Background
Gross trunnion failure (GTF) is a rare complication in total hip arthroplasty reported across a range of manufacturers. Specific lots of the Stryker LFIT Anatomic cobalt chromium alloy (CoCr) V40 femoral head were recalled in August of 2016. In part, the recall was based out of concerns for disassociation of the femoral head from the stem and GTF.
Methods
We report on 28 patients (30 implants) with either GTF (n=18) or head-neck taper corrosion (n=12) of the LFIT CoCr femoral head and the Accolade TMZF femoral stems. All of these cases were associated with adverse local tissue reaction (ALTR) requiring revision of the THA.
Results
In our series, a conservative estimate of the incidence of failure was 4.7% (n = 636 total implanted) at 8.0±1.4 years from the index procedure. Failures were associated with a high offset 127° femoral stem nec k angle and increased neck lengths. 43.3% (13/30) of the observed failures included implant sizes outside of the voluntary recall (27.8% (5/18) of the GTF and 75.0% (8/12) of the taper corrosion cases). Serum cobalt and chromium levels were elevated (Cobalt: 8.4±7.0μg/mL; Chromium: 3.4±3.3μ/L; Cobalt/Chromium ratio: 3.7). MARS MRI demonstrated large cystic fluid collections typical with ALTR. During revision, a pseudotumor was observed in all cases. Pathology suggested a chronic inflammatory response. Impending GTF could be diagnosed based on aspiration of black synovial fluid and an oblique femoral head as compared to the neck taper on radiographs.
Conclusion
In our series of the recalled LFIT CoCr femoral head, the risk of impending GTF or head-neck taper corrosion should be considered as a potential diagnosis in a painful Accolade TMZF THA with unknown etiology. Almost half of the failures we observed included sizes outside of the voluntary recall.
Percutaneous vertebroplasty procedure is of major importance, given the significantly increasing aging population and the higher number of orthopedic procedures related to vertebral compression fractures. Vertebroplasty is a complex technique involving the injection of polymethylmethacrylate (PMMA) into the compressed vertebral body for mechanical stabilization of the fracture. Our understanding and ability to modify these mechanisms through alterations in cement material is rapidly evolving. However, the rate of cardiac complications secondary to PMMA injection and subsequent cement leakage has increased with time. The following review considers the main effects of PMMA bone cement on the heart, and the extent of influence of the materials on cardiac embolism. Clinically, cement leakage results in life-threatening cardiac injury. The convolution of this outcome through an appropriate balance of complex material properties is highlighted via clinical case reports.
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