively). However, there was no significant difference in the serum cobalt level or cobalt/chromium ratio between symptomatic patients with a pseudotumor and asymptomatic patients with a pseudotumor (7.6 versus 6.2 μg/L [p = 0.37] and 8.3 versus 10.6 μg/L [p = 0.46], respectively). The UCLA scores of asymptomatic patients with a pseudotumor were similar to those of patients without a pseudotumor (6.7 versus 6.6). CONCLUSIONS The prevalence of asymptomatic taper-corrosion-related pseudotumors on MARS-MRI in this study demonstrated that the absence of symptoms does not exclude the presence of adverse local tissue reactions. Elevated cobalt levels and cobalt/chromium ratios were associated with the presence of pseudotumors in asymptomatic and symptomatic patients. Cross-sectional imaging such as MARS-MRI is indicated for patients with elevated metal-ion levels. A longitudinal study is required to determine whether asymptomatic patients with taper-corrosion-related pseudotumors will develop symptoms with time. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sariah Khormaee
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew A Freiberg
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harry E Rubash
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Barlow BT, Ortiz PA, Fields KG, Burge AJ, Potter HG, Westrich GH. Magnetic Resonance Imaging Predicts Adverse Local Tissue Reaction Histologic Severity in Modular Neck Total Hip Arthroplasty. J Arthroplasty 2016; 31:2325-31. [PMID: 27118350 DOI: 10.1016/j.arth.2016.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The association between advanced imaging, serum metal ion levels, and histologic adverse local tissue reaction (ALTR) severity has not been previously reported for Rejuvenate modular neck femoral stems. METHODS A cohort of 90 patients with 98 Rejuvenate modular neck femoral stems was revised by a single surgeon from July 2011 to December 2014. Before revision, patients underwent multiacquisition variable resonance image combination sequence magnetic resonance imaging (MRI), and serum cobalt and chromium ion levels were measured. Histologic samples from the revision surgery were scored for synovial lining, inflammatory infiltrate, and tissue organization as proposed by Campbell. Regression based on the generalized estimating equations approach was used to assess the univariate association between each MRI, demographic, and metal ion measure and ALTR severity while accounting for the correlation between bilateral hips. Random forest analysis was then used to determine the relative importance of MRI characteristics, demographics, and metal ion levels in predicting ALTR severity. RESULTS Synovial thickness as measured on MRI was found to be the strongest predictor of ALTR histologic severity in a recalled modular neck femoral stem. CONCLUSION MRI can accurately describe ALTR in modular femoral neck total hip arthroplasty. MRI characteristics, particularly maximal synovial thickness and synovitis volume, predicted histologic severity. Serum metal ion levels do not correlate with histologic severity in Rejuvenate modular neck total hip arthroplasty.
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Affiliation(s)
- Brian T Barlow
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Philippe A Ortiz
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Kara G Fields
- Epidemiology and Biostatistics Core, Hospital for Special Surgery, New York, New York
| | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Division of Adult Reconstruction and Joint Replacement Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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High serum ion levels in Conserve Plus big femoral head cemented total hip arthroplasty. Hip Int 2016; 26:474-478. [PMID: 27646510 DOI: 10.5301/hipint.5000385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 02/04/2023]
Abstract
AIM We report the short-term clinical, radiographic and ion level data of the Conserve Plus metal-on-metal (MoM) big femoral head (BFH) total hip arthroplasty (THA), used with a cemented cobalt-chrome (Co-Cr) Profemur Xm stem and a titanium (Ti) modular neck. RESULTS In a consecutive series of 40 hips, survivorship at 3 years was 92.5% with revision for any reason. Average Harris Hip Score was 91.3. There were no implant loosenings. No osteolysis was observed. 5 patients had signs of adverse local tissue reaction (ALTR); their clinical scores were not different from the whole cohort. All but 1 patient had their Co serum ion levels measured. The average Co level was 14,1 µg/l (range 0.9-29.0; median 13.0 µg/l). Clinical scores did not correlate with ion level data. A comparative group of 42 hip resurfacing arthroplasties from the same manufacturer had significantly lower serum Co levels: 1.51 µg/l (range 0.9-4.0; median 0.9 µg/l). CONCLUSIONS All patients with the MoM BFH THA design should be followed regularly and should have ion level testing.
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