Cobalt-chromium-molybdenum alloy, used for over four decades in orthopedic implants, may corrode and release wear debris into the body during use. These degradation products may stimulate immune and inflammatory responses in vivo. We report here on evidence of direct inflammatory cell-induced corrosion of human implanted and retrieved CoCrMo implant surfaces. Corrosion morphology on CoCrMo implant surfaces, in unique and characteristic patterns, and the presence of cellular remnants and biological materials intimately entwined with the corrosion indicates direct cellular attack under the cell membrane region of adhered and/or migrating inflammatory cells. Evidence supports a Fenton-like reaction mechanism driving corrosion in which reactive oxygen species are the major driver of corrosion. Using in vitro tests, large increases in corrosion susceptibility of CoCrMo were seen (40 to 100 fold) when immersed in phosphate buffered saline solutions modified with hydrogen peroxide and HCl to represent the chemistry under inflammatory cells. This discovery raises significant new questions about the clinical consequences of such corrosion interactions, the role of patient inflammatory reactions, and the detailed mechanisms at play.

The objective of this article is to provide an up-to-date overview of zirconia-toughened alumina (ZTA) components used in total hip arthroplasties. The structure, mechanical properties, and available data regarding the clinical performance of ZTA are summarized. The advancements that have been made in understanding the in vivo performance of ZTA are investigated. This article concludes with a discussion of gaps in the literature related to ceramic biomaterials and avenues for future research.

The purpose of this study was to characterize the prevalence of taper damage in modular TKA components. 198 modular components were revised after 3.9±4.2y (range: 0.0–17.5y). Modular components were evaluated for fretting corrosion using a semi-quantitative 4-point scoring system. Flexural rigidity, stem diameter, alloy coupling, patient weight, age and implantation time were assessed as predictors of fretting corrosion damage. Mild-to-severe fretting corrosion (score≥2) was observed in 94/101 of the tapers on the modular femoral components and 90/97 of the modular tibial components. Mixed alloy pairs (p=0.03), taper design (p<0.001), and component type (p=0.02) were associated with taper corrosion. The results from this study supported the hypothesis that there is taper corrosion in TKA. However the clinical implications of fretting and corrosion in TKA remain unclear.

Background Metal debris and ion release has raised concerns in joint arthroplasty. The purpose of this study was to characterize the sources of metallic ions and particulate debris released from long-term (in vivo > 15y) TKA femoral components. Methods A total of 52 CoCr femoral condyles were identified as having been implanted for more than 15 years. The femoral components were examined for incidence of five types of damage (metal-on-metal wear due to historical polyethylene insert failure, MACC at taper interfaces, cement interface corrosion, third-body abrasive wear, and ICIC). Third-body abrasive wear was evaluated using the Hood method for polyethylene components and a similar method quantifying surface damage of the femoral condyle was used. The total area damaged by ICIC was quantified using digital photogrammetry. Results Surface damage associated with corrosion and/or CoCr debris release was identified in 98% (n=51) of the CoCr femoral components. Five types of damage were identified: 98% of femoral components exhibited 3rd body abrasive wear (mostly observed as scratching, n=51/52), 29% of femoral components exhibited ICIC damage (n=15/52), 41% exhibited cement interface damage (n=11/27), 17% exhibited metal-on-metal wear following wear-through of the polyethylene insert (n=9/52), and 50% of the modular femoral components exhibited MACC taper damage (n=2/4). The total ICIC damaged area was an average of 0.11 ± 0.12 mm2 (Range: 0.01–0.46mm2). Conclusion Although implant damage in TKA is typically reported with regard to the polyethylene insert, the results of this study demonstrate that abrasive and corrosive damage occurs on the CoCr femoral condyle in vivo.

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Background Previous studies identified imprinting of the stem morphology onto the interior head bore, leading researchers to hypothesize an influence of taper topography on mechanically assisted crevice corrosion (MACC). The purpose of this study was to analyze whether micro-grooved stem tapers result in greater fretting corrosion damage than smooth stem tapers. Methods A matched cohort of 120 retrieved head-stem pairs from metal-on-polyethylene bearings was created controlling for implantation time, flexural rigidity, apparent length of engagement, and head size. There were two groups of 60 heads each, mated with either smooth or micro-grooved stem tapers. A high precision roundness machine was used to measure and categorize the surface morphology. Fretting corrosion damage at the head/neck junction was characterized using the Higgs-Goldberg scoring method. Fourteen of the most damaged heads, were analyzed for the maximum depth of material loss and focused ion beam (FIB) cross-sectioned to view oxide and base metal. Results Fretting corrosion damage was not different between the two cohorts at the femoral head (p = 0.14, Mann Whitney) or stem tapers (p = 0.35). There was no difference in the maximum depths of material loss between the cohorts (p = 0.71). Cross sectioning revealed contact damage, signs of micro-motion, and chromium rich oxide layers in both cohorts. Micro-groove imprinting did not appear to have a different effect on the fretting corrosion behavior. Conclusion The results of this matched cohort retrieval study do not support the hypothesis that taper surfaces with micro-grooved stems exhibit increased in vivo fretting corrosion damage or material release.

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The findings of this retrieval study support that similar damage mechanisms exist in contemporary and long-term total knee arthroplasty devices. Additionally, we observed associations between loosening, anterior-posterior conformity, and patient weight with increased surface damage.